State of Digital Health in 32 Countries of the WHO African Region: A Multi-Country Maturity Assessment with Short-Term Longitudinal Comparisons Across Leadership, Policy, and Health Systems Domains (2023 - 2025)

Evidence on digital health maturity in Africa remains limited. We characterized maturity across countries in the World Health Organization African Region between 2023 and 2025 to generate a regional baseline for policies and investments.

We analyzed the Global Digital Health Monitor data, which scored seven domains of the digital health enabling environment on a 5-phase scale. All assessments from the 2023, 2024, and 2025 cycles were extracted in April 2026, yielding 50 country-year observations from 32 of the 47 member states of the World African Region, with 17 of these 32 countries reassessed in at least one subsequent cycle. Assessment coverage declined over time (29, 17, and four countries in 2023, 2024, and 2025, respectively); therefore, the 2025 comparison rests on a small subset. The data are self-reported by the country focal points and published only after government approval. We used descriptive statistics (means with medians and interquartile ranges for the ordinal phase scale), choropleth mapping, short-term descriptive change analysis, Spearman correlation (reported with sample size and p-values), hierarchical clustering with internal validation (silhouette score, gap statistic, and linkage sensitivity), and within-country gap analysis.

We analyzed 32 countries and 50 country-year observations. Most countries were in Phase 3 (established; 21 of 32, 66%), with none in phases 1 or 5; 5 were at Phase 4, and 6 were at Phase 2. Leadership and governance were consistently the strongest (mean phase 3.00 in 2023 and 3.75 in 2025), and the workforce was the weakest. Of the 17 reassessed countries, three improved and none declined; one country (Kenya) advanced two phases in one year. Standards and interoperability were strongly correlated with services and applications (Spearman ρ = 0.70, n = 30, p < 0.001). Clustering yielded three archetypes: infrastructure-oriented, governance-led, and early stage. A total of 26 of the 32 countries had gaps of two or more phases between the strongest and weakest domains, typically strong governance with a weak workforce.

Among the assessed countries in the World Health Organization African Region, digital health rests on established governance but is constrained by a weak workforce and uneven interoperability. Targeted investment in the workforce, shared data architectures, and broader maturity monitoring are the most consequential levers for progress in this field. The findings should not be extrapolated to non-assessed Member States or to the wider African continent, which extends beyond the World Health Organization's African Region.