Developing a National eHealth Enterprise Architecture in Botswana: a digital health case study

Botswana's health sector comprises numerous digital health systems that operate in isolation, thereby constraining interoperability, limiting data exchange, and hindering coordinated patient care. Although national strategies such as the Botswana eHealth Strategy (2020-24) articulate overarching digital health objectives, they offer limited technical direction for harmonizing digital investments and achieving system-wide interoperability. This article presents a national digital health case study detailing the development of the Botswana eHealth Enterprise Architecture, a strategic blueprint intended to guide the integration and governance of digital health systems nationwide. The architecture was formulated through a participatory process involving stakeholders from the Ministry of Health, healthcare facilities, academic institutions, and international partners. The initiative was informed by internationally recognized frameworks, including The Open Group Architecture Framework and the Open Health Information Exchange interoperability model. Through an iterative development process undertaken between 2023 and 2024, the architecture delineated four core layers-business, data, application, and technology-and established a national interoperability framework grounded in open standards, including HL7 Fast Healthcare Interoperability Resources and HL7 v2. The resulting architecture further introduced a suite of shared national digital health services, such as a Master Patient Index, a Shared Health Record, and national facility and provider registries. Key lessons from Botswana's experience underscore the importance of robust governance structures, inclusive stakeholder engagement, the adoption of open standards, and phased implementation approaches in the development of national digital health architectures. This case study offers practical insights for other low- and middle-income countries seeking to mitigate fragmentation in their health information systems and to implement interoperable digital health ecosystems.