Open Health APIs and Ecosystem Thinking: Unlocking Interoperability for African Digital Health

Abstract

Open Health APIs and ecosystem thinking represent a paradigm shift in designing scalable, interoperable, and sustainable digital health systems. In Africa—where health information is fragmented across public and private systems—these frameworks offer a powerful strategy to integrate data, foster innovation, and improve patient outcomes. This paper outlines the principles of open APIs and digital ecosystems, examines African case studies, and offers policy and technical recommendations for building a more connected health future.

Introduction

The African continent is experiencing a digital health boom: mHealth platforms, EMRs, disease surveillance systems, and AI-driven diagnostics are being piloted and deployed across both rural and urban settings. However, these systems often operate in silos, limiting their potential impact.

Open Health APIs—software interfaces that allow third-party applications to securely interact with health data—enable systems to “talk to each other.” Coupled with ecosystem thinking, which emphasizes interconnectedness, modularity, and co-creation, these tools can dramatically enhance coordination, access, and scale in African health systems.

What Are Open Health APIs?

An Application Programming Interface (API) is a software intermediary that allows two applications to communicate. In healthcare, APIs facilitate:

• Secure data exchange between EMRs, pharmacies, labs, etc.

• Integration of new services without rebuilding legacy systems

• Support for mobile health applications and patient portals

Open APIs are standardized, transparent, and publicly documented interfaces that reduce vendor lock-in and enable collaborative innovation.

The Case for Ecosystem Thinking

Ecosystem thinking treats digital health not as isolated software products, but as interconnected systems composed of:

• Core infrastructure (servers, databases)

• Shared services (ID verification, clinical coding, payment)

• APIs for data exchange

• A wide range of apps (telehealth, registries, etc.)

• Policy, governance, and community stakeholders

Such ecosystems thrive on interoperability, openness, and collaboration—ideals essential for Africa’s health future.

African Case Studies

🇰🇪 Kenya – OpenHIE and FHIR Integration

Kenya’s Ministry of Health adopted the Open Health Information Exchange (OpenHIE) architecture and FHIR (Fast Healthcare Interoperability Resources) standard to promote interoperability across EMRs, the national data warehouse (NDWH), and DHIS2.

Source: Kenya eHealth Policy 2021–2030
🔗 https://www.health.go.ke

🌍 Digital Square – API-First Investments Across Africa

Digital Square, a PATH-led initiative, funds the development of open-source tools that prioritize open APIs (e.g., OpenSRP, OpenLMIS, OpenMRS). These tools are designed to plug into larger systems and support modular expansion.

🔗 https://digitalsquare.org

🇳🇬 Nigeria – Health Data Interoperability with Smart Africa

Nigeria, in partnership with the Smart Africa Alliance, piloted a Trusted Interoperability Framework that integrates patient data across state health information systems using APIs and blockchain for data integrity.

🔗 https://smartafrica.org/initiative/health

Benefits of Open Health APIs in Africa

Key Challenges

1. Lack of Shared Standards: Many systems use proprietary data formats

2. Low Technical Capacity: Few developers trained in FHIR, OpenHIE, or OAuth

3. Data Sovereignty Concerns: Countries need frameworks for secure, ethical sharing

4. Vendor Resistance: Commercial EMR vendors may oppose open interface requirements

5. Policy Gaps: Limited national eHealth strategies mandate API use

Recommendations

1. Adopt Open Standards (FHIR, OpenHIE, HL7)

• Mandate use of open APIs in all government-funded digital health systems

• Provide public documentation and sandbox environments

2. Create National Digital Health Ecosystem Frameworks

• Define how platforms, APIs, and apps interact under government coordination

• Encourage public-private co-creation and local innovation

3. Develop API Governance Policies

• Establish policies on authentication, security, consent, and data ownership

• Use frameworks such as the Trusted Digital Health Ecosystem Toolkit by WHO

4. Invest in Digital Workforce

• Train developers, data scientists, and product managers in health informatics

• Create fellowships through Africa CDC, AUDA-NEPAD, and academic institutions

5. Regional API Hubs and Testing Sandboxes

• Support regional platforms to test, certify, and scale open APIs across borders

The Future: Building Africa’s Health API Economy

By 2030, open API-enabled digital health ecosystems could become the foundation for primary care delivery, public health monitoring, and universal health coverage. Like digital payments leapfrogged banks, Africa can leapfrog fragmented systems by embracing API-first public infrastructure.

References (APA 7th Edition)

Digital Square. (2023). API-first digital health investments in LMICs.
https://digitalsquare.org

Kenya Ministry of Health. (2021). Kenya eHealth Policy 2021–2030.
https://www.health.go.ke

OpenHIE. (2023). Open Health Information Exchange Architecture.
https://ohie.org

HL7 International. (2023). FHIR Overview.
https://www.hl7.org/fhir

Smart Africa. (2023). Trusted Digital Health Interoperability Framework.
https://smartafrica.org/initiative/health

World Health Organization. (2021). Global Strategy on Digital Health 2020–2025.
https://www.who.int/publications/i/item/9789240020924