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Jumlah Markah Peratus Markah = Jumlah Markah / 33 x 5% Nota Kaki: Cara pengukuran Kacauganggu yang terlalu nyata = 0 Kacauganggu ada kelihatan = 1 Kacauganggu kadang ada berlaku = 2 Tiada Kacauganggu = 3 18 B STATUS DALAM KAWASAN PENEMPATAN 3.0 Kemudahan asas /basic facilities (20%) 3.1 Sistem saluran air dan longkang didalam kawasan penempatan sementara 3.2 System saliran ke longkang besar / final outlet 3.3 Jenis lantai dan kebersihannya / floor 3.4 System bekalan air selamat yang berterusan dari JBA / water supply 3.5 System bekalan letrik dari TNB / electrical supply 3.6 Pengurusan tandas yang sistematik / toilet 3.7 Sinki yang mencukupi dan bersih / sink 3.8 Sistem pelupusan sisa pepejal yang terurus dan bersih/ solid waste disposal 3.9 Dewan atau ruang makan yang mencukupi dan baik / dinning hall 3.10 Dapur – bersih dan terurus / kitchen 3.11 Setor yang mencukupi dan kemas untuk pengendali makanan/ store Jumlah markah Peratus Markah = Jumlah Markah / 33 x 20% Nota Kaki : Cara permarkahan Rosak dan tidak boleh diguna = 0 Rosak tetapi masi boleh diguna = 1 Baik tetapi ada sedikit kerosakkan = 2 Baik dan sempurna = 3 BIL PERKARA/ITEM SKOR 4.0 Kawalan vektor / vector control (10%) 4.1 Kawalan lipas dilakukan / cockroaches control 4.2 Kawalan lalat dilakukan / fly control 4.3 Kawalan nyamuk dilakukan / mosquito control 4.4 Kawalan rodent dilakukan 4.5 Kawalan binatang belaan dilakukan / pet 4.6 Kawalan binatang liar dilakukan Jumlah Markah Peratus Markah = Jumlah Markah / 18 x 5% Nota Kaki : Cara Permarkahan Binatang kelihatan merata = 0 Binatang ada kelihatan = 1 Ada tanda binatang kelihatan = 2 Tiada tanda atau binatang = 3 19 5.0 Pengendalian makanan / food management (25%) untuk mangsa bencana 5.1 Kesemua pengendali makanan mendapat suntikan dan pemeriksaan kesihatan 5.2 Makanan mengunakan alatan utensil yang baik / utensil use 5.3 Semua pengendali makanan mengunakan pakaian yang sesuai dan sepatutnya ketika menyediakan makanan. 5.4 Semua pengendali makanan mempunyai kesihatan yang baik. 5.5 Semua pengendali makanan yang mempunyai kuku pendek dan rambut yang terurus / terlindung 5.6 Dapur dan Sinki berada dalam keadaan baik / sink 5.7 Mengunakan pemanas makanan yang berfungsi / food warmer. 5.8 Peti sejuk berfungsi pada suhu yang sepatutnya / refrigerator 5.9 Mempunyai sistem melupuskan buangan makanan dengan baik / 5.10 Mempunyai sistem penyediaan makanan yang sistematik dan bersih. 5.11 Semua pengendali makanan mempunyai tahap pengetahuan kesihatan dan


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keadaan baik / sink 5.7 Mengunakan pemanas makanan yang berfungsi / food warmer. 5.8 Peti sejuk berfungsi pada suhu yang sepatutnya / refrigerator 5.9 Mempunyai sistem melupuskan buangan makanan dengan baik / 5.10 Mempunyai sistem penyediaan makanan yang sistematik dan bersih. 5.11 Semua pengendali makanan mempunyai tahap pengetahuan kesihatan dan kebersihan makanan yang baik Jumlah Markah Peratus Markah = Jumlah Markah / 33 x 25% Nota Kaki : Cara Permarkahan Tiada = 0 Ada tapi masih boleh digunakan = 1 Ada dan ada sedikit kelemahan = 2 Ada dan sempurna = 3 6.0 Keselamatan / safety untuk mangsa bencana(5%) 6.1 Ada jawatankuasa pengurusan kebersihan ruang makanan 6.2 Ada Jawatankuasa keselamatan dan kebersihan makanan / safety committee 6.3 Ada jawatankuasa keselamatan dan kebersihan bangunan termasuk trafik / safety and emergency facilities 6.4 Ada peralatan bantuan kecemasan 6.5 Pelan lantai kecemasan disediakan pada tempat yang strategik 6.6 Sistem Laluan kenderaan / kemudahan letak kereta/ car parking yang terurus. Jumlah Markah Peratus Markah = Jumlah Markah / 18 x 5% Nota Kaki : Cara Permarkahan Tiada system langsung = 0 Ada system tapi tak berfungsi = 1 Ada tetapi system lemah = 2 Ada dan system berjalan lancar= 3 20 7.0 Sudut klinik kesihatan dan maklumat awam / health corner (15%) 7.1 Klinik Bergerak disediakan 7.2 Jumlah Kakitangan mencukupi 7.3 Peralatan Klinik dalam keadaan baik dan mencukupi 7.4 Ubat-ubatan disedia secukupnya 7.5 Jumlah pesakit menunggu tidak tinggi 7.6 Tiada aduan dari mangsa bencana 7.7 Rawatan dilakukan secara sistematik 7.8 Maklumat dan data statistik ada dan dikemaskini 7.9 Ambulan disediakan untuk rujukan 7.10 Lain-lain perkhidmatan diberikan No. telefon klinik yang terlibat: ada/tiada Jumlah Markah Peratus Markah = Jumlah Markah / 18 x 15% Nota Kaki : Cara Permarkahan Tidak ujud = 0 Ada tapi tidak mencukupi = 1 Ada tapi masih ada kelemahan = 2 Berjalan dengan lancar = 3 8.0 Sudut Maklumat Kesihatan / Health Corner 8.1 Papan dan notis / notice board 8.2 Risalah / booklet. 8.3 Alat pandang dengar / entertainment 8.4 Aktiviti Pendidikan Kesihatan 8.5 Notis Kawasan larangan merokok mencukupi/ smoke free area 8.6 Notis mengalakkan cuci tangan dan kebersihan sebelum makan Jumlah Markah Peratus Markah = Jumlah Markah / 18 x 5% Nota Kaki : Cara Permarkahan Tidak ujud = 0 Ada tapi tidak mencukupi = 1 Ada dan ada kelemahani = 2 Berjalan dengan lancar = 3 21 BIL PERKARA/ITEM SKOR 9.0 Lain-lain kemudahan / other facilities. (5%)


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sebelum makan Jumlah Markah Peratus Markah = Jumlah Markah / 18 x 5% Nota Kaki : Cara Permarkahan Tidak ujud = 0 Ada tapi tidak mencukupi = 1 Ada dan ada kelemahani = 2 Berjalan dengan lancar = 3 21 BIL PERKARA/ITEM SKOR 9.0 Lain-lain kemudahan / other facilities. (5%) 9.1 Surau./praying room 9.2 Tempat riadah./ recreational area 9.3 Kemudahan permainan kanank-kanak / children playground 9.4 Peti cadangan / suggestive box 9.5 Susun atur dan hiasan dalaman 9.6 Kemudahan orang kurang upaya Jumlah Markah Peratus Markah = Jumlah Markah / 18 x 5% Nota Kaki : Cara Permarkahan Tidak ujud = 0 Ada tapi tidak mencukupi = 1 Ada tapi masih ada kelemahan = 2 Berjalan dengan lancar = 3 10.0 Statistic kesihatan / health statistic (5%) 10.1 Kes keracunan makanan /Food poisoning cases 10.2 Kes denggi / dengge outbreak 10.3 Kes deman yang dilaporkan 9.10 Kes cirit birit 10.5 Kes penyakit kulit dan gatal 10.6 Kes penyakit batuk dan selsema 10.7 Kes penyakit meningitis 10.8 Kes deman kuning 10.9 Kes kematian berkaitan dengan penyakit berjangkit Nyatakan secara terperinci: 10.10 Kes kematian berkaitan dengan penyakit tidak berjangkit Nyatakan secara terperinci: 10.11 Kes kematian yang berlaku disebabkan bencana Nyatakan secara terperinci: Jumlah Markah Peratus Markah = Jumlah Markah / 33 x 5% Nota Kaki : Cara Permarkahan Wabak penyakit = 0 Ada beberapa kes tapi terkawal = 1 Ada satu kes = 2 Tiada kes = 3 11.0 Factor psikososial / psychosocial factor (5%) 11.1 Kepuasan mangsa perpindahan bencana 11.2 Komen masyarakat sekeliling berhubung keadaan penempatan sementara yangb baik 11.3 Sokongan politik tempatan 11.4 Sumbangan oleh masyarakat tempatan 11.5 Pekerja dipenempatan sementara ini Jumlah Markah Peratus Markah = Jumlah Markah / 15 x 5% Nota Kaki : Cara Permarkahan Masalah dan penuh dengan aduan = 0 Ada aduan tapi tidak terkawal = 1 Ada dan terkawal = 2 Tiada masalah , berjalan dengan lancar = 3 22 PENILAIAN KAWASAN PENEMPATAN SEMENTARA BAGI MANGSA BENCANA (Ringkasan) JENIS BENCANA : CATATAN (comment):- Tandatangan :………………………………….. A KAWASAN PERSEKITARAN LUAR PENEMPATAN SEMENTARA 1.0 Kawasan persekitaran / lokasi (10%) 2.0 Kawasan bermasaalah kesihatan / health indicator (10%) B KAWASAN PERSEKITARAN DALAM PENEMPATAN SEMENTARA 3.0 Kemudahan asas /basic facilities (20%) 4.0 Kawalan vektor / vector control (10%) 5.0 Pengendalian makanan / food management (25%) 6.0 Keselamatan / safety (5%) 7.0 Klinik Kesihatan (15%)) 8.0 Sudut Kesihatan / Health Corner (5%) 9.0 Lain-lain kemudahan / other facilities. (5%)


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(10%) B KAWASAN PERSEKITARAN DALAM PENEMPATAN SEMENTARA 3.0 Kemudahan asas /basic facilities (20%) 4.0 Kawalan vektor / vector control (10%) 5.0 Pengendalian makanan / food management (25%) 6.0 Keselamatan / safety (5%) 7.0 Klinik Kesihatan (15%)) 8.0 Sudut Kesihatan / Health Corner (5%) 9.0 Lain-lain kemudahan / other facilities. (5%) 10.0 Statistic kesihatan / health statistic (5%) 11.0 Factor psikososial / psychosocial factor (5%) Peratus markah keseluruhan ………………………………….


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Dokumen rujukan rasmi mengenai tatacara pengujian sistem IPES kesihatan digital menggunakan enjin kecerdasan buatan OpenAI gpt-5-mini melalui infrastruktur pelayan tempatan


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APPROACH FOR FACILITATING SEAMLESS HEALTH AND CARE DELIVERY ACROSS THE AFRICAN CONTINENTDigital Health Blueprint 2024Smart Africa Alliance Under the Leadership of the Republic of Rwanda, Smart Africa & Africa CDC Supported by Smart Africa is a bold and innovative commitment from African Heads of State and Government to accelerate sustainable socio-economic development on the continent, ushering Africa into a knowledge economy through affordable access to Broadband and usage of Information and Communications Technologies. The Transform Africa Summit held in Kigali, Rwanda on 28th- 31st October 2013 culminated in the adoption of the Smart Africa Manifesto document by seven (7) African Heads of States (Rwanda, Kenya, Uganda, South Sudan, Mali, Gabon, Burkina Faso) in which they committed to provide leadership in accelerating socio-economic development through ICT’s. On 30th-31st January 2014, The SMART Africa Manifesto was endorsed by all Heads of State and Government of the African Union at the 22nd Ordinary Session of the Assembly of the African Union in Addis Ababa. This development places the Manifesto at the heart of the ICT agenda in Africa beyond just the 7 original signatories at the Summit to all the 53 African countries. The Smart Africa Alliance has since grown to include 40 African countries that represent over 1 billion people. For more information, please visit the Smart Africa corporate website at www.smartafrica.org.Africa Centres for Disease Control and Prevention (Africa CDC) is a continental autonomous health agency of the African Union established to support public health initiatives of Member States and strengthen the capacity of their public health institutions to detect, prevent, control and respond quickly and effectively to disease threats. Africa CDC supports African Union Member States in providing coordinated and integrated solutions to the inadequacies in their public health infrastructure, human resource capacity, disease surveillance, laboratory diagnostics, and preparedness and response to health emergencies and disasters. Established in January 2016 by the 26th Ordinary Assembly of Heads of State and Government and officially launched in January 2017, Africa CDC is guided by the principles of leadership, credibility, ownership, delegated authority, timely dissemination of information, and transparency in carrying out its day- to-day activities. The institution serves as a platform for Member States to share and exchange knowledge and lessons from public health interventions. For more information, please visit the Africa CDC website at www.africacdc.org. 1 Approach for facilitating seamless health and care delivery across the African continentList of Abbreviations 2 List


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to-day activities. The institution serves as a platform for Member States to share and exchange knowledge and lessons from public health interventions. For more information, please visit the Africa CDC website at www.africacdc.org. 1 Approach for facilitating seamless health and care delivery across the African continentList of Abbreviations 2 List of figures 3 List of tables 4 Foreword 5 Acknowledgements 9 Executive Summary 10 Section 1.0 The state of digital health initiatives in Africa 13 1.1 Background 14 1.2 Digital Health Flagship Project 16 Section 2.0 Blueprint principles and framework 20 2.1 Principles 21 2.2 Digital Health Blueprint Framework 25 Section 3.0 Cross-border exchange of health information in Africa 32 3.1 Patient Identity (ID) Document 35 3.2 Access intended patient’s information 40 3.3 Key registries 43 3.4 Semantic interoperability 47 3.5 Patient consent management and Data access 49 3.6 Data Integration 54 Section 4.0 Roadmap to a Single Digital Health Market 56 4.1 Key actions for framework operationalization 57 4.2 Actions for exchange of health information 60 4.3 Suggested phasing of actions 68 Section 5.0 Conclusion 71 Section 6.0 References 74 Appendix 1 79 Country level good practices leveraged by the blueprint 79Table of Contents Smart Africa Alliance Digital Health Blueprint2 2024API Application Programming Interface Africa CDC Africa Centres for Disease Control and Prevention AU African Union EHR Electronic Health Record FHIR Fast Healthcare Interoperability Resources HL7 Health Level 7 ICT Information and Communication Technology ID Identity Document ITU International Telecommunication Union OAuth Open Authorization PIN Permanent Identifier Number RHIE Rwanda Health Information Exchange RISA Rwanda Information Society Authority SADA Smart Africa Digital Academy SAML Security Assertion Markup Language SATA Smart Africa Trust Alliance List of Abbreviations 3 Approach for facilitating seamless health and care delivery across the African continentFigure 1: Snapshot of digital health initiatives in Rwanda 18 Figure 2: Needs of Digital Health in Africa 19 Figure 3. A patient’s treatment journey is a Single Digital Health Market 25 Figure 4: Framework for Single Digital Health Market 26 Figure 5. Zoomed in view of ‘Technology platforms’ pillar 33 Figure 6: Interoperable solutions at national and continental levels for exchange of health information across borders 35 Figure 7. Process flow illustrating patient ID authentication in a cross-border scenario 38 Figure 8: Process flow illustrating options available for countries to enable access to intended patient’s information 42 Figure 9: Process flow illustrating steps to operationalize the three key registries 46


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exchange of health information across borders 35 Figure 7. Process flow illustrating patient ID authentication in a cross-border scenario 38 Figure 8: Process flow illustrating options available for countries to enable access to intended patient’s information 42 Figure 9: Process flow illustrating steps to operationalize the three key registries 46 Figure 10: Process flow illustrating translation and transcoding at country level for exchange of information across borders 48 Figure 11: Process flow illustrating patient consent via SMS (one of many options available with countries) and subsequent access to data across borders 53 Figure 12: Process flow illustrating integration of data from different sources in a country 55List of figures Smart Africa Alliance Digital Health Blueprint4 2024Figure 13. Actions for operationalizing the blueprint framework components and recommendations for interoperable solutions 57 Figure 14: Depiction of readiness phases and corresponding health information exchange functionalities available 68 Table 1: Principles governing the Smart Africa Digital Health Blueprint 21 Table 2: Actions led by governments for operationalization of framework components at national level 58 Table 3: Actions led by digital health stakeholders for operationalization of framework components at national and continental level 59 Table 4: Practical applications and use cases for the functionalities that can be provided by the continent level platform 62 Table 5: Continent level health information exchange functionalities and corresponding recommendations to be implemented by a country to avail the functionalities 65List of tables 5 Approach for facilitating seamless health and care delivery across the African continentIN AN increasingly interconnected era driven by rapid technological advance - ments, the intersection of technology and healthcare presents unprecedented opportunities to build healthcare systems that are inclusive, responsive, and sus - tainable. Rwanda recognizes the trans - formative power of digital technologies as a catalyst for economic growth. Our commitment to building resilient health - care systems, prioritizes building capabil - ities to deploy digital technologies across the healthcare continuum, ensuring ev - ery citizen can access quality healthcare services. Rwanda’s journey serves as one approach among many other valuable initiatives across Africa. As we continue this journey, we value the opportunity to exchange ideas and best practices with other countries, intended to drive harmo - nized legal frameworks and health infor - mation exchange across the continent. We are grateful to everyone involved in this initiative, working together towards a healthier, more inclusive Africa. Each country’s unique experience and knowl - edge is


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ideas and best practices with other countries, intended to drive harmo - nized legal frameworks and health infor - mation exchange across the continent. We are grateful to everyone involved in this initiative, working together towards a healthier, more inclusive Africa. Each country’s unique experience and knowl - edge is invaluable to enhancing our ef - forts to bring inclusive digital healthcare to all African citizens. Building on existing digital healthcare ini - tiatives driven by various partners; ITU, WHO, AU, and Africa CDC, the launch of Smart Africa Digital Health Blueprint is Foreword Hon. Paula Ingabire Minister of Information Communication Technology and Innovation Government of Rwanda Smart Africa Alliance Digital Health Blueprint6 2024designed to facilitate seamless healthcare delivery across the African continent. The blueprint facilitates African nations to align their digital healthcare priorities at the regional, continental, and global are - na. The blueprint lays out a bold vision to deliver equitable, quality, and accessible healthcare services to all. This blueprint emphasizes the need for interoperabil - ity—ensuring that health systems can communicate effectively, exchange data securely, and deliver timely care, regard - less of the technology platform or provid - er. Central to this effort is the protection of privacy and data security. As we inte - grate digital health solutions, we must en - sure that patient data is handled with the highest levels of integrity and confidenti - ality. Robust policies on cybersecurity and data governance will be critical to foster trust among patients, providers, and the public. Effective governance structures and strong collaboration across various stakeholders is crucial for the successful execution of digital health initiatives. At the core of this blueprint is collabo - ration—between governments, health - care providers, technology partners, and development organizations—to cre - ate an interoperable health system that seamlessly integrates health information across platforms. Interoperability is key to ensuring that patient data can flow se - curely between health providers across borders, empowering clinicians with timely information while avoiding dupli - cation of care. This connectivity will en - able better decision-making and improve patient outcomes, even in cross-border contexts. This digital health blueprint is not just a roadmap for countries to adopt; it is a call to action. Its success depends on collec - tive effort and innovation. It requires joint efforts to align national priorities, lever - age technology, and build human capaci - ty to implement


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contexts. This digital health blueprint is not just a roadmap for countries to adopt; it is a call to action. Its success depends on collec - tive effort and innovation. It requires joint efforts to align national priorities, lever - age technology, and build human capaci - ty to implement sustainable solutions. To - gether, we will create a health system that is resilient, secure, and capable of meet - ing the evolving needs of our people. I invite all member states, and partners to turn this blueprint into a reality and deliver on the promise of an intercon - nected, future-ready digital healthcare ecosystem for Africa. The task ahead will not be easy, but the rewards—stronger health systems, empowered citizens, and healthier communities—will benefit us all. Let us work together to bring this vision to life. 7 Approach for facilitating seamless health and care delivery across the African continentHon. Dr. Sabin Nsanzimana Minister of Health Government of Rwanda Our approach to digital health is ground - ed in the belief that technology is a pow - erful enabler of equitable, efficient, and people-centered care. It strengthens the quality and reach of services while equip - ping decision-makers with real-time data to identify gaps, allocate resources more effectively, and adapt policies to drive meaningful impact. By embracing digi - tal innovation, we are making healthcare more accessible, affordable, and respon - sive for all Rwandans - regardless of loca - tion or background. As a champion country for the Smart Africa Digital Health Flagship Project, Rwanda is committed to advancing re - gional cooperation to scale digital health solutions across the continent. Our goal is to improve health outcomes, empower citizens to reach their full potential, and strengthen health system resilience. Realizing the vision set out in this digital health blueprint will require strong and sustained collaboration among all stake - holders. By working together to build interoperable systems that allow secure and seamless data exchange across plat - forms and borders, we can empower healthcare workers with timely informa - tion, enhance clinical decision-making, and improve patient outcomes. This is a shared responsibility and a collective op - portunity to shape a resilient, inclusive, and future-ready digital health ecosys - tem for Africa.RWANDA HAS embarked on a digital transformation journey, guided by a vi - sion of building a connected and pros - perous nation - and continent. Our


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is a shared responsibility and a collective op - portunity to shape a resilient, inclusive, and future-ready digital health ecosys - tem for Africa.RWANDA HAS embarked on a digital transformation journey, guided by a vi - sion of building a connected and pros - perous nation - and continent. Our com - mitment to integrating digital solutions has led to significant progress across var - ious sectors, notably in healthcare. From implementing electronic medical records throughout the healthcare system to de - ploying mobile health applications and leveraging advanced data analytics, we are establishing a robust digital infra - structure that enhances service delivery and improves patient experience. Smart Africa Alliance Digital Health Blueprint8 2024SINCE THE Smart Africa Manifesto was endorsed by seven Heads of State on Oc - tober 29, 2013, the Smart Africa Alliance has grown and now includes 40 African member states, representing over 1 billion people as of December 2023. The Man - ifesto was also endorsed by all Heads of State and Government of the African Union at the 22nd Ordinary Session of the Assembly of the African Union in Ad - dis Ababa. This development placed the Manifesto at the heart of the ICT agenda for Africa. Chaired by His Excellency President Paul Kagame, Republic of Rwanda, the Smart Africa Board brings together the 41 Heads of State and Government along with the International Telecommunication Union, the African Union Commission as well as Smart Africa’s Platinum members, with one common goal: to transform Af - rica into a single digital market. To op - erationalize the Smart Africa Manifesto, the Smart Africa Alliance identified flag - ship projects led by Member States. One of these flagship projects is “The Digital Health Flagship Project”, championed by the Government of Rwanda. This blueprint will enable the Digital Health Flagship Project to move from concept to implementation under the Smart Africa Trust Alliance (SATA) um - brella, an implementation vehicle to en - able cross-border use of digital identities and data for boosting trade and ser - vices in Africa. Its main goal is to move towards a single digital market in health. To achieve this, the blueprint provides an approach for facilitating seamless health and care delivery across the African con - tinent and recommends an implementa - tion framework with the following pillars: technology platforms, innovation and entrepreneurship and financing mod - el, and foundational


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a single digital market in health. To achieve this, the blueprint provides an approach for facilitating seamless health and care delivery across the African con - tinent and recommends an implementa - tion framework with the following pillars: technology platforms, innovation and entrepreneurship and financing mod - el, and foundational layers: governance and leadership, infrastructure for digital health, policy and regulations, standards and workforce. These suggestions have been developed based on a thorough exchange within the Smart Africa Working Group for the Digital Health Flagship Project and with external experts who kindly shared their knowledge. We would like to express our gratitude to them once again and call for others to join us during the operational - ization of this blueprint.Mr. Lacina Koné Director General of Smart Africa 9 Approach for facilitating seamless health and care delivery across the African continentTHE BLUEPRINT was led by the Smart Africa Secretariat (Ralph Oyini Mbouna, Olivier N. Twagirayezu, and Jeanne Yamfashije) and prepared by a team from IQVIA (led by Steph - anie Berrada and team members - Roma Bhujabal, Sattvika Ashok, Santos Das, Manushi Shah; experts - Eric Ruble and Iyadh Abid; and advisor - Alexandre de Carvalho). The officials from the Government of Rwanda (Sylvere Mugumya and Benjamin Niyitegeka from the Ministry of Health, and Esther Kunda from the Ministry of ICT and Innovation) were instrumental in guiding the development of the blueprint. We would also like to thank the officials from the Government of Tunisia (Slah Ben Wahida) and the Govern - ment of Senegal for their contributions. The team would like to acknowledge the significant contributions made by the techni - cal working group members representing various organizations, including Internation - al Telecommunications Union (Hani Eskandar), Africa CDC (Jean Philbert Nsengimana, Cyril Seck, and Bekure Tamirat), UNICEF (Sean Blaschke), The Global Fund (Erik Gaju), HISP (Sean Broomhead), WHO (Derrick Muneene, Mark Landry, Arturs Mietulis, Alain Labrique, Garrett Livingston, and Farouk Mohamed), GIZ (Kirstin Grosse Frie and Nor - man Schrapel), GSM Association (Kamal Tamawa), PATH (Henry Mwanyika, Fatou Fall, and Carolyn Kamasaka), Transform Health (Kirsten Mathieson), IGAD (Bashir Ahmed and Hamza Zbidi), HELINA, USAID (Adele Waugaman), and Digital Health Partnerships (Flor - ence Gaudry-Perkins and Peter Drury). We extend our gratitude and appreciation to the experts, reviewers, and consultants whose dedication, expertise, and support have ensured that this blueprint reflects the needs and pathway for digital health on the


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and Hamza Zbidi), HELINA, USAID (Adele Waugaman), and Digital Health Partnerships (Flor - ence Gaudry-Perkins and Peter Drury). We extend our gratitude and appreciation to the experts, reviewers, and consultants whose dedication, expertise, and support have ensured that this blueprint reflects the needs and pathway for digital health on the African continent.Acknowledgements THIS BLUEPRINT IS THE OUTCOME OF A JOINT INITIATIVE BY SMART AFRICA AND AFRICA CDC, CHAMPIONED BY THE GOVERNMENT OF RWANDA. Smart Africa Alliance Digital Health Blueprint10 2024Executive Summary THE AFRICAN economy is poised to witness exponential growth through digital trans - formation wherein an integrated and inclusive digital economy is envisioned to improve the quality of life for its citizens. Among the key focus areas for the continent, digital transformation in health provides an impetus for accelerating improvements in strength - ening the health system and public health outcomes. Multiple strategies and initiatives in - cluding the WHO Global Strategy on Digital Health (2020-25), CDC Global Digital Health Strategy (2022), African Union Digital Transformation Strategy (2020-30) and Africa CDC Digital Transformation Strategy (2023-30) have underscored the need for advanc - ing digital health at the global and continental level. Smart Africa provides its leadership in information and communication technology, spearheading the mission to establish a Single Digital Market by 2030. Specifically, for health domain, Smart Africa has collaborated with Africa CDC, through this digital health blueprint. The blueprint seeks to enable seamless health and care delivery across the African continent, by focusing on interoperable solutions that facilitate the exchange of health information. The vision of a Single Digital ‘Health’ Market is supported by a guiding framework in Section 2 , which outlines foundational layers (governance and leadership, infrastructure for digital health, policy and regulations, standards, and workforce) and operational pillars (innovation and entrepreneurship, technology platforms, and financ - ing model). The blueprint acknowledges the multiplicity of digital health needs in Africa and commits to engaging in multistakeholder collaborations on initiatives advancing dig - ital health on the continent. Section 3 of the blueprint zooms in on the technology platform. It leverages the Africa CDC African Union Health Information Exchange Guidelines and Standard and recom - mends a high-level implementation mechanism from an information and communica - tions technology lens. At the national level, the technology platform is composed of connectivity and technology infrastructure and foundational digital public infrastructure. The digital health platform and applications are built on


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Information Exchange Guidelines and Standard and recom - mends a high-level implementation mechanism from an information and communica - tions technology lens. At the national level, the technology platform is composed of connectivity and technology infrastructure and foundational digital public infrastructure. The digital health platform and applications are built on this foundational layer. Lastly, a continent level health information exchange layer is envisaged to facilitate exchange of health information between countries. At the continental level, as countries are more connected and the demand for services expands, a huge market potential exists for the healthcare industry to plug in as service providers catering to the healthcare needs of the African population. With a focus on interoperable solutions for exchange of health information across bor - ders, the blueprint covers the identified solutions and provides recommendations on pre-requisites at the national level and actions at the continental level: 11 Approach for facilitating seamless health and care delivery across the African continent1. Patient identity document (ID): A continental platform may facilitate cross-border requests to access patient ID and the authentication of this request between coun - tries, for which, at minimum, o Countries should create unique patient IDs, adopting a suitable identification system and model relevant to the context, o Countries should establish governance for overseeing patient ID creation, management, and protection, authorize entities to issue patient IDs, and certifying authorities for issuing digital certificates, and o Countries should ensure adequate legal protection is provided for patient identity information and data protection mechanisms are implemented. 2. Access intended patient’s information: In addition to the patient ID, it is crucial to have the right mechanism in place to allow the correct identification of a patient by health care professionals at every point of contact. Lack of proper patient identifica - tion has adverse and unwanted effects as it can negatively affect important clinical decision making, treatment, patient outcomes, and impact patient privacy. The blue - print elaborates on the mechanism of matching of permanent identifier number (PIN) signature generated at the time of patient ID creation with a PIN generated using the strict traits (that do not change over time, such as maiden name, date of birth) or national identity number provided by the patient at the time of care delivery. 3. Key registries: Setting up of registries for healthcare professionals, health facilities, and terminology standards at the national level are pre-requisites that countries


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(that do not change over time, such as maiden name, date of birth) or national identity number provided by the patient at the time of care delivery. 3. Key registries: Setting up of registries for healthcare professionals, health facilities, and terminology standards at the national level are pre-requisites that countries need to fulfill to be able to participate in the exchange of health information across border. There is a variety of registries that assist in and enhance the quality of exchange of health information. However, the blueprint covers only the basic registries that are required for initiating exchange of health information which can be supplemented with other registries as per national priorities. In addition, the blueprint recommends countries to establish a National Health Information System with access and identity management systems along with setting up a National Data Gateway for managing terminologies. 4. Semantic interoperability: With the establishment of unified semantics at the con - tinental level, countries can communicate with one another such that the data com - prising of medical terminology and codes are understood by the concerned parties regardless of the standards prevalent in either country. One of the key pre-requisites for this is the establishment of a national data gateway system for data translation and transcoding from local semantics into unified semantics, and vice versa. 5. Patient consent management and data access: The continental platform can facili - tate patient consent through country of origin’s consent management system for ac - Smart Africa Alliance Digital Health Blueprint12 2024cess to data by the healthcare professional being consulted by the patient in another country. The pre-requisites to achieve this functionality are: o Countries should consider different security functions and operating mechanism for consent management (e.g., SMS, two-factor one time password authentication and so on) o Countries to also consider the consent process and requirements during medical emergencies o Countries to define a national framework on access authorization, that is, who can access what data 6. Data integration: Interoperable electronic health records at the continental level relies on comprehensive patient data to extend appropriate health service. Comprehensive patient data would require integration of patient data from different sources and calls for national level actions: o Countries should strive for the national health information exchange platform to interface with independent systems to consolidate and centralize patient data into a national health data repository o Countries should create a health mediation


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would require integration of patient data from different sources and calls for national level actions: o Countries should strive for the national health information exchange platform to interface with independent systems to consolidate and centralize patient data into a national health data repository o Countries should create a health mediation component that is capable of unifying disparate systems and data sources through Application Program Interface (API) o Countries should also engage private service providers to participate in the data integration process. o Countries can consider sandbox initiatives to test software in a controlled environment before integration with national health information exchange. In Section 4 , the blueprint outlines a roadmap for implementing interoperable solutions explained in section 3 along with key milestones. There are cross-border services that need to be enabled for activation of a Single Digital Health Market. These services deter - mine the actions that need to be led by (1) governments at national level (2) digital health stakeholders at national and continent level, and (3) continent level platform in response to the national requests. The blueprint roadmap acknowledges that countries have dif - ferent priorities and allocated resources; therefore, depending on a country’s readiness, a set of continent level services will be made accessible. The state of digital health initiatives in AfricaSection 1.0 Smart Africa Alliance Digital Health Blueprint14 20241.1 Background Africa has made significant progress in improving health outcomes for all age groups. The region has been successful at reducing the number of deaths caused by preventable diseases such as malaria, HIV, and diarrhea since 2000 by 66%, 57%, and 52%, respec - tively. Africa has also seen a significant increase in life expectancy during the same peri - od with a rise of 3 years on average.1 However, the region’s share of disease burden still remains high with the region reporting 234 million cases of malaria in 2021 accounting for 95% of the global disease burden and 60% (860,000) of new HIV infections reported globally.2 The region still has some of the world’s highest rates of preventable neonatal (27 per 1000 live births) and maternal mortality (531 deaths per 100,000 live births)3 as well as the highest deaths from infectious diseases, antimicrobial-resistant infections, and malnutrition. The prevalence of stunting among children under five years of age is 30.7%, which is higher than the global average of 22.0%.4 Additionally, due to recent economic progress, lifestyle changes


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mortality (531 deaths per 100,000 live births)3 as well as the highest deaths from infectious diseases, antimicrobial-resistant infections, and malnutrition. The prevalence of stunting among children under five years of age is 30.7%, which is higher than the global average of 22.0%.4 Additionally, due to recent economic progress, lifestyle changes including rapid urbanization, poor diet, physical inactivity and a rise in alcohol consumption and tobacco usage have led to an epidemic of non-communicable diseases. As life expectancies among African populations rise, the number of individuals living with multiple chronic health conditions is increasing. Nearly 10% of adult (aged 18 years and over) women live with diabetes, compared to 9.8% of men while 20.8% of women and 9.2% of men live with obesity.4 This rise in the double burden of diseases (communicable and non-communicable dis - eases) and increasing rates of co-morbidities, demands that public health programs (that previously focused on single diseases) must be able to diagnose and manage patients with intersecting conditions. Post COVID-19, despite the prioritisation of spending on health by governments in sub-Saharan Africa, the region is lagging behind others with a health expenditure growth rate of about just 3% in two decades, in comparison to 6% in regions like South Asia.5 Africa’s current and future health security will depend on many factors, which include the need for increasing the local capacities for both (1) specialized healthcare and to address its challenges, and (2) reducing reliance on importing life-saving diagnostics, treatments, and medical technologies. African-led initiatives will be critical in addressing these chal - lenges and shaping the region’s health future. Furthermore, the continent presents opportunities for robust and inclusive growth har - nessing the power of digital transformation, with its digital economy expected to reach 180 billion US dollars by 2025.6 The growing potential of information and communication technology (ICT) in Africa, particularly the increase in access to mobile phones, internet connectivity, and digital technologies present significant opportunities to address the unique health care challenges that Africa faces and lead to an advancement in health - care. 15 Approach for facilitating seamless health and care delivery across the African continentBy leveraging ICT in healthcare, Africa will be able to reach the last mile with healthcare needs, improve the efficiency of healthcare systems, improve the quality of care, strength - en workforce capacity and empower healthcare workers with more effective methods of training, increase accountability, management and


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across the African continentBy leveraging ICT in healthcare, Africa will be able to reach the last mile with healthcare needs, improve the efficiency of healthcare systems, improve the quality of care, strength - en workforce capacity and empower healthcare workers with more effective methods of training, increase accountability, management and overall health systems governance by being able to make data-driven decisions, and improve health systems’ capabilities to detect, investigate and respond to health threats. However, realizing the full potential of ICT in healthcare will also require that the conti - nent’s current challenges such as limited ICT infrastructure, digital literacy barriers, in - teroperability issues, data privacy and security concerns are addressed in order to allow equitable access to ICT enabled healthcare solutions for all and eventually not creating a digital gap. This will require collaborative efforts involving governments, healthcare orga - nizations, technology providers, and other stakeholders to harness the potential of ICT in transforming healthcare to make it more accessible, equitable and affordable for African citizens. Given this background, Smart Africa was born as the outcome of a bold and innovative commitment from African Heads of State and governments to accelerate sustainable so - cio-economic development, ushering Africa into a knowledge economy through ICT with healthcare being a key domain for this development. Currently, the Alliance includes 41 African countries that represent over 1 billion people7. Smart Africa’s vision is to trans - form Africa into a Single Digital Market by 2030 through a multi-stakeholder approach. Smart Africa’s governance model leverages the power of partnerships, collaborations, and participation by Member States to ensure sustainability, accountability, participation, and ownership of its initiatives. Smart Africa has multiple projects ongoing within its four programs, spanning different phases including concept, blueprint, pilot, and scale-up. Some of the blueprints that have been published include Smart Cities, ICT Start-Ups, Broadband, Digital ID, Digital Econo - my, ICT Skills, Cybersecurity, amongst others8. Previously, blueprints have led to the suc - cessful scale-up of initiatives such as the Smart Africa Trust Alliance (SATA), Smart Africa Digital Academy (SADA), Smart Africa Network of Incubators and Accelerators (SANIA) and Smart Africa Scholarship Fund. Smart Africa is well-placed to contribute to the digital health ecosystem, given its unique value propositions, namely: Ø Government leadership: Smart Africa is uniquely placed to highlight the ‘why’ and ‘how’ of tech-enabled development and build high-level political will and commitment in digital health policies.


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and Smart Africa Scholarship Fund. Smart Africa is well-placed to contribute to the digital health ecosystem, given its unique value propositions, namely: Ø Government leadership: Smart Africa is uniquely placed to highlight the ‘why’ and ‘how’ of tech-enabled development and build high-level political will and commitment in digital health policies. Ø Convening diverse stakeholders: Smart Africa can leverage its connections with ICT and digital health stakeholders from government, private sector, development and in - ternational organizations who can demonstrate, support, and/or contribute to tech-en - abled innovation and change in the health sector. Smart Africa Alliance Digital Health Blueprint16 2024Ø Implementation of ICT projects across borders: Smart Africa has experience in imple - menting a range of cross-border ICT projects. Smart Africa launched SATA as its im - plementation vehicle to promote open standards and interoperability for cross-border digital frameworks and systems in national policies, strategies, and action plans. The Smart Africa Alliance Digital Services Interoperability Platform (SADX) can enable cross-border interoperability of digital identities and data exchange. Smart Africa can leverage its resources to facilitate interoperable solutions for exchange of health in - formation at the continental level by providing coordination and operational guidance on development and implementation of policies, standards, health data governance, technology platforms, and solutions. 1.2 Digital Health Flagship Project The Digital Health Flagship Project (“flagship project”), championed by the Republic of Rwanda, is one of Smart Africa’s flagship initiatives. The flagship project is part of the Digital Transformation and Services Program and contributes to its strategic objectives, namely, to drive policy and regulatory harmonization for attracting investment to the digital landscape and to leverage technology to accelerate the inclusive uptake of digital public goods and services across Africa. Aligned with Smart Africa’s vision of creating a Single Digital Market in Africa, the goal of the flagship project is to create a Single Digital Health Market in Africa. A connected healthcare system is envisaged to transform the access to and delivery of healthcare ser - vices, while enabling effective governance of healthcare programs and creating market opportunities for innovations and investments. Smart Africa aims to complement the ongoing work of numerous stakeholders and ini - tiatives and further its multistakeholder collaborative approach to address the critical needs in infrastructure, governance, policies and standards, capacity development, inno - vations, and investments to advance digital health in the African continent. Multiple global and regional strategies and initiatives have


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the ongoing work of numerous stakeholders and ini - tiatives and further its multistakeholder collaborative approach to address the critical needs in infrastructure, governance, policies and standards, capacity development, inno - vations, and investments to advance digital health in the African continent. Multiple global and regional strategies and initiatives have underscored the need to ground digital infrastructure, platforms, frameworks, and standards for digital health. The initiatives include, but are not limited to: 17 Approach for facilitating seamless health and care delivery across the African continent Global and regional strategies & guidelines • WHO Global Strategy on Digital Health 2020-20259 • CDC Global Digital Health Strategy 202210 • ITU Digital Health Platform Handbook: Building a Digital Information Infrastructure (Infostructure) for Health, 202011 • WHO Global Initiative on Digital Health, 202412 • WHO Leading the future of global health with responsible artificial intelligence, 202413. WHO has pioneered the evaluation and adoption of digital health technolo - gies, which includes benchmarking Artificial Intelligence (AI) • WHO SMART Guidelines for standards-based, interoperable, and sustainable health systems • World Bank Global Civil Registration and Vital Statistics Scaling Up Investment Plan 2015-2024 • World Bank Implementation Know-how Briefs to support countries to prioritize, con - nect and scale for a Digital-in-Health future14 • African Union Digital Transformation Strategy, 202315 • African Union - Agenda 2063: The Africa We Want16 Standards & Frameworks • African Union Interoperability Framework for Digital ID, 202217 • African Union Health Information Exchange Guidelines and Standards, 202318 o Continental data exchange architecture, reporting, and sharing guidelines o Data exchange standards, Privacy and security standards, Common foundation standards for interoperability Regional Initiatives • Africa CDC’s flagship initiatives including HealthConnekt Africa, Health Data Gover - nance, Africa Digital Health Network, Digital Innovation and Data Sandbox15 • ITU’s GovStack initiative provides an approach for the delivery of interoperable, ge - neric, and reusable “building blocks” to build cost-effective and efficient digital pub - lic services, including access to health records, identity documents, digital payments, and other services.19 • ITU and WHO’s eHealth Africa Initiative to support countries build ICT foundations, digital infrastructure, and digital skills of health workers • Workforce capacity building programs by WHO Regional Office for Africa, ITU, PATH, and others Smart Africa Alliance Digital Health Blueprint18 2024 Rwanda has emerged as champion country for the flagship project. Given its strong - hold in ICT, Rwanda prioritized digital technologies as key enablers for


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of health workers • Workforce capacity building programs by WHO Regional Office for Africa, ITU, PATH, and others Smart Africa Alliance Digital Health Blueprint18 2024 Rwanda has emerged as champion country for the flagship project. Given its strong - hold in ICT, Rwanda prioritized digital technologies as key enablers for healthcare deliv - ery towards driving improved health outcomes. Rwanda’s Digital Health Strategic plan (2018-2023) sets an overarching goal to improve health service delivery and accessibil - ity through Digital Health. The Ministry of Health’s strategic plan aligns with the Smart Rwanda Masterplan under the Ministry of ICT, exemplifying the spirit of collaboration across sectors ensuring accessible, quality, and efficient delivery of health services using technology towards achieving universal health coverage. At the core of this success lies a comprehensive framework encompassing governance, policy initiatives, national digital ID, information technology infrastructure development, digital health architecture and innovative applications adapted to meet the evolving needs of its population. Some of the key initiatives that Rwanda has pioneered in order to champion digital health trans - formation are highlighted in Figure 1. Figure 1: Snapshot of digital health initiatives in RwandaE-tracker Immunization System Integration of immunization data within DHIS2 platformNational Vision & Commitment To transform country to a knowledge-based economy, developed eHealth strategyInfrastructure & Connectivity Increased investments and expansion of ICT infrastructureHealth Information Exchange Implementing nationwide health information exchange (pilot phase)Electronic Medical Records Standardized data capture and management (HMIS in DHIS2 and OpenMRS) Health Insurance Integration Integration of digital solutions with Mutuelle de Santé, health insurance program from Social Security BoardInnovation & Research Innovation Fund, conferences, hackathons, and hubs to support tech-enabled companies and entrepreneursMobile Technology & Telemedicine Enhancing healthcare delivery through remote consultations and diagnosesPartnerships & Collaboration Active collaboration with international organizations, non-profit entities, and private sector partners One Health Surveillance System Developed one Health Strategis Plan (2021- 2026); One Health Surveillance SystemDisease Surveillance Systems Implementing systems to enhance disease outbreak detection, reporting, and response Smart Africa follows a phased approach for all its flagships including the digital health flagship from concept to implementation. These phases are: 19 Approach for facilitating seamless health and care delivery across the African continent For the flagship, at the concept level, a whitepaper “Digital Health Agenda for Smart Africa”20 was developed. The paper sets the context of the digital health landscape, iden - tifies the needs and where Smart Africa can contribute to the digital


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seamless health and care delivery across the African continent For the flagship, at the concept level, a whitepaper “Digital Health Agenda for Smart Africa”20 was developed. The paper sets the context of the digital health landscape, iden - tifies the needs and where Smart Africa can contribute to the digital health ecosystem. The six thematic areas identified are as seen in Figure 2. Figure 2: Needs of Digital Health in AfricaScale-up Level (Implementation Phase)Concept LevelBlueprint LevelPilot Level (Implementation Phase) Increased and Coordinated Investments Foster synergies between the ICT and health sector to rationalize the investments of the “common building blocks” and establish national digital health public infrastructure.Internet Connectivity and Infrastructure Strong relations with the leadership of Governments, the ICT sector, connectivity providers, mobile operators etc. Interoperability and Health Information Exchange (HIE) Interoperability of health information systems at the country level and HIE for healthcare services nationwide and continent- level. Innovation & Entrepreneurship Smart Africa has partnerships and cooperation already with innovation hubs and incubatorsData Governance and Security Endorsement of government on the Health Data Governance Principles Harmonize and advocate across governments on the continent Guidance to ICT sector on issues around data storage and securityCapacity Development Leverage the Digital Health capacity development activities. To support the next phases of the flagship, a toolkit will be developed. It will cover opera - tional guidance for implementing the blueprint recommendations, thereby setting stage for the pilot and scale up phases. At the national level, the toolkit can be referred by the Ministries of ICT and Health along with technical experts for fulfilling the pre-requisites to exchange health information across borders. At the continental level, the toolkit will guide the continent level health information exchange to implement interoperable solu - tions in order to provide the cross-border services requested by countries. Blueprint principles and frameworkSection 2.0 21 Approach for facilitating seamless health and care delivery across the African continentTHE KEY objective of the blueprint is to provide an approach for facilitating seamless health and care delivery across the African continent and focuses on key interoperable solutions such that- • patients have access to healthcare services across the continent in a seamless way, • providers have access to patients’ health information and deliver appropriate care, and • payor (e.g., government and insurance) can support delivery of healthcare services across the continent. 2.1 Principles A set of principles has been formulated based on the blueprint


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healthcare services across the continent in a seamless way, • providers have access to patients’ health information and deliver appropriate care, and • payor (e.g., government and insurance) can support delivery of healthcare services across the continent. 2.1 Principles A set of principles has been formulated based on the blueprint objective. These prin - ciples are foundational to the blueprint and guide the recommendations provided in Section 3. The principles cover the domains of ‘Public health’ and ‘ICT’ in digital health. Table 1: Principles governing the Smart Africa Digital Health Blueprint Principle Rationale Implication PUBLIC HEALTH 1. Continuity of care• Healthcare system should prioritize the delivery of healthcare services, upholding citizens’ right to health. • Healthcare operations should be maintained irrespective of technological interruptions.• Digital health serves as an enabler but should not be considered a prerequisite for healthcare provision. 2. Trust-based system• Prioritize legal and regulatory compliance for trusted exchange of health information between countries. • Encourage adoption of strong, common, and agreeable standards and mechanisms for digital identification and data security. • Commitment towards transparency and public accountability.• African countries can collaborate effectively, having faith in an equitable, safe, and secure system from the perspective of national and citizen security. Smart Africa Alliance Digital Health Blueprint22 2024Principle Rationale Implication 3. Inclusive design • Support countries in adopting digital health irrespective of maturity level – leave no country behind. • Address population health needs including marginalized, displaced, vulnerable populations – leave no individual behind.• Supports goal of universal health coverage, equity, and accessibility of healthcare for all. • Allows different modalities for care delivery based on readiness factors. 4. Innovation • Promote innovation and entrepreneurship in locally relevant and sustainable digital health technologies. • Utilize data for health systems preparedness, strengthening, research, and development through health analytics. • Generate financing through innovative mechanisms (such as blended finance, social impact bonds, etc.)• Innovations must keep pace with rapid technology development and growing healthcare demands. • Increased investments can lead to economic benefits. 5. Collaboration • Promote collaboration between ICT and Health Ministries. • Enable cross-learning and sharing of good-practices between countries. • Understand and leverage the existing system, initiatives, and actors; foster collaboration with partners including the private sector. • Coordinated efforts between ministries at the highest- level to advance ICT in healthcare with combination of technical and domain expertise. • Avoid duplication of efforts, work towards learning and building


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countries. • Understand and leverage the existing system, initiatives, and actors; foster collaboration with partners including the private sector. • Coordinated efforts between ministries at the highest- level to advance ICT in healthcare with combination of technical and domain expertise. • Avoid duplication of efforts, work towards learning and building on existing initiatives and learnings of countries and development partners for the 23 Approach for facilitating seamless health and care delivery across the African continentPrinciple Rationale Implication mutual benefit of all stakeholders in the system. ICT 6. Interoperability • Any technological tool or intervention should be able to connect and communicate with other entities in a coordinated manner. • Technology should conform to defined standards that promote interoperability for data, applications, and technology.• Citizens can avail health services anywhere on the continent seamlessly. • Healthcare providers have access to data enabling them to make informed decisions. 7. Minimalistic approach• Use lightweight technology apps, tools, and protocols to enable easy, early adoption of technology building blocks without compromising essential functionality. • Countries can set up the required technology and scale up with minimum investment and operational costs.• Simplified technology adoption accelerates implementation. • Cost-effectiveness and scalability are key benefits. 8. Leverage open-source resources• Utilize open API, standards, data, and innovation to avoid vendor lock in and also enable local management, scalability, and sustainability. Can potentially be cost-effective also.• Open-source solutions are independent of specific technology choices offering flexibility. • Advantage of benefitting from community wide experience. Smart Africa Alliance Digital Health Blueprint24 2024Principle Rationale Implication 9. Common use building blocks• Leverage and strengthen foundational technology components/ building blocks in the digital ecosystem (digital identity, messaging services, etc.) • Develop digital health platforms that have functionality beyond health to maximize investment and accelerate progress to the Sustainable Development Goals.• Minimize duplication, maximize investments with cross-sectoral application. 10. Privacy and Security• Ensure data protection through appropriate mechanisms and technological process flows for consent management, authentication, and authorization of sensitive patient data.• Privacy and security safeguards should be intrinsic to every level of the technical process flow for patient data. 25 Approach for facilitating seamless health and care delivery across the African continent2.2 Digital Health Blueprint Framework The blueprint seeks to provide a framework, with components for creating and sustain - ing a Single Digital Health Market, by adopting a human centric approach. As an illustra - tion, the journey of a patient in


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seamless health and care delivery across the African continent2.2 Digital Health Blueprint Framework The blueprint seeks to provide a framework, with components for creating and sustain - ing a Single Digital Health Market, by adopting a human centric approach. As an illustra - tion, the journey of a patient in a Single Digital Health Market is showcased in Figure 3. Figure 3. A patient’s treatment journey in a Single Digital Health Market Patient journeys, like that of Waraidzo’s, have helped in formulating the different compo - nents of the blueprint framework for exchange of health information within and across borders to be possible. The digital health blueprint framework recognizes the foundational structure and key op - erational requirements for realizing the vision of a Single Digital Health Market. The foun - dational layers, namely governance and leadership, infrastructure for digital health, policy and regulation, standards, and workforce, when strengthened, create opportunities for innovation, technology, and financing to operationalize the vision (Figure 3). Ultimate - ly, the African continent is envisaged to become a single market connecting patients, SINGLE DIGITAL HEALTH MARKET Given Waraidzo’s health records are electronic, and the necessary systems are in place to communicate between Zimbabwe’s and South Africa’s system, the treatment and recovery can be tracked seamlessly. Waraidzo agrees for the hospital in Zimbabwe to share her healthcare records with the hospital in South Africa. The hospital can arrange for her teleconsultation pre- and post- surgery so that her healthcare team has the necessary information to support her recovery.He refers her case Dr Hassan, a specialist in Southe Africa who can treat Waraidzo with the surgery at Life Park Lane Hospital that has upgraded its facility with the latest technology. The doctor recommends advanced surgery. However, the technology is not yet available in the country.Waraidzo is a resident of Zimbabwe, she is diagnosed with a heart condition requiring specialized treatment. Patient Provider Payor1 23 45 Smart Africa Alliance Digital Health Blueprint26 20241. Governance and Leadership The vision of a Single Digital Health Market warrants strong governance and leadership at the continental level, built on a foundation of trust. Alliances play an important facili - tation role for accelerating national level digital efforts by providing technical assistance to member states, a forum for consensus on joint action and review, and a platform for accountability. Defining the role and mandate of healthcare service providers and insti - tuting appropriate


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trust. Alliances play an important facili - tation role for accelerating national level digital efforts by providing technical assistance to member states, a forum for consensus on joint action and review, and a platform for accountability. Defining the role and mandate of healthcare service providers and insti - tuting appropriate checks and balances are also key mechanisms for governance. providers, and payors enabling seamless access to and delivery of healthcare services. The relevance of each of the layers/pillars and ongoing initiatives towards strengthening these areas are described as follows: Figure 4: Framework for Single Digital Health Market VISION Single Digital Health Market 8- Financing Model For funding the digital health work and expanding digital health interventions for generating sustainable financing and investments in digital health7- Technology Platforms National and continent level ICT components enabling interoperable solutions for exchange of health information6- Innovation and Entrepreneurship Promoting innovation and entrepreneurship in digital health that are locally relevant and sustainable solutions 1- Governance and Leadership: for creation of structures to prioritize digital health agenda at the highest level and give impetus to digital health initiatives5- Workforce: for building the capacities of human resources for executing digital health 4- Standards: internationally accepted data standards that facilitate interoperability and information exchange in a secure and trusted manner 3- Policy and regulations: for putting the framework and guidelines within which digital health initiatives need to operate 2- Infrastructure for digital health: physical infrastructure needed to provide digital services for health (and across the sectors) including power, connectivity, and devices 27 Approach for facilitating seamless health and care delivery across the African continentAt the national level, a strong governance structure with visionary leadership contrib - utes to the success of digital health transformation. Clear, accountable steering body with representation from the Ministry of Health and the Ministry of ICT at minimum, a designated nodal department, and a focal officer are crucial to ensure coordination and implementation of digital health activities at the national level. Digital health requires col - laboration at the highest level – leveraging the resources and strengths of the respective departments to ensure effective systems-level strategies and initiatives. National bodies which will help guide the implementation of digital health solutions need to be identi - fied or established. Efforts must be taken to ensure that these bodies are capacitated and funded, with adequate policy and regulatory coverage, so that they can serve as the


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systems-level strategies and initiatives. National bodies which will help guide the implementation of digital health solutions need to be identi - fied or established. Efforts must be taken to ensure that these bodies are capacitated and funded, with adequate policy and regulatory coverage, so that they can serve as the custodians of digital transformation over a 5 – 10 year time horizon. Overall, these foster an environment that promotes collaboration and accountability, with commitment to equity and inclusion. For example, Rwanda’s success in digital transformation and overall economic progress is attributed to its government-led national growth strategies and strategic leadership and investments in building its government-wide enterprise ar - chitecture. Kenya’s Digital Health Bill 2023 provides for the establishment of the Digital Health Agency with the core mandate to develop, operationalize and maintain a Com - prehensive Integrated Health Information System.21 2. Infrastructure for digital health Infrastructure for digital health encompasses critical physical and digital components essential for health and other sectors. It includes robust power infrastructure, ensuring uninterrupted operations, advanced connectivity via reliable internet and mobile net - works, and appropriate healthcare devices like medical sensors and Internet of Things (IoT) tools. An integrated infrastructure supports telemedicine, remote monitoring, and secure data management through data centers and cloud computing. From a security and vendor lock in point of view, each country should set up and manage its own sover - eign cloud infrastructure. Regulatory frameworks and interoperability standards further underpin this infrastructure, enabling seamless exchange of healthcare information and safeguarding patient information privacy across interconnected systems. The national level infrastructure is foundational, whereas the continental level infrastructure (such as a continent level Health Information Exchange platform) is required for facilitating ex - change of health information across borders. The African Union Digital Transformation Strategy (2020-2030) provides recommen - dations to promote national, regional, and intra-continental interconnectivity including promoting the implementation of common infrastructures and capitalizing on sectoral infrastructure. Further, Africa CDC identifies specific activities in its Digital Transforma - tion Strategy (2023-30) with a strategic objective to help Member States design and implement the physical infrastructure needed to provide digital health solutions. Aligned with the continental strategies, Smart Africa’s SMART Broadband 2025 strategy seeks Smart Africa Alliance Digital Health Blueprint28 2024to provides a pathway that brings together stakeholders and a coordinated approach to improve internet connectivity in the region. HealthConnekt Africa, a bold new initiative from Africa CDC and


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digital health solutions. Aligned with the continental strategies, Smart Africa’s SMART Broadband 2025 strategy seeks Smart Africa Alliance Digital Health Blueprint28 2024to provides a pathway that brings together stakeholders and a coordinated approach to improve internet connectivity in the region. HealthConnekt Africa, a bold new initiative from Africa CDC and Global System for Mobile Communications Association aims to connect all health facilities and workforce in Africa to the internet by 2030. 3. Policy and regulations The policy and regulations layer is crucial for realizing the vision of a unified African dig - ital health market. While policies drive the vision, legal and regulatory elements are the necessary underlying enablers. At the national-level, a foundational legal and regulatory basis is needed to define mandates, and authorize institutional bodies to act. The legal and regulatory layer is also key to achieving a delicate balance between safeguarding the data and privacy of individuals while enabling the sharing of pertinent data to achieve the vision of a Single Digital Health Market. Clear rules around data privacy, security, and interoperability ensure that data is only shared for legitimate purposes and accessed by authorized personnel. At the continental-level, regulatory harmonization is a prerequisite for data flow, mobility of individuals and interoperability. Furthermore, a sound and solid policy and regulatory foundation fosters trust and con - fidence. Without clear rules carrying the required protective measures, patients could hesitate to trust the system, hindering its adoption. Finally, consistent regulations have the potential to create a favorable business climate, attract investment and foster inno - vation and entrepreneurship. The vision to achieve continental integration and drive tre - mendous change on a large scale, is ultimately only as strong as its policy and regulatory foundation. The Model Law on Health Data Governance22 is one such initiative under - taken by Transform Health to establish consensus on essential elements that should be included in national legislation and regulation. 4. Standards Standards are a set of rules, guidelines, or specifications that establish a common lan - guage, format, or process. Standards promote interoperability by providing a common framework that can be adopted by various entities at both national and continental level. In healthcare, standards support the exchange of health information offering protection of patient data, promoting effective use of data by healthcare providers, and improving the quality of healthcare delivery. National or international standards may also be “open standards”. Open standards


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adopted by various entities at both national and continental level. In healthcare, standards support the exchange of health information offering protection of patient data, promoting effective use of data by healthcare providers, and improving the quality of healthcare delivery. National or international standards may also be “open standards”. Open standards are publicly available and intended for widespread adoption (e.g., XML, SQL, etc.). They allow the development and integration of various interopera - ble products and services and are developed and maintained collaboratively. International Telecommunication Union’s (ITU) Digital Health Platform Handbook elabo - rates on the various types of common standards (such as public key infrastructure, Open 29 Approach for facilitating seamless health and care delivery across the African continentAuthorization/OAuth for privacy and security) and health-specific standards (such as International Classification of Diseases-10, LOINC, etc.), and their functionalities using the case of a patient’s journey. African Union’s Interoperability Framework for Digital ID defines the minimum standards for promoting trusted exchange of data between the parties. Africa CDC18 promotes Member States to adopt international interoperability standards such as Health Level 7 (HL7) and Fast Healthcare Interoperability Resources (FHIR) which defines how healthcare information can be exchanged electronically be - tween different systems. Africa CDC also recommends standards for data exchange, sys - tems, communication, messaging, vocabulary, privacy, and security that Member States must adopt while developing their digital health systems. 5. Workforce The benefits of digital health can be reaped when supported by a capacitated workforce in digital systems, data use, planning, and management at both national and continental levels. Countries need to focus on the development of skilled health and technologi - cal workforce and continuous upskilling given the rapid pace of technological advance - ments. Healthcare and ICT professionals need to be capacitated with digital health skills that are at the intersection of the two domains. Organizations such as WHO Regional Office for Africa, PATH and ITU, have undertaken digital health capacity building and curriculum development workshop for digital health leaders23. With support from devel - opment partners, countries are developing innovative platforms for in-service training of health workforce through e-learning tools. Africa CDC focuses on workforce devel - opment through its many initiatives to enhance knowledge, skills, and competencies. Some of these initiatives include launching a Health Informatics Fellowship and Network, provide trainings through Africa CDC Institute for workforce development, among oth - ers. Smart Africa’s ICT Skills Capacity


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e-learning tools. Africa CDC focuses on workforce devel - opment through its many initiatives to enhance knowledge, skills, and competencies. Some of these initiatives include launching a Health Informatics Fellowship and Network, provide trainings through Africa CDC Institute for workforce development, among oth - ers. Smart Africa’s ICT Skills Capacity Building Blueprint seeks to provide guidance to countries to implement innovative skill development initiatives to accelerate uptake and use of digital health technologies, where SADA functions as a catalyst to empower all African citizens to develop digital skills and competencies. 6. Innovation and Entrepreneurship Innovation and entrepreneurship are central to the rapid pace of advancements in dig - ital health, particularly fostering local production and ownership of solutions that are product or software agnostic, built using open standards, making them sustainable in the long-term. The WHO Global Strategy on Digital Health 2020-25 envisages multis - takeholder support for the scaling up of digital health and innovations, innovations hubs to promote digital health solutions aligned with country needs, and the promotion of cutting-edge technologies such as artificial intelligence, blockchain, big data analytics, etc. At the continental level, innovation accelerator platforms such as the HealthTech Smart Africa Alliance Digital Health Blueprint30 2024Hub Africa drives the development of health technologies, fast-track innovation in pub - lic health systems through collaboration with governments and funders. Such initiatives support local startups and entrepreneurs to deliver impactful innovations by generating evidence, and fosters partnerships between innovators, policymakers, funders, research - ers, and others at the country-level. Africa CDC’s sandbox initiative aims to foster inno - vation by providing an environment to test and learn from experimentation. The sandbox is intended for innovators to also access data, tools, resources, and engage with various stakeholders to design innovative digital health solutions. Further, SANIA, Smart Africa’s implementation vehicle for fostering entrepreneurship in the digital health space. 7. Technology Platforms The technology platform consists of national and continent level ICT components that enable interoperable solutions for exchange of health information. At the national-level, a technology platform refers to the infrastructure upon which the digital health platform and applications are built. It relies on components such as con - nectivity, technological infrastructure, foundational digital public infrastructure that are common ICT infrastructure applicable across sectors. This digital health platform is an integrated set of common and reusable components that can support diverse sets of digital health applications and systems. It consists of


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It relies on components such as con - nectivity, technological infrastructure, foundational digital public infrastructure that are common ICT infrastructure applicable across sectors. This digital health platform is an integrated set of common and reusable components that can support diverse sets of digital health applications and systems. It consists of software solutions and shared in - formation resources to support processes such as patient identification, patient consent, authentication, data integration, data definitions, and messaging standards for interop - erability. At the continental level, a cross-border health information exchange layer is responsible for facilitating exchange of health information between countries. The technology plat - form functions in accordance with the policies and legislation, relevant standards and guidelines, data governance frameworks for health information exchange. The technolo - gy platforms are the focus of the blueprint and is elaborated in Section 3. 8. Financing Model Financing is the bedrock to the sustainability of digital health transformation. The scaling of digital health solutions is resource intensive and has a high maintenance operating ex - penditure. This necessitates innovative financing models and investments from both the public and private sectors such as public private partnerships, blended financing, etc., at both national and continental-level. Building common reusable building blocks, in partic - ular those that support management and technical foundations, can lead to economies of scale, pooled investments, cross-financing benefitting a wide range of stakeholders in the system. For the long-term stability of these foundational digital health solutions, securing sustainable investments and a robust financing plan while embedding an in - 31 Approach for facilitating seamless health and care delivery across the African continentvestment appraisal plan that assesses both the financial and non-financial (e.g., time savings, quality of care, improved health outcomes) return on investment is critical for its success.24,25 The financing structure has to be evolved to move spends from capex to opex models, from margin to volume models, from dedicated to shared infrastructure models. Overall, digital health solutions that enable improvements in efficiency, quality, and access together make a strong business case for digital health. Financing is a key operational pillar to advance the agenda of digital health. Cross-border exchange of health information in AfricaSection 3.0 33 Approach for facilitating seamless health and care delivery across the African continent THE PROPOSED “technology platform” pillar comprises six components, encompassing essential common ICT infrastructure and layers supporting health-specific functions as described in Figure 5 (adapted


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the agenda of digital health. Cross-border exchange of health information in AfricaSection 3.0 33 Approach for facilitating seamless health and care delivery across the African continent THE PROPOSED “technology platform” pillar comprises six components, encompassing essential common ICT infrastructure and layers supporting health-specific functions as described in Figure 5 (adapted from Digital Public Infrastructure for Health26). At the national level, connectivity and technology infrastructure (component 1) is the foundational physical infrastructure needed to provide digital services across sectors including healthcare. The foundational digital public infrastructure (component 2) refers to solutions and systems (such as identity, payment, data) that enable effective provi - sion of essential society-wide functions and services in the public and private sectors.26 The digital health platform (component 3) is a common digital health information infra - structure that digital health applications (component 4) and systems are built upon in order to deliver digital health services to support healthcare delivery in a consistent and integrated manner.11 Exchange of health information across borders will rely on the establishment of (com - ponents 1 - 4) national-level health information exchange systems to facilitate data shar - ing between countries. The continent level health information exchange (component 5) offers market opportunities for the healthcare industry to plug in (component 6) for providing products and services such as telemedicine services, insurance claims, digital devices, biotechnology research, and so on. Figure 5. Zoomed in view of ‘Technology platforms’ pillar1- Connectivity and technology infrastructureCONTINENTAL LEVEL COMPONENTS (5 –6) 6- Healthcare Industry plug 5- Continent-level Health Information Exchange COMPONENTS FOR EACH OF THE PARTICIPATING COUNTRIES (1-4) 4- Applications 3-Digital Health Platform 2- Foundational digital public infrastructureICT across domainsHealth specific Smart Africa Alliance Digital Health Blueprint34 2024From an ICT lens, the development of a Single Digital Health Market for Africa will require concurrent development of foundational infrastructure needed for sustainable digital health transformation and of digital health services that improve the access, quality, and efficiency of healthcare delivery responding to population needs. This section covers the continental-level requirements and the national-level pre-requisites that need to be es - tablished for implementing interoperable solutions for cross-border exchange of health information. An interoperable electronic record of a patient’s medical history enables the patient to avail healthcare services by enabling a healthcare provider to access electronic health record (EHR) (with the required consent) irrespective of the providers and the patient’s location anywhere on the continent. At the national level,


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of health information. An interoperable electronic record of a patient’s medical history enables the patient to avail healthcare services by enabling a healthcare provider to access electronic health record (EHR) (with the required consent) irrespective of the providers and the patient’s location anywhere on the continent. At the national level, creating a unique patient ID enables linking a patient to digital records and allows the patient to be accurately iden - tified and securely share the required information with healthcare professionals. Further, countries will need to maintain registries of healthcare professionals and facilities who are authorized to engage in the exchange of health-related information. For the collec - tion, transmission and use of health data understood uniformly by healthcare providers, countries will need to maintain a registry of terminology standards. A key responsibility of countries is to provide adequate legal protection to patient data, whether at rest or in transit. This involves managing patient consent applications, access to relevant data (such as International Patient Summary) and traceability of patient records. At the na - tional level, it is crucial for countries to ensure their various systems are interoperable and data is integrated. Given that countries develop and strengthen their national health information exchange systems through diverse mechanisms, they can communicate with one another, facili - tated by an independent body at the continental level. Countries joining the continental platform can create an adapter to transform and map their data into the standard API set up at the continental-level. These standard APIs could be available for facilitating several cross-border operations such as identity, authentication, translation and transcoding, etc. The continental platform serves as a conduit between countries engaging in exchange of health information such that the data can be read and understood irrespective of the standards adopted by countries independently. These continental level functions and pre-requisites at national level form the key in - teroperable solutions for the exchange of health information across borders as described in Figure 6 and elaborated in the following subsections. This chapter covers recommen - dations for these solutions and is supported by use cases in the form of process flows in - cluding describing a patient’s movement from Country A to Country B on the continent and the relevant digital health moments that are triggered for enabling the exchange of health information within and between countries. 35 Approach for facilitating seamless health and care delivery


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the form of process flows in - cluding describing a patient’s movement from Country A to Country B on the continent and the relevant digital health moments that are triggered for enabling the exchange of health information within and between countries. 35 Approach for facilitating seamless health and care delivery across the African continent Figure 6: Interoperable solutions at national and continental levels for exchange of health information across borders 3.1 Patient Identity (ID) Document A patient ID is an alphanumeric code uniquely assigned to a patient within a country’s health records system. This patient ID is used to identify and manage patient informa - tion, providing a way to link patient ID with patient data, allowing creation of a single comprehensive EHR for an individual at the country-level. By using the patient ID, health - care professionals can access patient data linked to the ID, from the EHR at the point of care level and thereby extend appropriate healthcare services. The patient ID is one of the foundational interoperable solutions enabling exchange of health information. Any subsequent reference to patient ID is understood to be a unique identity. Often governments operate a variety of ID systems to provide citizens with proof of legal identity to access services, opportunities, and protection. This can include two main ID systems – (1) a foundational ID system created to manage identity information for the general population and serve as proof of identity to access various services such as cit - izen ID, (2) a functional ID created for a particular service or transaction such as tax ID, voting ID, patient ID etc. 26 4Data integration consolidating data from various sources such as hospitals, pharmacies, and national health programs to be reflected in the patient records Semantic interoperability Semantics (terminologies, and codes related to diseases, pharmaceuticals, diagnostics, and other health indicators) uniformly understood for extending seamless health services within and across countriesAccess to intended patient’s information Retrieving information of the correct patient to be able to appropriately extend treatmentKey interoperable solutions for exchange of health information Patient Identity document Alphanumeric code used to uniquely identify a patient within a country’s health records system 1 Key registries Create and maintain registries for (1) healthcare professionals, (2) health facilities and (3) terminology standards at national level 3Patient consent management & data access Process of inviting patient consent, access to patient data and update, and tracking the


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identify a patient within a country’s health records system 1 Key registries Create and maintain registries for (1) healthcare professionals, (2) health facilities and (3) terminology standards at national level 3Patient consent management & data access Process of inviting patient consent, access to patient data and update, and tracking the data origin, movement, and transformation 5 Smart Africa Alliance Digital Health Blueprint36 2024Country experiences of implementing patient ID systems vary depending on the con - text and are at different stages of maturity. For instance, in Rwanda, a Unique Patient Identifier is linked to the National ID of the citizen, whereas, in Botswana, the Ministry of Health has adopted a National ID (OMANG) number as a unique identifier for all citizens seeking health services in the public sector, with non-citizens patients registered by their passport number. Similarly, Ethiopia’s Ministry of Health and its national identity program have formed a partnership to integrate the Fayda digital ID with the country’s healthcare sector. Whichever model countries follow, the country’s strategy target is to be inclusive to guarantee the identity of all and harmonize multiple ID systems (if present) to avoid fragmented systems. Given the different identity systems adopted by countries, the African Union (AU) In - teroperability Framework highlights the need for digital identity systems to foster trust between participating countries, ensuring the legal rights of data owners are observed and ethical use of identity is promoted. To ensure this trust, a set of rules that all parties sign up to and observe must be defined through a Trust Framework.17 The continent-level health information exchange platform should drive the implementation of an interop - erable patient ID in accordance with an established and agreed upon trust framework for exchange of health information. One such “trust network” is the WHO Global Digital Health Certification Network , an open, interoperable digital public infrastructure, that aims to facilitate the verification and secure exchange of digital health certificates by member countries and is relevant to digital IDs.27 Recommendations • The AU Digital Transformation Strategy, AU Interoperability Framework for Digital ID, and Smart Africa’s Blueprint for Digital ID provide the framework and guidance for foundational ID that countries can leverage to formulate a strategy and plan for de - signing and implementing patient ID systems. In addition, GovStack provides detailed guidance on standards and guidelines for creating and maintaining identity system that countries may follow.28 • At


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ID provide the framework and guidance for foundational ID that countries can leverage to formulate a strategy and plan for de - signing and implementing patient ID systems. In addition, GovStack provides detailed guidance on standards and guidelines for creating and maintaining identity system that countries may follow.28 • At the national-level, countries must create unique patient IDs. The creation of patient ID should ideally be (1) governed by a body that oversees the creation of patient ID, authorizes entities that can issue patient ID and ensures compliance (2) issued by en - tities authorized to issue patient IDs (3) secured by independent entities responsible for encrypting and electronically signing the patient ID, thereby establishing trust in communication, verification, and validation of identity. • The patient ID should contain a set of basic demographic details in line with standards adopted (such as HL7 FHIR29). Based on existing national programs and context, countries can opt for an appropriate identification system and model, where- 37 Approach for facilitating seamless health and care delivery across the African continent1. patient ID is linked to a foundational ID (e.g., national ID), as we see in Rwanda or, 2. patient ID is independent of foundational ID or, 3. the foundational ID is used as the patient ID, as we see in Botswana and Ethiopia. • Patient identity information and patient data is treated as “sensitive” information. Countries should use data encryption as a security measure for the data while at “rest” and “in transit” to prevent unauthorized access to the patient’s data. • The legal framework for patient ID is elaborated further in Box 1 and the legal frame - work for data protection is covered in a subsequent section (sub-section 3.5: Patient consent and data access). Countries must ensure these are aligned with an estab - lished and agreed upon trust framework (co-created in line with African Union recom - mendations) such that the underlying set of rules that countries agree on, for cross border exchange, are adhered to. • Any access to a patient summary would first require the patient’s consent, specific to the country’s regulations and systems (refer to sub-section 3.5 for details related to patient consent). Patient ID authentication would require a decryption operation of the security credential. For cross-border exchange of health information, the conti - nental level platform will facilitate the retrieval of electronic certificates of the issuer and the


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country’s regulations and systems (refer to sub-section 3.5 for details related to patient consent). Patient ID authentication would require a decryption operation of the security credential. For cross-border exchange of health information, the conti - nental level platform will facilitate the retrieval of electronic certificates of the issuer and the authentication process. Functional ID systems have enabled developments and reforms in the health sec - tor, including mHealth platforms and electronic health information systems benefit - ing patients, healthcare professionals, and governments in planning and improving health programs. However, health-specific ID systems at scale can be costly and siloed from other systems.30 On the other hand, the foundational ID system enables streamlining identity man - agement overall and eliminating patient ID specific costs. Using a foundational iden - tifier shared with other systems will make health systems interoperable with other government databases. These linkages can also help strengthen identification and civil registration systems by driving demand for the foundational system and cre - ating more points of contact with individuals for updating information. However, there are potential issues related to safeguarding citizens, privacy in linking multiple sources of data with varying levels of protection. Also, foundational IDs may be linked to a specific age threshold, whereas healthcare is needed starting at birth. Smart Africa Alliance Digital Health Blueprint38 2024 • Countries should authorize healthcare professionals, facilities, pharmacies, diagnostic centers, and any other trusted entity and clearly identify those who can request au - thentication of patient ID for delivering health services. These are further detailed in subsequent sections (sub-section 3.3: Key registries and 3.5: Patient consent and data access) • Countries should ensure that standard protocols (e.g., Security Assertion Markup Lan- guage/SAML2, OAuth) for identity and access management are adopted. A continen - tal-level health information exchange platform may facilitate cross-border requests to access patient ID and the authentication of this request between countries. The recommendations have been illustrated in the form of a process flow in Figure 7. The focus of the process flow is on patient ID and remaining concepts related to exchange of health information across borders will be elaborated in the subsequent sub-sections. Figure 7. Process flow illustrating patient ID authentication in a cross-border scenarioPatient requests authorized entity in Country A to create her patient ID. The healthcare professional in Country B is now sure of the patient ID and next action can be taken. Country


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will be elaborated in the subsequent sub-sections. Figure 7. Process flow illustrating patient ID authentication in a cross-border scenarioPatient requests authorized entity in Country A to create her patient ID. The healthcare professional in Country B is now sure of the patient ID and next action can be taken. Country A system authenticates the request received and responds through the continent level platform. The healthcare professional places a request through continent level platform for Country A to confirm patient ID.This patient later travels to Country B where she visits a healthcare professional.Process is initiated and patient provides the required details; Country A’s system creates a security credential through encryption of patient ID and personal demographic data. Country A Country B 1 2 3 4 56 39 Approach for facilitating seamless health and care delivery across the African continent Box 1: Legal framework for patient ID Legal provisions allow and enable the creation and implementation of unique pa - tient IDs for interoperability within and between countries. Countries are responsi - ble for drafting, revision, and enactment of their own legal provisions that support trusted information exchange between countries. A continental body may work with member countries on gathering consensus on acceptable legal principles gov - erning patient ID and the protection mechanisms to be afforded by respective na - tional legislation.31 1. A set of important principles that need to be considered as health-related data is no ordinary personal data, it is deemed by several legislations as “Sensitive Data”, including the AU Convention on cybersecurity and personal data protec - tion (Article 1 –Definitions). The protection afforded needs to be adequate to that level of required protection. 2. Each participating country needs to ensure the patient ID complies with its na - tional legislation as well as its regional and/or international commitments, and especially the AU Convention on cybersecurity and personal data protection (articles 10-23 in particular) on requirements to process health-related personal data (for party states who ratified it). 3. If patient ID is based on or is the same as the existing national ID for a given country, • Participating countries need to enact and implement national legal frame - works governing digital IDs that consider cross-border data flow in accor - dance with the AU Interoperability framework for Digital ID. • The legal framework governing that national ID should consider its use case for health including its


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• Participating countries need to enact and implement national legal frame - works governing digital IDs that consider cross-border data flow in accor - dance with the AU Interoperability framework for Digital ID. • The legal framework governing that national ID should consider its use case for health including its cross-border usage and be amended accordingly. 4. An anonymization (for secondary uses, in research and statistics) and/or en - cryption mechanism of patient identity and related data needs to be set up to guarantee patients privacy and personal data safeguarding. This mechanism should be codified in the respective legal framework and harmonized across participating countries where patients’ data can be accessed/used. Considerations • Attribution of patient ID should include the criteria of residency wherein any resi- dent of an African country is integrated into the digital health system and can access health services. The legal framework should allow for this design element in the cre - ation of patient ID. Smart Africa Alliance Digital Health Blueprint40 2024• Rwanda’s national single digital identity system law 29-2023 is a good basis for a legal framework for patient ID. It may be used as a starting point, but needs to be adapted to the purpose of patient ID. 3.2 Access intended patient’s information Issuance of patient ID alone does not guarantee that healthcare professionals will be able to access the intended patient’s data. In an event where the patient provides incorrect patient ID, or the patient is unable to produce the patient ID, the healthcare professional must be able to accurately identify and access the intended patient’s information. Lack of proper patient identification has adverse and unwanted effects as it can negatively af - fect important clinical decision making, treatment, patient outcomes, and impact patient privacy.a It is crucial to have the right mechanisms in place to allow the correct identifica - tion of a patient every time by health care professionals. Identifying traits are a set of data points that are used to uniquely identify a patient. The choice of these traits is the basis of the quality of the identification. Thus, the traits must be reliable and always available. These traits will make it possible to compose a perma - nent identifier. Even globally, a one-to-one relationship between the patient and their identification developed from these traits must be maintained. This is especially crucial since a continental platform is being suggested.


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the traits must be reliable and always available. These traits will make it possible to compose a perma - nent identifier. Even globally, a one-to-one relationship between the patient and their identification developed from these traits must be maintained. This is especially crucial since a continental platform is being suggested. An identifier must only correspond to one patient and in the case where several persons have the same identifier – it is known as a collision.32 This must be avoided as it can lead to a patient being incorrectly matched to another patient’s record. This can result in pa - tient care and safety being jeopardized as incorrect data can cascade into a multitude of internal and external systems and databases such as laboratory, radiology, and health information networks, potentially leading to laboratory, imaging, and medication errors. Additionally, a patient must only correspond to one identifier. If a patient has several identifiers – it is known as a duplicate.5 This also must be avoided as the existence of mul - tiple records for a single patient, can lead to healthcare workers missing critical informa - tion because it may be in a duplicate record. It is therefore suggested that de-duplication mechanism should be embedded in all the record systems to address issues such as- a Patient privacy is impacted in the scenario that a patient is incorrectly identified, and the health worker accesses the wrong patient record. 41 Approach for facilitating seamless health and care delivery across the African continent1. Several identifiers for the same patient have been created, then allowing only one identifier to be recorded and stored. 2. Several patients have the same identifier, thus preventing the same identifier from being allocated to any other patient. In addition to the patient ID, it is important for the ideal patient attributes to be unique, ubiquitous, and unchanging. Patient care and continuity of care require identification as well as authentication, which is precise and reliable. It is crucial to be certain that the information available corresponds to the patient, as there is no scope for medical errors arising out of wrong identification of the patient. Therefore, the quality of the information used to identify a person as well as the identity control and management procedures must be high. Recommendations • During creation of patient ID, demographic and other relevant information of the pa- tient is captured. Among these, it is


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wrong identification of the patient. Therefore, the quality of the information used to identify a person as well as the identity control and management procedures must be high. Recommendations • During creation of patient ID, demographic and other relevant information of the pa- tient is captured. Among these, it is essential to define traits that do not change with time, and these are called strict traits. For example, the maiden name and the date of birth are features that receive the approval of experts to serve as the basis for a patient’s identification. Items such as phone number, email address change often and thus cannot form a permanent identifier as these can change over a period of time. Additionally, it is necessary to precisely define the formats and methods for entering and processing this information. An example includes - the format of the date of birth must be harmonized, and the input screens can help with avoiding errors (e.g., num - ber of characters permitted). • Existing identification numbers used in vast information systems can be considered a permanent identifier for the patient, such as the social security number. The advan - tage of this is that many of the national-based identification schemes already use bio - metrics/ biographic information and thus have a high level of assurance, allowing the identification and the authentication process to be highly credible. This also allows for savings that would otherwise be spent on mobilizing resources to collect biometrics at the patient ID level. While the disadvantage remains that each country has its own identification number that may vary greatly across borders and some countries may not have any at all – thus in the case of continental wide use, using such an identifica - tion number, such as a social security number, as an authenticator can be challenging. • At the time of patient ID creation, a combination of the strict traits’ information is used to get a unidirectional hashing algorithm which is used to obtain a unique per - manent identifier number (PIN) signature of the patient concerned. This number is kept in a “master index” and serves as the unique identifier. Whenever a healthcare professional inputs the strict traits provided by the patient, a PIN is produced. A cor - Smart Africa Alliance Digital Health Blueprint42 2024 rect identification is thus established if the PIN produced is the same as the


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in a “master index” and serves as the unique identifier. Whenever a healthcare professional inputs the strict traits provided by the patient, a PIN is produced. A cor - Smart Africa Alliance Digital Health Blueprint42 2024 rect identification is thus established if the PIN produced is the same as the PIN pro - duced during the patient ID creation as recorded in the master index. The recommendations have been illustrated in the form of a process flow in Figure 8. Please note, the focus of the process flow is on accessing the intended patient’s infor - mation and the remaining concepts related to the exchange of health information across borders will be elaborated subsequently. Figure 8: Process flow illustrating options available for countries to enable access to intended patient’s information Patient visits a healthcare professional Healthcare professional asks the patient ID and for his/her strict traits (e.g. maiden name, date of birth) that are required in the country during patient ID creationHealthcare professional inputs the strict traits of the patient into the systemAdditionally, healthcare professional asks for foundational or functional ID (like social security number) if availableThe system matches the patient ID along with the strict traits (and foundational or functional ID if available) with the master key. The system confirms the information inputted matches the master keyORHealthcare professional asks for the patient ID and foundational or functional ID (like social security number) that are required in the country during patient ID creationOR Option 1 Option 2 Option 3 The healthcare professional asks for patient’s strict traits (e.g. maiden name, date of birth) that are required in the country during patient ID creationThe healthcare professional inputs the strict traits of the patient into the systemThe system matches patient ID along with foundational or functional ID, possibly with digital verification with the master key {Applicable in countries with universal coverage of foundational or functional ID}1 2 2 23 3 34 5 Healthcare professional inputs the patient ID and foundational or functional ID into the system 4 4 43 Approach for facilitating seamless health and care delivery across the African continentConsiderations • It is important to ensure that the authentication process should be as close as to that of foundational systems. • Additional elements that can be used to avoid identifier collisions include biometrics - It does not require, for the patient, the use of any document whatsoever or memo - rization


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It is important to ensure that the authentication process should be as close as to that of foundational systems. • Additional elements that can be used to avoid identifier collisions include biometrics - It does not require, for the patient, the use of any document whatsoever or memo - rization of information. Though, the precision and reliability of biometric techniques, for example, fingerprints, iris, retinal image are not optimal in all circumstances. For example, finger injuries can alter this means of identification. Furthermore, the cost and constraints generated by the use and accessibility of technical devices are also a barrier. 3.3 Key registries Designed to be nationally recognized and accepted, registries are trusted sources of in - formation in the national digital health ecosystem. The establishment of such registries is intended to create a single and reliable source of information for healthcare profession - als and health facilities, which is uniformly understood without ambiguity. To enable ex - change of health information across borders, (1) healthcare professional’s registries, (2) health facilities’ registries and (3) terminologies registries are pre-requisites and should be created at the country level. A system for identity management of healthcare professionals and facilities needs to be instituted at the national level. Identification and authentication of healthcare profes - sionals and health facilities of the country should rely on security credentials provided by appropriate national authority. It will ensure healthcare professionals’ participation in the system and affiliation with health facilities. Next, countries need to fulfil the pre-requisites of maintaining registries of healthcare professionals to verify and authorize healthcare professional’s credentials, restrict access to sensitive data and support national regulato - ry compliances. The federated identity system streamlines the management of identity processes and policies among the collaborating entities for exchange of health informa - tion. Health facility registry ensures the authenticity of healthcare facilities, guarantees their legitimacy, and verifies healthcare professionals’ affiliation with recognized facilities. The registry functions as a comprehensive information system, containing essential data on various types of healthcare establishments, such as hospitals, pharmacies, laboratories, and clinics. Tagging patient records with facility IDs is crucial to ensure traceability, ac - countability, and reliability of health information, enabling secure exchange of informa - tion within and then across borders. Healthcare professionals affiliated with recognised Smart Africa Alliance Digital Health Blueprint44 2024health facilities are qualified to access and update patient records in the national termi - nology standards.


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ensure traceability, ac - countability, and reliability of health information, enabling secure exchange of informa - tion within and then across borders. Healthcare professionals affiliated with recognised Smart Africa Alliance Digital Health Blueprint44 2024health facilities are qualified to access and update patient records in the national termi - nology standards. Terminology standards ensure that clinical concepts are represented consistently and clearly between senders and receivers within health information ecosystems. This in - cludes structured vocabularies, code sets, and classification systems. Some notable examples of terminology standards are International Classification of Diseases -10, SNOMED CT, LOINC, RxNorm etc. Each country uses its own and diverse terminology standards possibly even within the country, which leads to suboptimal sharing of health information. Without standardization, sharing and integrating health data becomes dif - ficult, limiting its usefulness in the health information ecosystem. To ensure consistency of terminologies in digital format, a national terminology registry needs to be created by countries that will be maintained by the national data gateway of each country. National data gateway will manage the terminologies repository in the country. Centralizing a ter - minology registry enables standardization of code and definitions, allows encoding and semantic interoperability among applications. Acting as a centralized database of stan - dardized terminologies, it encompasses international and local terminology standards for diseases, pharmaceuticals, and health measurements. To be consistent with the latest advancements in terminology standards, it should be regularly updated, incorporating the changes with the addition or deletion of any code. These are the three recommended registries that countries can begin with. Other regis - tries such as product registries can be considered for cross border drug prescription use cases, but this is not a pre-requisite for exchange of health information across borders. Some countries also create what is called a ‘shared health record registry’. However, shared health records are dynamic in nature, and a ‘shared health record repository’ would be more appropriate. Recommendations • Countries will need to set up three registries- 1. National healthcare professional registry: to centralize identities and details of healthcare professionals 2. National facilities registry: to centralize identities and details of facilities 3. National terminologies registry: to centralize all terminologies used in the country • The relationship between healthcare professional and facility registries can be estab - lished where each healthcare professional may work at zero to “n” facilities. • Countries should establish a National Health Information System, also


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details of facilities 3. National terminologies registry: to centralize all terminologies used in the country • The relationship between healthcare professional and facility registries can be estab - lished where each healthcare professional may work at zero to “n” facilities. • Countries should establish a National Health Information System, also called ‘Access and Identity Management’ systems, which will have- 45 Approach for facilitating seamless health and care delivery across the African continent1. User directory, where healthcare professional from the healthcare professional registry will be the ‘users’ 2. Portal Log in credentials, which will be provided to these users • Authorization for users to access the continent level health information exchange portal should be based on user directory of countries. • The National Health Information System should list, describe, and identify terminolo - gy standards for use within the country’s health system. • Countries should set up a National Data Gateway that will receive the terminologies standards from the National Health Information System and can have terminology mapping tables to map the country’s terminologies with other international termi - nologies. This terminology registry also stores all the clinical code standards (country specific code /local and international) that is used within the National Health Informa - tion System to enable verification and mapping between codes. It exposes endpoints that allow codes to be verified against the stored code systems. • A federated identity system architecture can be implemented at the continental-lev - el health information exchange platform at continental level. The federated identity system can implement SAML, as recommended in the African Union health informa - tion exchange guidelines and standards, or the latest protocols like OpenID Connect, which is OAuth based can be explored. OpenID Connect requires lightweight pro - cessing and is less complex compared to SAML and can facilitate exchange of health information exchange between countries. The recommendations have been illustrated in the form of a process flow in Figure 9. Please note, the process flow for registry is segregated in two process flows a) pre-req - uisites at national level for creation of registries and b) cross border data exchange and authentication. Smart Africa Alliance Digital Health Blueprint46 2024 *HIS: Health Information System Figure 9: Process flow illustrating steps to operationalize the three key registries Additional considerations • Data of healthcare professionals from government health institutions and private in- stitutions are required. • Healthcare professional enrolment is performed


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data exchange and authentication. Smart Africa Alliance Digital Health Blueprint46 2024 *HIS: Health Information System Figure 9: Process flow illustrating steps to operationalize the three key registries Additional considerations • Data of healthcare professionals from government health institutions and private in- stitutions are required. • Healthcare professional enrolment is performed by authorized healthcare facilities, or all healthcare professionals are enrolled centrally by the Ministry of Health. • Healthcare facility registry to cover both public and private facilities, clinics, laborato - ries, and pharmacy within the country. • The Kenya National Health Data Dictionary Governance Framework33 provides de - tailed information and structure for a terminology registry, serving as a foundation and the starting point for its creation.After successful enrollment, unique facility ID is issued to the health facility by National Facility registry system,National healthcare professional (HCP) registryNational facility registry Terminology registry Country sets up terminology registry that includes all the terminologies used in the country The National HIS lists, describes and identifies terminologies standards available for use within the health system in the country Authorized agency undertakes the necessary verifications of the professionalCountry sets up National healthcare professionals (HCP) registryCountry sets up National facility registry A healthcare professional request enrollment in the National HCP registryA representative from facility requests enrollment in the National facility registry by providing facility details and credentials The National Data Gateway receives the terminology standards from the National HIS and has the terminology mapping tables storing all the clinical code standardsAuthorized agency undertakes the necessary verifications of the facility After successful enrollment, unique login credentials are provided to the professional by National HIS user directory ; this enables the professional to log into National HIS portal321 4321 321 4 47 Approach for facilitating seamless health and care delivery across the African continent3.4 Semantic interoperability Electronic health data comprises terminologies and codes related to diseases, pharma - ceuticals, diagnostics, and other health indicators. These terminologies and codes, com - monly referred to as “semantics”, are not uniform within and across countries. Even if patient data is made available, different semantics pose a challenge for healthcare pro - fessionals to correctly understand disease conditions, patient history, past and ongoing treatment, and related information, critical for extending appropriate healthcare services to the patient. Therefore, a system is required to ensure a uniform understanding of dif - ferent semantics by healthcare professionals across countries. This is critical for contin -


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fessionals to correctly understand disease conditions, patient history, past and ongoing treatment, and related information, critical for extending appropriate healthcare services to the patient. Therefore, a system is required to ensure a uniform understanding of dif - ferent semantics by healthcare professionals across countries. This is critical for contin - ued care to be extended to patients. To enable semantic interoperability, components of digital health platforms and applica - tions at the national level, as well as continent-level health information exchange, are key within the technology platform. Countries that want to participate in the exchange of health information across borders will be taking services of a continent level health infor - mation exchange platform that will facilitate interoperability based on a unified semantic. The countries need not adopt this unified semantics for health information exchange within the country, instead they can choose to set up a national data gateway that can translate and transcode the local semantics into the unified semantic and vice versa (as detailed in sub-section 3.3: Key registries) for exchange of health information across borders. This national data gateway and the continent-level health information exchange platform will together enable semantic interoperability for exchange of health informa - tion across borders. Syntactical interoperability means that information is conveyed from country A to country B in compliance with a common data structure and format stan - dard. The data gateway will also manage syntactic interoperability, making sure that data complies with common data structure and format standards. Recommendations • At the continent level, a master catalogue of terminologies (list of international termi - nology standards), needs to be created.34 An alliance like Africa CDC can facilitate the process with countries to create the unified semantics at continent level as indicated in the AU health information exchange guidelines and standards.b • For each terminology (in the master catalogue), a master value set is defined. This master value set lists codes and values. • Countries will need to map their national terminologies and value sets to the master catalogue of terminologies and master value sets. (sub-section 3.3: Key registries cov- ers details setting up national terminology registries). b AU HIE guidelines and standards have suggested terminology standards for adoption such as SNOMED CT, ICD 11, LOINC, RX-Norm etc. which will facilitate harmonization of standards. Smart Africa Alliance Digital Health Blueprint48 2024 • The National Data Gateway of each country to have


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details setting up national terminology registries). b AU HIE guidelines and standards have suggested terminology standards for adoption such as SNOMED CT, ICD 11, LOINC, RX-Norm etc. which will facilitate harmonization of standards. Smart Africa Alliance Digital Health Blueprint48 2024 • The National Data Gateway of each country to have terminology mapping tables and facilitate verification and mapping between codes. Hence, the National Data Gateway should be able to undertake data translation and transcoding of country terminolo - gies into the unified semantics and vice versa. • The continental level health information exchange platform will facilitate communica - tion between the country systems.c The recommendations have been illustrated in the form of a process flow in Figure 10. The focus of the process flow is on semantic interoperability and remaining concepts re - lated to exchange of health information across borders will be elaborated subsequently. Process Flow c There are different international standards like HL7 CDA level 3 and level 1 and HL7 FHIR, which is commonly used for document exchange. International Patient Summary is the suggested for exchange of patient information while the patient data stays within the original country.Figure 10: Process flow illustrating translation and transcoding at country level for exchange of information across bordersPatient from country A travels to country B Healthcare professional of country B accesses the patient information in the national language terminologies.National Data Gateway of country B then translates and transcodes unified semantics to country B languageCountry B accesses patient data in the unified semantics language through the continent HIE platformThe continent level HIE platform facilitates communication with country A; the National Data Gateway of country A translates and transcodes the patient data into a unified semanticUsing credentials provided by country B National HIS, the healthcare professionals of country B requests for relevant patient data through continent level health information exchange platformPatient goes to a health facility and consults with available healthcare professional Country A Country B 1 2 3 4 5 6 7 49 Approach for facilitating seamless health and care delivery across the African continent3.5 Patient consent management and Data access 3.5.1 Patient Consent Management Patient consent is the process by which the patient is invited to permit or reject the re - quest of healthcare professional to access data captured in the patient’s EHR. Consent also includes ensuring the patient understands what data is collected, why it is collected, and their


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Patient Consent Management Patient consent is the process by which the patient is invited to permit or reject the re - quest of healthcare professional to access data captured in the patient’s EHR. Consent also includes ensuring the patient understands what data is collected, why it is collected, and their rights regarding accessing, changing or removing their data from the system. This process must take into account several factors such as- • National legal and regulatory framework pertaining to protection of personal data and the management of EHR (Box 2). • Data sharing circles: treating physicians, care teams, healthcare professionals con- sulted in the home country, healthcare professionals consulted abroad. Consent should strictly be based on the role and entity. • Bilateral agreements between countries regulating the sharing of health data and patient consent modalities. Recommendations • Given the diversity of countries that will participate in cross-border exchange of health information, a consent management system at the national level is a pre-requisite and should be implemented by countries in alignment with respective national legal and regulatory requirements. • A national e-consent system (which can later be connected with the continent level health information exchange platform via an API) should be maintained by the coun - try. Countries to consider application of home country consent rules regardless of where on the continent the patient receives health services. • Countries to consider introducing security functions and operating mechanism to the consent management process. This can be done by various e-consent transaction methods such as: o Interactive SMS message wherein patient can send a message back indicating preference such as 1 to give consent or 2 for denying o Set up patient portal and use a two-factor authentication (example, one time pass - word received by patients on the phone to be entered on the portal) Smart Africa Alliance Digital Health Blueprint50 2024o Adopt a default operating mechanism; by virtue of providing his/ her patient ID and related details, the patient is consenting the healthcare professional to access his/ her data. • Countries should also consider a mechanism in a situation where a patient is not in a position to provide consent. For example, a healthcare professional may bypass patient consent in a medical emergency situation, such as when the patient is un - conscious or unable to give consent due to their health situation at that point in time. Common minimum data


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patient is not in a position to provide consent. For example, a healthcare professional may bypass patient consent in a medical emergency situation, such as when the patient is un - conscious or unable to give consent due to their health situation at that point in time. Common minimum data sets and data types can be defined that are appropriate in the scenario of care delivery (E.g., preventive, monitoring, triage, etc., apart from emergency). This can include different levels of detail of the same information. Box 2: Legal framework for personal health data protection While enabling the seamless flow of patient-related data, it becomes imperative to secure the data to avoid mishandling of private and sensitive health information. A balance between data sharing and data protection can be facilitated through legal frameworks that allow data sharing to take place within and between countries to ensure citizens’ rights are safeguarded. Recommendations • Participating countries need to enact and implement national legal frameworks governing data protection with adequate provisions for exchange of personal health data compliant with national, regional, and international commitments (AU Convention on cybersecurity and personal data protection – for Member States who have ratified it) and aligned with best practices (such as European Union’s General Data Protection Regulation 35, Health Insurance Portability and Accountability Act of 199636). • Guiding principles should include principles of legitimacy (of collection and pro- cessing of personal data), specificity, proportionality (of the data collection/use and their explicit purpose), adequacy, relevance, confidentiality, and clear, legit - imacy authority of users/collectors of personal data (ref: AU health information exchange guidelines and standards). • Legal framework should provide for the principle of informed consent of the data subject. As good practice, sensitive personal data should be subject, in col - lection, processing, storage and handling, to the strictest standard of care, and particularly to the explicit written informed consent of the data owner (while accounting for exceptions provided for in legal frameworks). Data owners/pa - 51 Approach for facilitating seamless health and care delivery across the African continent tients need to have the right to revoke their consent, in addition to the right to consult, correct and object to the data collected. • There needs to be provision for medically sound compartmentalization of health data which should allow the healthcare professional to access only what is necessary for the purpose that prompted that access. • Choice of


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consent, in addition to the right to consult, correct and object to the data collected. • There needs to be provision for medically sound compartmentalization of health data which should allow the healthcare professional to access only what is necessary for the purpose that prompted that access. • Choice of technical standards for data collection, storage and usage need to ensure the privacy of patients, the sovereignty over data centres and other infrastructure (ref: AU Interoperability Framework for Digital ID). The legal framework should allow im - plementation of adequate technical mechanisms such as anonymization (for research and statistics), technical auditing of Information Systems, trust mechanisms, etc. • Participating countries should have independent personal data protection authorities empowered to apply the data protection framework and act as a privacy regulator, if not present already. • Efforts to harmonize legislations and improve legal interoperability are crucial to en- able countries with different legal frameworks, policies, and strategies to overcome barriers to interoperability and health information exchange (ref: AU Digital ID, AU health information exchange guidelines and standards, EU Common Guidelines for eHealth Harmonization and Interoperability). Considerations • African governments should endorse the model law on global health data governance (containing core elements and reference legal text), as part of a global framework through a World Health Assembly resolution and regionally as part of an African Com - mon Position or model law through the AU (under development through the Africa CDC flagship initiative on Health Data Governance, with Transform Health and HELI - NA) • Rwanda’s Law 58/2021 relating to the protection of personal data and privacy (Arti- cles 6 and the following) provides a suitable example of the principle of consent. • Lawful informed consent provided by patient does not necessarily entail access to patient’s data by the medical professional, if that professional is not duly authorized to have that access - by way of their role, rank, involvement in the patient’s medical journey, affiliation to a medical facility, academic and professional qualifications and standing - as stated in the section above. There may be needs for special provisions when access may be granted without patient consent. This includes scenarios such as an emergency where the patient is not able to provide consent, criminal cases. These special provisions should be uniformly agreed upon and can be facilitated by a conti - nental body. Smart Africa Alliance Digital Health Blueprint52 20243.5.2


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access may be granted without patient consent. This includes scenarios such as an emergency where the patient is not able to provide consent, criminal cases. These special provisions should be uniformly agreed upon and can be facilitated by a conti - nental body. Smart Africa Alliance Digital Health Blueprint52 20243.5.2 Data Access Data access refers to the ability of authorized individuals or entities to view, retrieve or edit a patient’s health records. This access is typically granted to healthcare providers, clinicians, administrative staff, and other personnel involved in providing patient care or the management of healthcare operations. Data access needs to be governed by several principles and regulations to ensure patient privacy, confidentiality, and security. Sustain - ing rightful data access to patient health records that are shared across multiple systems is crucial so that patient safety, accountability and data quality can be maintained. Data exchange between government and entities is mandated under special clauses by law. This is considering that both private and public sector health care entities will participate in the network. An important aspect to data access is data traceability, which is the tracking and un - derstanding the origin, movement, and transformations of data throughout its usage. It involves maintaining a record of data lineage called an audit trail, documenting by whom, when and where the data was created, accessed, or edited. Recommendations • At the national level, a framework on access authorization defined for healthcare pro- fessionals needs to be formulated. The National HIS should follow this national frame - work on access authorization. Only individuals with a legitimate requirement will have access to patient health records and this will be defined for different healthcare pro - fessionals. The framework will also define what kind of patient data can be accessed by the authorized individuals. Ideally, the International Patient Summary37 should be the bare minimum that should be accessed for treatment purposes. The International Patient Summary should cover a basic dataset of essential information required from a clinical point of view to provide healthcare services, without which a sound medical decision cannot be made. Countries can agree and define what encompasses the mandatory and optional data points. • An access management platform, fed by information from the healthcare profession - al and facilities registries and managed at the national level as per the above stated framework agreements, should be able to grant access as per


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can agree and define what encompasses the mandatory and optional data points. • An access management platform, fed by information from the healthcare profession - al and facilities registries and managed at the national level as per the above stated framework agreements, should be able to grant access as per the access matrix. This can be controlled through mechanisms, such as usernames and passwords to verify the identity of users (refer to section 3.3: Key registries ). • To check the validity of the request, the process should include a decryption opera - tion of the security credential, using the issuer’s public key. This has been outlined in detail in section 3.1: Patient identity (ID) document . 53 Approach for facilitating seamless health and care delivery across the African continent • Any access to a patient summary would first require the patient’s consent, specific to the country’s regulations and systems as explained in section 3.5.1: Patient Consent Management . • The audit trail can be hosted, maintained, and monitored by the access management platform at the national level. The platform should be able to monitor the audit trail and flag if any breach has occurred. During cross-border exchange, the access man - agement platform, should continue to record the audit trail even outside the home country allowing the maintenance of the trail. The recommendations have been illustrated in the form of a process flow in Figure 11. Figure 11: Process flow illustrating patient consent via SMS (one of many options available with countries) and subsequent access to data across bordersOn receiving consent country A National Data Gateway translates and transcodes the relevant data into unified semantic and communicates via continent HIECountry A Country B Patient is from country A and is travelling to country B Patient visits a pharmacy to get medicines. The pharmacist uses credentials to log into the country B national HIS portal. Since the patient is from another country, the national HIS portal directs the pharmacist to continent HIE portal where patient ID and other details are entered. Via the API on continent HIE platform, the national e-consent system hosted and maintained by country A is notified.Patient receives an SMS asking to respond with 1 if data access is acceptable or 2 if access is to be deniedThe patient responds with 1 allowing the data accesses as per country A access authorization.Country B National Data Gateway translates


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e-consent system hosted and maintained by country A is notified.Patient receives an SMS asking to respond with 1 if data access is acceptable or 2 if access is to be deniedThe patient responds with 1 allowing the data accesses as per country A access authorization.Country B National Data Gateway translates and transcodes the unified semantics to country B languageThe pharmacist receives the patient data that is required for dispensing prescribed medicine 1 2 3 4 5 6789 Smart Africa Alliance Digital Health Blueprint54 20243.6 Data Integration Data integration refers to consolidation of patient data from various Point of Care system applications and data sources at the national level such that patient data is comprehen - sive. The healthcare landscape faces several challenges in achieving data integration. Typically, patient related data is scattered across different stakeholders and systems, impeding the creation of comprehensive patient health profiles. Additionally, disparate data types originating from various sources and applications further complicate the in - tegration process, necessitating harmonization to bridge existing gaps and foster in - tegration. These sources and applications encompass health management information system, EHRs, laboratory information system, small-medium private facilities, such as pharmacies, clinics, hospitals, labs and national public health programs like national pro - grams on Integrated Disease Surveillance and Response, the National AIDS/STI Control program, and Expanded Program on Immunization etc. To address the challenge of data integration, it is necessary for countries to institute a Health Information Mediator that is capable of unifying disparate systems through APIs. With integrations of data from different sources, unified patient data (in the form of electronic patient records) will be placed in the health information exchange platform at the national level. Recommendations • Countries to strive for a National Health Information Exchange platform to interface with each Point of Care system applications and data sources (e.g., Integrated Dis - ease Surveillance & Response, National AIDS/STI program, Expanded Program on Immunization etc.). This is critical for the National Health Information Exchange plat - form to be able to consolidate and centralize patient data into national health data repository, which can also transform anonymized patient level data. • Countries to create a health information mediator to coordinate all the interactions and exchange of information among various sources and applications within the na - tional health information system. It should facilitate ingestion, and routing of data amongst various sources and recipients through APIs. Additionally, adaptors


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patient level data. • Countries to create a health information mediator to coordinate all the interactions and exchange of information among various sources and applications within the na - tional health information system. It should facilitate ingestion, and routing of data amongst various sources and recipients through APIs. Additionally, adaptors can be used to transform various data formats and data structures into the prescribed stan - dards and should integrate with existing translators (e.g., HL7). • To enable health information exchange, central infrastructure services like National healthcare professional registry, facility registry, and terminology registries be acces - sible at Point of Care systems. This will allow to uniquely identify the patient, health - care provider and facility for information exchange. • Countries to engage private service providers to participate in data integration pro- cesses. • Countries can consider sandbox initiatives that allow testing any software, facilitating the exchange of health information, in compliance with the country’s digital health 55 Approach for facilitating seamless health and care delivery across the African continent protocols and guidelines. After successfully completing the test, the software can be connected to the national health information system. The sandbox initiative of Africa CDC can be explored by countries. The recommendations have been illustrated in the form of a process flow in Figure 12. Figure 12: Process flow illustrating integration of data from different sources in a country Additional Considerations • Rwanda Health Information Exchange (RHIE) offers a central architecture of key na- tional service components, such as a health information mediator, shared health re - cord and an interoperability layer. The RHIE is the central system where all the other health sector systems connect, serving as a foundation and starting point for its cre - ation. • The India-National Digital Health Mission-Sandbox framework offers a framework that allows technologies or products to be tested in the contained environment in compliance with National Digital Health Mission standards. It supports organizations intending to be a part of the national digital health ecosystem to become a Health Information Provider, serving as a starting point for data integration.1 2 4Data IntegrationCountry has set up health mediation component connected with different data sources through APIs Health programs (such as National AIDS/STI program, Expanded Program on Immunization) are integrated into the health information mediation component, which serves as a central hub for data exchange within the country Point of care systems and applications


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has set up health mediation component connected with different data sources through APIs Health programs (such as National AIDS/STI program, Expanded Program on Immunization) are integrated into the health information mediation component, which serves as a central hub for data exchange within the country Point of care systems and applications (Health Management Information system/Laboratory Management Information System) at hospitals, labs, pharmacies etc. generates patient data Roll out sandbox initiatives to test system integration of private services providers in a controlled environmentOn successful testing in controlled environment, integrate the private service providers’ point of care applications 3 Roadmap to a Single Digital Health MarketSection 4.0 57 Approach for facilitating seamless health and care delivery across the African continent THE PREVIOUS sections of the blueprint cover key concepts on Single Digital Health Market and interoperable solutions for the exchange of health information. The ‘Road - map’ aims to lay out phase-wise actions - primarily based on country-level priorities – re - quired for realising the vision of a Single Digital Health Market. The implementation steps will be covered in a subsequent toolkit. Section 4 elaborates on the key actions – at the national and continental levels - that need to be taken for each component of the blueprint framework (introduced in Sec - tion 2). To operationalize the recommendations for interoperable solutions covered in Section 3, this section covers the services that a continental level platform will have to make available for the exchange of health information across borders. Finally, phase-wise actions are proposed based on a country’s choice of health information exchange func - tionalities that it would like to offer to healthcare seekers. Figure 13. Actions for operationalizing the blueprint framework components and recommendations for interoperable solutions 4.1 Key actions for framework operationalization Concerted efforts by different healthcare stakeholders are needed for the operation - alization of the framework components. At the national level, governments are the key stakeholders as they have the required mandate and authority to roll out the recom - mended actions. Other digital health stakeholders such as development partners, alli - ances and networks including regional economic communities, funders, technology and data players, research and academia, and civil society organizations need to work closely with governments to be able to contribute to the operationalization of the framework at both the national level and the continent level.• Services to be enabled by continental level platform for the


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economic communities, funders, technology and data players, research and academia, and civil society organizations need to work closely with governments to be able to contribute to the operationalization of the framework at both the national level and the continent level.• Services to be enabled by continental level platform for the exchange of health information • Mapping of country recommendations with health information exchange functionalities and suggested phasing of action Key concepts explained in previous sections Section 2 covers framework components and how these contribute to the vision of the single digital health marketActions (to operationalize concepts) covered in section 4 Key actions for each of the framework components at national and continental level Deeper dive into technology platform With a deep dive into the technology platform of the framework, Section 3 covers the key interoperable solutions and makes recommendations for exchange of health information Smart Africa Alliance Digital Health Blueprint58 2024Table 2: Actions led by governments for operationalization of framework components at national level Framework componentsActions led by governments Governance & leadership • Set up a governance structure and mandate an existing body or a new entity to provide leadership and oversight over digital health. • Establish dedicated body led by a Chief Digital Health Officer. • Prepare a costed operational plan for implementing digital health strategy. Infrastructure for digital health• Ensure access to power and network connectivity for all health facilities, and availability of devices to support healthcare services. • Build cloud-enabled government data centers and security gateways. Policy & regulation• Formulate national digital health strategy with cross-border vision integrated. • Incorporate health data sensitivities in laws and regulations concerning data protection. Standards • Establish and adopt national interoperability framework for health systems. Workforce • Promote digital health leadership. • Design skills enhancement strategy and implementation plan. Innovation & entrepreneurship• Support local startups and entrepreneurs to deliver impactful innovations • Set up innovation centers and create funding opportunities. Technology platform • Define and implement a unique patient identification system • Setup the three key registries: healthcare professionals, health facilities, and terminologies. • Implement patient consent management system • Set up a Health information mediator. Financing model • Expand budget allocations for health, including for digital health • Raise sustainable investments and financing solutions. 59 Approach for facilitating seamless health and care delivery across the African continentTable 3: Actions led by digital health stakeholders for operationalization of framework components at


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up a Health information mediator. Financing model • Expand budget allocations for health, including for digital health • Raise sustainable investments and financing solutions. 59 Approach for facilitating seamless health and care delivery across the African continentTable 3: Actions led by digital health stakeholders for operationalization of framework components at national and continental level Framework componentsActions led by digital health stakeholders Governance & leadership • Facilitate creation of trust frameworks. • Provide forums for state consensus on joint action and review, and accountability (such as the Africa Digital Health Leadership Network) • Mobilize technical assistance for participating countries. Infrastructure for digital health• Continue to drive the Africa’s cross-cutting digital transformation strategy in power, network connectivity, and overall technology infrastructure. Policy & regulation • Provide technical assistance on key elements to be included in national legislation and regulation. • Facilitate harmonization of regulatory environment. Standards • Provide technical assistance on functional and technical specification that can be included in tender documents for digital health projects. Workforce • Set up capacity building forums such as Africa Digital Health Leadership Forum. • Facilitate and encourage coordination and cross-sectoral collaboration among diverse stakeholders. Innovation & entrepreneurship• Advocate for potential avenues for innovations. • Set up platforms and design incentives for encouraging innovative ideas and digital health entrepreneurs. Technology platform • Facilitate the development of national health data interoperability frameworks. • Encourage an open organization and an “Open Source” model to foster optimal collaboration with countries’ digital health teams. Financing model • Create a harmonized environment for participating countries to raise investment and financing. Smart Africa Alliance Digital Health Blueprint60 20244.2 Actions for exchange of health information There are continent level services to be enabled and certain basic conditions to be ful - filled by countries to initiate the exchange of health information - i. Services to be enabled by continent level platform: At the continent level, the health information exchange platform needs to build infrastructure, standards, and work - force to facilitate the following- - Connect users for cross-border functions through portal to the continental-level health information exchange - Authentication of healthcare professional - Authentication of healthcare facilities - Verification of patient identity - Interoperability of semantics - Management of patient consent - Management of data viewing requests - Management of requests for updating Electronic Health Records (EHRs) and Shared Health Records - Other value-added services may include digital wallets, secure health messaging, tele-consultation,


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Authentication of healthcare facilities - Verification of patient identity - Interoperability of semantics - Management of patient consent - Management of data viewing requests - Management of requests for updating Electronic Health Records (EHRs) and Shared Health Records - Other value-added services may include digital wallets, secure health messaging, tele-consultation, electronic payments, etc. ii. Requirement for countries to fulfil: Irrespective of the services a country wants to avail from the continent level platform, it needs to achieve the following- - The country has a governance structure for digital health initiatives and has man - dated a body (existing or a new entity created) to provide leadership and over - sight for transformation of digital public infrastructure. There is a vision and a plan for capacitation and funding of this body to serve as custodian of the transforma - tion over a 5-10 year horizon. - The national digital health strategy recognises the need for continental interop - erability and this includes a strategic objective. For successful implementation of these strategies, a health information exchange maturity assessment – currently under development by Africa CDC and its partners – will enable countries or re - gions to have common criteria to assess current levels of interoperability, identify areas of strengthening, and plan efficient use of resources and improved capabili - ties for health information exchange.38 61 Approach for facilitating seamless health and care delivery across the African continent- The relevant government department has developed a costed operational plan for the digital health strategy implementation. - The relevant government department has initiated efforts to adapt legal and reg - ulatory framework for digital health. - The country has a digital health interoperability framework or is under develop - ment. - The country is undertaking digital health leadership and skilling initiatives for workforce development . With (i) and (ii) achieved, a country has a menu of choices in terms of health information exchange functionalities that it can avail (Table 4). There are a total of eleven functional - ities listed and can be further extended by the continent level platform: 1. Portal hosting 2. Healthcare professional authentication 3. Facility authentication 4. Teleconsultation 5. Electronic payment interface management 6. Health messaging (amongst healthcare professionals) 7. Semantic interoperability operationalization 8. Patient authentication 9. Electronic Health Record updating 10. Shared health records maintenance 11. End-to-end teleconsultation services These functionalities can be understood in terms of practical applications


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Healthcare professional authentication 3. Facility authentication 4. Teleconsultation 5. Electronic payment interface management 6. Health messaging (amongst healthcare professionals) 7. Semantic interoperability operationalization 8. Patient authentication 9. Electronic Health Record updating 10. Shared health records maintenance 11. End-to-end teleconsultation services These functionalities can be understood in terms of practical applications and use cases as detailed in Table 4. The use cases are illustrative and have been built around mpox outbreak. These can be extended to different disease areas and health services. For a country to avail a functionality, it will have to implement the corresponding recom - mendations (refer to the row headers of Table 5) which have been explained in detail in section 3 of the blueprint. For instance, if a country decides to provide the functionality of teleconsultations to its people, then it will have to set up national healthcare profes - sional registry and authorize users to access national/ continent level health information exchange as a bare minimum. Smart Africa Alliance Digital Health Blueprint62 2024Functionalities Practical application (illustrative and not exhaustive)Use cases (illustrative and not exhaustive) A Portal hostingPatient is able log into the continent level portal and avail services such as digital wallet that allows patient to save vaccination certifications, test results, health declarations etc. for easy referenceGloria (resident of Rwanda) has uploaded her mpox vaccination certificate on the continental platform in case this is required to be shown at the border control during her travel to Kenya. She can use her credentials to access the digital copy of her mpox vaccination anytime and anywhere. B Healthcare professional authenticationPatient can check the list of registered healthcare professionals to plan a consultationMusa is developing lesions and he wants to consult a doctor. He prefers to consult a reliable doctor so decides to check the continental platform for licensed general practioners. C Facility authenticationPatient can check the list of registered facilities to plan a visitHe realises that there are few clinics close to his resident so he checks if any of these are licensed. D TeleconsultationPatients can consult doctors virtually through the continent platformFinally Musa goes ahead with teleconsultation with Dr. Kofi (one of the general practioners at a private clinic). 63 Approach for facilitating seamless health and care delivery across the African continentFunctionalities Practical application (illustrative and not exhaustive)Use cases (illustrative and not exhaustive) E Electronic payment interface managementPatient can make electronic payments for any services availedHe


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teleconsultation with Dr. Kofi (one of the general practioners at a private clinic). 63 Approach for facilitating seamless health and care delivery across the African continentFunctionalities Practical application (illustrative and not exhaustive)Use cases (illustrative and not exhaustive) E Electronic payment interface managementPatient can make electronic payments for any services availedHe makes payment for the consultation through the payment gateway in the continental platform. Musa also purchases the prescribed medicines through the platform and waits for the home delivery. F Health messaging (amongst healthcare professionals)Healthcare professionals can exchange professional opinion on different medical casesA follow up consultation is scheduled and Dr. Kofi wants to get professional opinion on Musa’s case from other doctors during this time. He uses the health messaging feature of the continental platform for secure sharing of Musa’s case (notes). G Semantic interoperability operationalizationHealthcare professionals can comprehend the electronic health record located in another country for extending health servicesThe other doctors are able to view Musa’s case and initial diagnosis (in semantics that can be comprehended and syntax that is meaningful to them) and share their opinion on possible mpox diagnosis. H Patient authenticationHealthcare professionals can validate the patient identity before accessing patient’s recordsDuring the follow up consultation after 2 days, Dr. Kofi asks for Musa’s basic details (name, DoB etc.) to pull up Musa’s diagnosis and other details. Smart Africa Alliance Digital Health Blueprint64 2024Table 4: Practical applications and use cases for the functionalities that can be provided by the continent level platform Functionalities Practical application (illustrative and not exhaustive)Use cases (illustrative and not exhaustive) I Electronic Health Record updatingAt facility level, patient’s medical record is updated with any medical episode, treatment, or interaction with HCPDr. Kofi updates Musa’s health record with details of the follow up consultation. J Shared health records maintainencePatient’s medical record is updated with all medical episode, treatment, or interaction with HCP across facilitiesNext day, Musa once again consults Dr. Kofi as he has developed lesions on other parts of his body and is experiencing fever. Musa is referred to Dr. Ola at Government University hospital. Dr. Ola is able to go through Musa’s health records. K End-to-end teleconsultation servicesHealthcare professionals can provide health services to patient based on available electronic health records and update the sameThe consultation with Dr. Ola is through video conferencing. Dr. Ola updates Musa’s records and arranges for infectious disease ambulance to tranport Musa to the designated infectious


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Musa’s health records. K End-to-end teleconsultation servicesHealthcare professionals can provide health services to patient based on available electronic health records and update the sameThe consultation with Dr. Ola is through video conferencing. Dr. Ola updates Musa’s records and arranges for infectious disease ambulance to tranport Musa to the designated infectious disease ward in the hospital for isolaton and treatment. 65 Approach for facilitating seamless health and care delivery across the African continentFunctionalities --> A- Portal hostingB- Health - care pro - fessional authenti - cationC- Facility authenti - cationD- Tele - consulta - tionE- Elec - tronic payment interface manage - mentF- Health mes- saging (amongst healthcare profes - sionals)G- Se - mantic interop - erability opera - tionaliza - tionH- Patient authenti - cationI- Elec - tronic Health Record updatingJ- Shared health records main - tainenceK- End- to-end telecon - sultation services Recommendations to be implemented by countries to avail the corresponding functionalities ↓ 1 Patient ID and authentica - tion systems established√ √ √ √ 2 Entities set up for patient ID creation, reg - ulation, and encryption and electronic signatures√ √ √ √ 3 Demographic and other relevant in - formation of the patient to be captured decided√ √ √ √ 4 Data encryp - tion + decryp - tion operation of the security credential established√ √ √ √ √ 5 Mechanism set up for patient provided information to be checked with PIN in master index√ √ √ √ 6 National healthcare professional (HCP) registry set up√ √ √ √ √ √ √ √ √ 7 National facil - ities registry set up√ √ √ √ 8 National terminologies registry set up√ √ √ √ Smart Africa Alliance Digital Health Blueprint66 2024Functionalities --> A- Portal hostingB- Health - care pro - fessional authenti - cationC- Facility authenti - cationD- Tele - consulta - tionE- Elec - tronic payment interface manage - mentF- Health mes- saging (amongst healthcare profes - sionals)G- Se - mantic interop - erability opera - tionaliza - tionH- Patient authenti - cationI- Elec - tronic Health Record updatingJ- Shared health records main - tainenceK- End- to-end telecon - sultation services Recommendations to be implemented by countries to avail the corresponding functionalities ↓ 9 Nation - al Health Information System (HIS) established√ √ √ √ 10 HIS (national/ continent platform) user authoritization done√ √ √ √ √ √ √ √ 11 Established National Data Gateway


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End- to-end telecon - sultation services Recommendations to be implemented by countries to avail the corresponding functionalities ↓ 9 Nation - al Health Information System (HIS) established√ √ √ √ 10 HIS (national/ continent platform) user authoritization done√ √ √ √ √ √ √ √ 11 Established National Data Gateway + ter - minologies <> master value set + capable to map to other master value√ √ √ √ 12 Map national terminologies and value sets to continent terminologies and master value sets.√ √ √ √ 13 National Data Gateway set up to translate and transcode from national to continent language and vis versa√ √ √ √ 14 Consent management system set up√ √ √ Smart Africa Alliance Digital Health Blueprint67 2024Table 5: Continent level health information exchange functionalities and corresponding recommendations to be implemented by a country to avail the functionalitiesFunctionalities --> A- Portal hostingB- Health - care pro - fessional authenti - cationC- Facility authenti - cationD- Tele - consulta - tionE- Elec - tronic payment interface manage - mentF- Health mes- saging (amongst healthcare profes - sionals)G- Se - mantic interop - erability opera - tionaliza - tionH- Patient authenti - cationI- Elec - tronic Health Record updatingJ- Shared health records main - tainenceK- End- to-end telecon - sultation services Recommendations to be implemented by countries to avail the corresponding functionalities ↓ 15 Defined national framework on access autho - rization √ √ √ 16 National HIE platform interfaces with Point of Care system applications√ √ √ √ 17 National HIE platform interfaces with all health data sources √ √ √ 18 Health mediation component is capable of unifying systems/ data sources through APIs√ √ 19 Engaged private service providers in data integra - tion + sandbox initiative√ √ 68 Approach for facilitating seamless health and care delivery across the African continent 4.3 Suggested phasing of actions Phasing of actions is suggested for countries in the implementation of the recommen - dations for availing specific health information exchange functionalities. The phasing is based on the ease of implementation of the recommendations. Figure 14: Depiction of readiness phases and corresponding health information exchange functionalities availableRecommendations implemented by country- National register of healthcare professionals set up and/or - National register of facilities set up- Users for national/ continent level platform authorized - Recommendations from readiness level 1 implemented- All recommendations implemented for key registries, semantic interoperability, and patient ID


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and corresponding health information exchange functionalities availableRecommendations implemented by country- National register of healthcare professionals set up and/or - National register of facilities set up- Users for national/ continent level platform authorized - Recommendations from readiness level 1 implemented- All recommendations implemented for key registries, semantic interoperability, and patient ID (only for patient authentication) - National HIE interface with point of care applications (only for semantic interoperability) - Recommendations from readiness level 2 implemented- All recommendations implementedFunctionalities ImplementedServices at continental levelMobilization for next phasePrivate points of care in the process of integration- Majority of points of care have digital health application - Electronic health records piloted- Identified the select points of case with digital health applications + others encouraged - Unique patient ID pilotedRegistered Healthcare professionals (HCPs) encouraged to sign up as users of national/ continent level platform Implementation of shared health records and end-to- end teleconsultation services Electronic Health Record updating shared health records maintenance, and end- to-end teleconsultation servicesInvocation of semantic interoperability, and patient record updating Semantic interoperability operationalization, and patient authenticationOrchestration of patient service authentication, interface for managing electronic payments cross-border secure health messaging, and teleconsultations Teleconsultations, electronic payment interface management, and health messaging (amongst healthcare professionals)Portal hosting and digital wallets, healthcare professional authentication, and facility authentication1 Readiness phase 2 Readiness phase 3 Readiness phase 4 Readiness phase API Management hosting of portal, and orchestration of HCP and facilities authentication 69 Approach for facilitating seamless health and care delivery across the African continentReadiness phase 1: In this phase, the country would be able to extend services (illustrative and not exhaus - tive) such as that- - Patient is able to log into the continent level portal to use features like a digital wallet that allows patient to save vaccination certifications for easy reference. - Patient can check the list of registered healthcare professionals to plan a consultation. - Patient can check the list of registered facilities to plan a visit. To prepare for the next phase, country level mobilization would be required in terms of encouraging registered healthcare professionals to sign up as users of national (if this is already there) or continental level health information exchange platform. Readiness phase 2: In this phase, the country would be able to extend services (illustrative and not exhaus - tive) such as that- - Patients can consult doctors virtually through the continent platform. - Patient can make electronic payments


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this is already there) or continental level health information exchange platform. Readiness phase 2: In this phase, the country would be able to extend services (illustrative and not exhaus - tive) such as that- - Patients can consult doctors virtually through the continent platform. - Patient can make electronic payments for any services availed. - Healthcare professionals can exchange professional opinion on different medical cas - es. To prepare for the next phase, country level mobilization would be required in terms of identifying points of care with digital health application and preparing them for function - alities that will be enabled in subsequent phases. Also, the country would need to initiate pilot on issuing unique patient ID. Readiness phase 3: In this phase, the country would be able to extend services (illustrative and not exhaus - tive) such as that- - Healthcare professionals can comprehend the electronic health record located in an - other country while extending health services. - Healthcare professionals can validate the patient’s identity before accessing the pa - tient’s records. To prepare for the next phase, country level mobilization would be required in terms of ensuring majority points of care have digital health application and piloting of electronic health records is initiated. Smart Africa Alliance Digital Health Blueprint70 2024Readiness phase 4: In this phase, the country would be able to extend services (illustrative and not exhaus - tive) such as that- - At a facility level, patient’s medical record is updated with any medical episode, treat - ment, or interaction with healthcare professional. - Subsequently, patient’s medical record is updated with all medical episodes, treat - ments, or interactions with healthcare professionals across facilities. - Healthcare professionals can provide health services to patients based on available electronic health records and update the same. The country should continue to include private points of care in data integration for ro - bust shared health records. ConclusionSection 5.0 Smart Africa Alliance Digital Health Blueprint72 2024THE DIGITAL health blueprint framework is a step forward in realizing the vision of a Single Digital Health Market for Africa. Alongside developing the core technology ele - ments needed for the seamless exchange of health information across borders, countries should concurrently strengthen the foundational layers of governance and leadership, infrastructure for digital health, policy and regulations, standards, and workforce as well as innovation and entrepreneurship and financing models. Rwanda’s successful implementation of an interoperable


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technology ele - ments needed for the seamless exchange of health information across borders, countries should concurrently strengthen the foundational layers of governance and leadership, infrastructure for digital health, policy and regulations, standards, and workforce as well as innovation and entrepreneurship and financing models. Rwanda’s successful implementation of an interoperable national digital health architec - ture provides a reference for other countries embarking on their digital health journey. The African Union health information exchange guidelines and standards, developed by Africa CDC, serve as the foundation for interoperability frameworks to enable effective and sustainable harmonization of digital health platforms at national and continental-lev - els. From an ICT lens, the development of a Single Digital Health Market for Africa will re - quire the development of national-level as well as continent-level infrastructure. Partic - ularly, for cross-border exchange of health information, there are prerequisites at the national-level that need to be fulfilled to implement interoperable solutions. At the na - tional-level, a robust national health information system and interoperability framework are required to support the implementation of interoperable solutions, which include the implementation of a unique patient identifier, registries of healthcare professionals (in - cluding identity and access management), facilities, and terminologies, patient consent management system, access to shared electronic health records, national data gateway to facilitate semantic interoperability between countries, and integration of data across various systems. Countries may adopt different approaches based on their priorities, financial and human resources, and existing level of digital maturity. Smart Africa envisions the blueprint document to guide the Digital Health Flagship Proj - ect to move from concept to implementation under the SATA umbrella. While the role of digital health stakeholders in creating an enabling environment for countries to access necessary resources and collaborate with other institutions and/or countries will be in - tegral to achieving the vision. Continental initiatives such as the African Digital Health Leadership Network will be critical for facilitating regional coordination and collabora - tion and steering initiatives. This blueprint will be followed by a toolkit that will provide guidance to governments and digital health stakeholders on the implementation of the blueprint recommendations. The toolkit will cover actions that need to be taken at the national and continental levels to implement interoperable solutions at different stages of readiness. These ICT-focused actions will mainly cover the infrastructure required, standards to be adopted, and de - vices to be deployed. 73


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of the blueprint recommendations. The toolkit will cover actions that need to be taken at the national and continental levels to implement interoperable solutions at different stages of readiness. These ICT-focused actions will mainly cover the infrastructure required, standards to be adopted, and de - vices to be deployed. 73 Approach for facilitating seamless health and care delivery across the African continentThe rapid advancement in technology will necessitate that the national and continental systems are able to swiftly adapt to the advances in artificial intelligence, blockchain technology, wearables, the Internet of Things, smart devices, telemedicine, and so on. While technology will contribute to enhancing interoperability of healthcare information, appropriately leveraging data for improving the delivery of health and care services for citizens will be critical. In the interim, the blueprint provides a reference framework for interoperability and health information exchange that countries could consider in developing their national digital health strategies and action plans, ultimately moving towards and reaping the benefits of a Single Digital Health Market envisaged at the continent-level. ReferencesSection 6.0 75 Approach for facilitating seamless health and care delivery across the African continent1. Health in Africa. Nature Communications , https:/ /doi.org/10.1038/s41467-024- 45268-1 (2024). 2. Trends in communicable and noncommunicable disease burden and control in Africa. WHO | Regional Office for Africa , https:/ /www.afro.who.int/publications/ trends-communicable-and-noncommunicable-disease-burden-and-control-africa (2024, accessed 12 June 2024). 3. WHO AFRO. Analytical Factsheet , https:/ /files.aho.afro.who.int/ afahobckpcontainer/production/files/iAHO_Maternal_Mortality_Regional_ Factsheet.pdf (2023, accessed 12 June 2024). 4. Global Nutrition Report | Country Nutrition Profiles - Global Nutrition Report, https:/ /globalnutritionreport.org/resources/nutrition-profiles/africa/ (accessed 12 June 2024). 5. Global Health Expenditure Database, https:/ /apps.who.int/nha/database/Home/ Index/en (accessed 12 June 2024). 6. e-Conomy Africa 2020 - Africa’s $180 Billion Internet Economy Future. IFC, https:/ /www.ifc.org/en/insights-reports/2020/google-e-conomy (accessed 17 July 2024). 7. Smart Africa. Who we are, https:/ /smartafrica.org/who-we-are/ (accessed 10 May 2024). 8. Smart Africa. Smart Africa- Blueprints, https:/ /smartafrica.org/blueprint/ (accessed 10 May 2024). 9. World Health Organization. Global Strategy for Digital Health 2020-25 , https:/ /iris.who.int/bitstream/handle/10665/344249/9789240020924-eng. pdf?sequence=1 (accessed 20 May 2024). 10. Centers for Disease Control and Prevention. CDC Global Digital Health Strategy , https:/ /www.cdc.gov/global-health/topics-programs/global-digital-health- strategy.html (2022). 11. World Health Organization, International Telecommunication. Digital Health Platform Handbook: Building a Digital Information Infrastructure (Infostructure) for Health . Geneva, https:/ /www.itu.int:443/en/publications/ITU-D/Pages/ publications.aspx (2020, accessed 10 May 2024). 12. Global Initiative on Digital Health, https:/ /www.who.int/publications/m/item/ global-initiative-on-digital-health (accessed 12 June 2024). Smart Africa Alliance Digital Health Blueprint76 202413. Leading the Future of Global Health with


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Telecommunication. Digital Health Platform Handbook: Building a Digital Information Infrastructure (Infostructure) for Health . Geneva, https:/ /www.itu.int:443/en/publications/ITU-D/Pages/ publications.aspx (2020, accessed 10 May 2024). 12. Global Initiative on Digital Health, https:/ /www.who.int/publications/m/item/ global-initiative-on-digital-health (accessed 12 June 2024). Smart Africa Alliance Digital Health Blueprint76 202413. Leading the Future of Global Health with Responsible Artificial Intelligence, https:/ /www.who.int/publications/m/item/leading-the-future-of-global-health- with-responsible-artificial-intelligence (accessed 12 June 2024). 14. World Bank. Implementation Know-how Briefs to Support Countries to Prioritize, Connect and Scale for a Digital-in-Health Future. Digital-in-Health Flagship Program . Washington DC: World Bank, https:/ /openknowledge.worldbank.org/ entities/publication/61d80913-083f-41e7-81e3-0eb79843056d (2023, accessed 10 May 2024). 15. Africa CDC. Africa CDC Digital Transformation Strategy to revolutionize and strengthen Public Health systems across the continent. Africa CDC , https:/ / africacdc.org/news-item/africa-cdc-digital-transformation-strategy-to- revolutionize-and-strengthen-public-health-systems-across-the-continent/ (accessed 10 May 2024). 16. Agenda 2063: The Africa We Want. | African Union, https:/ /au.int/en/ agenda2063/overview (accessed 20 May 2024). 17. Africa Union. AU INTEROPERABILITY FRAMEWORK FOR DIGITAL ID, https:/ / au.int/en/documents/20231211/au-interoperability-framework-digital-id (accessed 10 May 2024). 18. Africa Union, Africa CDC. African Union Health Information Exchange Guidelines and Standards. Africa CDC , https:/ /africacdc.org/download/african-union-health- information-exchange-guidelines-and-standards/ (accessed 10 May 2024). 19. Accelerating the Digital Transformation of Government Services. GovStack , https:/ /www.govstack.global/ (accessed 17 July 2024). 20. Smart Africa. The Digital Health Agenda for Smart Africa: A whitepaper (DRAFT) . 2023. 21. Republic of Kenya. THE DIGITAL HEALTH BILL, NATIONAL ASSEMBLY BILLS NO. 57 OF 2023, http:/ /www.parliament.go.ke/sites/default/files/2024-02/THE%20 DIGITAL%20HEALTH%20BILL%2C%20NATIONAL%20ASSEMBLY%20BILLS%20 NO.%2057%20OF%202023.pdf (2023, accessed 10 July 2024). 22. Transform Health. Model Law: Health Data Governance Principles, https:/ / healthdataprinciples.org/modellaw (2024, accessed 10 May 2024). 23. WHO AFRO, ITU, Ministry of Health, Lesotho. Regional Digital Health Capacity Building and Curriculum Development Workshop For Digital Health Leaders , https:/ /www.afro.who.int/sites/default/files/WHO%20%E2%80%93%20 77 Approach for facilitating seamless health and care delivery across the African continentITU%20Donors%20and%20Partners%20Digital%20Health%20Learning%20 Meeting/Lesotho_Executive%20Report_2018_Regional%20Digital%20 Health%20Capacity%20Building%20and%20Curriculum%20Development%20 Workshop%20For%20Digital%20Health%20Leaders_23042023%5B.pdf (2018, accessed 10 May 2024). 24. Asian Development Bank, Drury P, Roth S, et al. Guidance for Investing in Digital Health . Asian Development Bank. Epub ahead of print 1 April 2018. DOI: 10.22617/ WPS179150-2. 25. Woods L, Eden R, Canfell OJ, et al. Show me the money: how do we justify spending health care dollars on digital health? Med J Aust 2023; 218: 53–57. 26. Co-Develop. Digital Public Infrastructure for Health: Charting a path to implementation in LMIC health systems , https:/ /static1.squarespace. com/static/59bc3457ccc5c5890fe7cacd/t/6543fe9cf99cbe3 db4300082/1698954914677/Digital+Public+Infrastructure+for+Health_Final.pdf (2023, accessed 22 May 2024). 27. Global Digital Health Certification Network, https:/ /www.who.int/initiatives/ global-digital-health-certification-network (accessed 12 June 2024). 28. GovStack - Identity, https:/


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Med J Aust 2023; 218: 53–57. 26. Co-Develop. Digital Public Infrastructure for Health: Charting a path to implementation in LMIC health systems , https:/ /static1.squarespace. com/static/59bc3457ccc5c5890fe7cacd/t/6543fe9cf99cbe3 db4300082/1698954914677/Digital+Public+Infrastructure+for+Health_Final.pdf (2023, accessed 22 May 2024). 27. Global Digital Health Certification Network, https:/ /www.who.int/initiatives/ global-digital-health-certification-network (accessed 12 June 2024). 28. GovStack - Identity, https:/ /govstack.gitbook.io/bb-identity/2-description (2024, accessed 20 May 2024). 29. HL7 FHIR v5.0.0, https:/ /www.hl7.org/fhir/person.html (accessed 10 May 2024). 30. World Bank. The Role of Digital Identification for Healthcare . World Bank, Washington, DC. Epub ahead of print 2018. DOI: 10.1596/31826. 31. The Principles: Health Data Governance Principles, https:/ /healthdataprinciples. org/principles (accessed 20 May 2024). 32. Riplinger L, Piera-Jiménez J, Dooling JP. Patient Identification Techniques – Approaches, Implications, and Findings. Yearb Med Inform 2020; 29: 81–86. 33. Ministry of Health. DRAFT Kenya National Health Data Dictionary Governance Framework, https:/ /knhts.health.go.ke/resources (2023, accessed 17 June 2024). 34. Joint Action Supporting the eHealth Network. Common Semantic Strategy for Health in the European Union , https:/ /health.ec.europa.eu/document/ download/92ac8823-19c4-4641-bf4d-5d9bf021a600_en?filename=ev_20190611_ co242_en.pdf (accessed 10 May 2024). Smart Africa Alliance Digital Health Blueprint78 202435. European Union. General Data Protection Regulation (GDPR) – Legal Text, https:/ /gdpr-info.eu/ (accessed 10 May 2024). 36. U.S. Department of Health and Human Services. Health Information Privacy - HIPAA, https:/ /www.hhs.gov/hipaa/index.html (2021, accessed 21 May 2024). 37. The International Patient Summary – key health data, worldwide, https:/ / international-patient-summary.net/ (2024, accessed 27 June 2024). 38. Tamirat B, Mazuguni F, Bamutura M, et al. Africa CDC spearheading the strengthening of health information exchange in Africa. The Lancet Digital Health 2024; 6: e382–e384. 39. IremboGov, https:/ /irembo.gov.rw/home/citizen/all_services?lang=en (accessed 22 August 2024). 40. Irembo eGovernment Portal, https:/ /www.itu.int/net4/wsis/archive/stocktaking/ Project/Details?projectId=1487078544 (accessed 10 May 2024). 41. Government of Rwanda. Data Protection & Privacy Office - DPP Law, https:/ /dpo. gov.rw/dpp-law/ (2021, accessed 10 May 2024). 42. World Health Organization. Data-Driven Development: How Rwanda is Pioneering Health Information Systems for Improved SDG Monitoring | Knowledge Action Portal on NCDs, https:/ /knowledge-action-portal.com/en/ news_and_events/country-stories/7924 (2023, accessed 10 May 2024). 43. Adjovi S. The Benin recipe and challenges for electronic and biometric identification data capture , https:/ /www.id4africa.com/2019/almanac/ PRESIDENCY-OF-THE-REPUBLIC-OF-BENIN-Serge-Adjovi.pdf (accessed 10 May 2024). 79 Approach for facilitating seamless health and care delivery across the African continentI. Rwanda’s success in ICT and digital health transformation In the early 2000s, Rwanda positioned ICT at the centre of its Vision 2020 development strategy. This was a significant turning point for the country to recognize that ICT would be


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for facilitating seamless health and care delivery across the African continentI. Rwanda’s success in ICT and digital health transformation In the early 2000s, Rwanda positioned ICT at the centre of its Vision 2020 development strategy. This was a significant turning point for the country to recognize that ICT would be a key enabler for economic growth of the nation. This vision was translated into a se - ries of 5-year strategic plans which focused on liberalization of the telecommunications sector, setting up of legal, regulatory, and institutional mechanisms to attract private sector investments. Subsequently, large scale investments contributed connecting the country through the fibre optic cable network providing a robust backbone for the coun - try. This resulted in focus of the next plan to digitize public services including agriculture, education, healthcare, government, and financial services. Rwanda’s success as an ICT leader can be attributed to its national vision and dedicated leadership. Rwanda has emerged as champion country in digital health transformation. Given its stronghold in ICT, Rwanda prioritized digital technologies as key enablers for healthcare delivery towards driving improved health outcomes. Rwanda’s Digital Health Strategic plan (2018-2023) sets an overarching goal to improve health service delivery and ac - cessibility through Digital Health. The Ministry of Health’s strategic plan aligns with the Smart Rwanda Masterplan under the Ministry of ICT, exemplifying the spirit of collabora - tion across sectors ensuring accessible, quality, and efficient delivery of health services using technology towards achieving universal health coverage. Rwanda has created an enabling environment for private sector participation by the implementation of laws for public private partnerships, thus being able to implement digital health solutions at scale. For instance, Irembo39 is an eGovernment platform which enables the access and provision of government services in Rwanda, built within a pub - lic-private partnership framework. Irembo hosts over 200 e-services deriving from more than 20 different government agencies and aims to improve the citizen’s way of life by making government services easier, faster and less costly to access.40 In 2021, the protec - tion of personal data and privacy law (058/2021)41 was officially gazetted in the country. This law protects personal data and ensures privacy of individuals in Rwanda aligned Appendix 1 Country level good practices leveraged by the blueprint Smart Africa Alliance Digital Health Blueprint80 2024with international data protection standards. One of the important aspects of this law is the clear and unambiguous


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in the country. This law protects personal data and ensures privacy of individuals in Rwanda aligned Appendix 1 Country level good practices leveraged by the blueprint Smart Africa Alliance Digital Health Blueprint80 2024with international data protection standards. One of the important aspects of this law is the clear and unambiguous consent of an individual to the collection, storage, and pro - cessing of personal data, which is a fundamental right. This law is significant for personal health data and provides a good reference for countries to consider while framing their laws. Rwanda’s key initiatives in digital health include, but are not limited to: Digital health leadership and governance Rwanda prioritizes governance as a cornerstone of its digital health interventions. At the highest level, under the Ministry of ICT and Innovation and Rwanda Information Society Authority (RISA), the digital directorate led by a Chief Digital Officer, plays a pivotal role in strengthening infrastructure and facilitating seamless information exchange. Ministry of ICT and RISA together with the Ministry of Health and involvement of national health bodies, development partners and private sector work in collaboration to drive digital health initiatives. An equal representation from both ministries facilitates joint commit - ment, actions, and accountability. One of the strengths of Rwanda’s governance is the use of Performance Contracts between independent agencies and the overseeing gov - ernmental authority and codifying this model at the legislative level. This is the case for RISA in law 58/2021, but also with the National Cyber Security Authority established by the law 26/2017. This model provides the agency the autonomy it needs to accom - plish its mission while maintaining a clear system of accountability and allows for a bet - ter monitoring and evaluation process and potential course adjustment. This operating mode is recommended for autonomous/independent agencies and similar steering bod - ies, especially those in charge of implementing large-scale projects. One Citizen - One Record A flagship initiative of Rwanda’s digital health agenda, “One Citizen - One Record” rep - resents the nations’ commitment to comprehensive healthcare management. This ini - tiative aims to harmonize healthcare system by facilitating interoperability, establishing common shared infrastructure, shared health records and integrating electronic medi - cal records and Hospital Management Information System. By centralizing patient data and ensuring its accessibility at all layers, One Citizen One Record empowers citizen and healthcare provider alike, with longitudinal patient record, enhanced patient care,


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by facilitating interoperability, establishing common shared infrastructure, shared health records and integrating electronic medi - cal records and Hospital Management Information System. By centralizing patient data and ensuring its accessibility at all layers, One Citizen One Record empowers citizen and healthcare provider alike, with longitudinal patient record, enhanced patient care, streamlined processes and improved health outcomes. Digital Health Reference Architecture Rwanda was one of the first countries to implement a national health information ex - change under the Rwanda Health Enterprise Architecture project in 2012. In 2020, the country adopted a unified Government Enterprise Architecture to ensure seamless inte - gration and interoperability of different government services in its Smart Rwanda Master Plan, with Health as one of its pillars. Aligned with the Enterprise Architecture framework, 81 Approach for facilitating seamless health and care delivery across the African continentRwanda’s digital health architecture framework serves to connect and integrate multiple components within the health ecosystem. Moreover, the Ministry of Health, has put in place several information systems for measuring progress on Sustainable Development Goal targets.42 Further, the Ministry has instructed the use of international standards for interoperability. Recognizing the need of multiple systems, the government has provided both public and private health facilities the option to use their own systems while ensur - ing they conform to the national interoperability layer where the shared resources are located. These include the Shared Health Record and the client registry, national product catalogue, terminology registry, healthcare provider registry, healthcare facility registry, among others. Currently, policy and regulations are in place for enabling interoperability and its implementation is in progress. Digitizing the community health information system With the support of the Data Science Catalytic Fund initiative, Rwanda invested in a unique and comprehensive community digital solution covering all community health packages and workflow: the electronic medical record for community health workers. Rwanda received technical assistance to integrate siloed data systems into the Rwanda Health Analytics Platform, support centralized data visualization to inform programmatic decisions at the central level as well as enhancing and maintaining Rwanda Health Infor - mation Exchange to allow smooth exchange of data. Building on this structured approach Rwanda seeks to simplify the complex patient journey with digital transformation. By leveraging digital health architecture framework, initiatives and innovative solutions, Rwanda endeavours to share its knowledge and ex - pertise with SATA and other member countries, to facilitate interoperability contribute to establishing a


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data. Building on this structured approach Rwanda seeks to simplify the complex patient journey with digital transformation. By leveraging digital health architecture framework, initiatives and innovative solutions, Rwanda endeavours to share its knowledge and ex - pertise with SATA and other member countries, to facilitate interoperability contribute to establishing a harmonized legal framework and health information exchange across the continent. This will further complement Smart Africa’s key objective for the digital health blueprint to move towards a unified national, regional, and continental health record for every African citizen. II. Benin’s Digital ID experience Benin has developed a national ID system, known as the RAVIP system: “Recensement Administratif à Vocation d’Identification de la Population” (Administrative Census for Population Identification Purposes). Benin established a 4-step plan to identify its pop - ulation and provide it with electronic ID: preparation, electronic ID database building, data gathering and exploitation and monetization43. The learnings that have emerged from implementing the initial phases are beneficial for countries embarking on a path to setting up a foundational digital ID system. Key facilitators include strong leadership, on - boarding of an experienced technical partner, setting clear objectives for scale, effective communication, appropriate legislative and regulatory framework. Smart Africa Alliance Digital Health Blueprint82 2024The legal basis for this program is the Digital Code of Benin (articles 278 and following), enacted in 2018. Art. 278 defines the legal guarantees that need to be embedded in any electronic identification scheme. Within any given electronic ID scheme, the identifica - tion mediums/means are coupled with increasingly strict guarantees. These guarantees are divided into levels proportionate to the precision of the identification, or its “reliabil - ity”. By law, all electronic ID schemes must be interoperable, and need to obey a set of technical and regulatory specifications adopted by decree. The law also provides that the interoperability framework must: • Be technologically neutral and does not operate any discrimination between particu - lar technical solutions aimed at electronic identification, • Follow international norms and recommendations insofar as possible, • Facilitate the implementation of principles respecting privacy at the inception level, and • Guarantee that personal data treatment is compliant with Benin’s legislation. Smart Africa’s Digital Identity blueprint, championed by Benin, proposes a governance structure and technical framework based on recognition of national ID systems, common standards, and rules governing them. SATA evolved from this blueprint as a mechanism by which public and private


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that personal data treatment is compliant with Benin’s legislation. Smart Africa’s Digital Identity blueprint, championed by Benin, proposes a governance structure and technical framework based on recognition of national ID systems, common standards, and rules governing them. SATA evolved from this blueprint as a mechanism by which public and private stakeholders agree on a common approach (rules, require - ments) to ensure mutual recognition of digital identities on the continent. III. Legal texts from Tunisia While Tunisia does not have a single, comprehensive legal text solely focused on digital health, there are several relevant laws and regulations, as well as a digital health policy in development on digital health. Tunisia has enacted an organic law on the protection for personal data since 2004 (law 2004/63). Organic Laws have a higher rank than ordinary laws in the Tunisian legal sys - tem, requiring a higher majority to be voted, amended, or repelled by the legislative assembly and taking precedence over ordinary laws. This law enforces the classification of data related to health and genetic information as “sensitive” and establishes the Na - tional Authority for the Protection of Personal Data (NPDP) as an independent regulator. It further devotes a specific section to the processing of personal data related to health (articles 63 to 65) and another one for scientific research purposes (articles 66 to 68). Specifically, the Law imposes that health data “may only be processed by medical doc - tors, or by individuals who are bound by a professional duty of confidentiality”. It impos - es an obligation of prior authorization from the national regulator upon doctors to trans - fer personal data to individuals or institutions conducting scientific research in the health field (article 63). The national regulator issued a decision in 2018 on processing personal 83 Approach for facilitating seamless health and care delivery across the African continentdata related to health, including in the context of scientific research, and detailing and clarifying the Law 2004/63. The decision affirms and defines several key concepts such as “anonymisation”, “pseudonymisation”, “data portability”, “the right to be forgotten” and details several conditions related to health data, including their processing, transfer, hosting, and security. In 2007, a decree was enacted that encompasses the conditions and procedures for declarations and authorizations before the INPDP related to processing personal data. It should be noted that a new personal data protection law is in the works


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related to health data, including their processing, transfer, hosting, and security. In 2007, a decree was enacted that encompasses the conditions and procedures for declarations and authorizations before the INPDP related to processing personal data. It should be noted that a new personal data protection law is in the works and could be enacted as a stand-alone organic law or as part of the upcoming digital code. In terms of international cooperation, Tunisia has signed the AU Convention on cyberse - curity and personal data protection of 2014 (the Malabo Convention). In 2017, the legis - lative Assembly approved Tunisia’s adhesion to The Convention for the Protection of In - dividuals with regard to Automatic Processing of Personal Data (Convention 108) and its Additional Protocol n° 181 regarding supervisory authorities and transborder data flows. Tunisia signed the Convention and the Additional Protocol in 2019. In 2020, the Tunisian government enacted a decree creating a Unique Citizen ID Registry, where a unique ID is attributed to every Tunisian citizen. This ID is subject to the protec - tions of the Personal Data protection law. Concurrently, Tunisia’s Ministry of Public Health has developed a Development Plan for Digital Health (still underway) that aims, among other objectives, to create and dissem - inate a Computerized Medical File across public health structures which includes the continuous and real-time sharing of medical data between all parties to a patient’s jour - ney. In 2018, the law 2018-43 amending the law 1991-21 on the practice of medicine and dental medicine, introduced the possibility of telemedicine, subject to conditions of pa - tient consent and the respect of the legislation on personal data protection. In 2022, the Presidential Decree 2022-318 established the general conditions for the practice of telemedicine and the areas of its application. On the digital ID front, the Ministry of ICT created an e-Identity system based on mo - bile telephony, “Mobile ID”. This identity is directed towards secure online administrative services and digital signature and verification of documents. This digital ID could be a foundation for a health digital ID, but its reliance on a verified nominative personal mo - bile number may be a limitation. The Ministry is also deploying the “Digital Tunisia 2020 Strategy” elaborated between 2012 and 2014 and implemented since 2015. smartafrica.org


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on a verified nominative personal mo - bile number may be a limitation. The Ministry is also deploying the “Digital Tunisia 2020 Strategy” elaborated between 2012 and 2014 and implemented since 2015. smartafrica.org


