Truth Before Tools: Grounding Nigeria's Digital Health Ambitions in Reality

Across Africa, governments are embracing digital health by launching ambitious platforms for electronic records, AI applications, and national data exchanges. Nigeria's recent Nigeria Digital in Health Initiative signals similar intent. Yet ambition without foundations, such as a reliable identity, usable addresses, and enforceable standards, risks failure.This commentary argues that Nigeria's digital health trajectory cannot succeed without first addressing key system enablers: accurate population data, stable power, and strong governance. Drawing on evidence from Nigeria, South Africa, and Ghana, we show how these foundational elements shape readiness. South Africa demonstrates that a Master Patient Index, facility lists, and interoperability standards form the backbone for integrated systems. Ghana's national ID and early telemedicine scale-up demonstrate the value of identity systems, while persistent data silos highlight the limitations of tools without effective coordination.Nigeria, by contrast, faces repeated census delays, weak addressing infrastructure, and unreliable electricity, constraints that stall even well-designed platforms. Donors and ministries must resist investing primarily in front-end tools or fragmented pilots. Instead, funding should be tied to verifiable milestones, such as the implementation of broadband access in clinics, the integration of national IDs into health records, and the national adoption of open interoperability standards. "Truth before tools" is not pessimism; it is the shortest route to digital health systems that work for people.