Conclusion

The Wilton Park dialogue on digital public infrastructure (DPI) for health confirmed that the field is approaching a potential tipping point. The foundational elements – the technologies, the frameworks, the country examples, and the institutional networks – are increasingly in place. What has been slower to develop is the political economy of change: the leadership, governance, financing mechanisms, and institutional capacities needed to move DPI from pilots and projects to national systems that countries can own, operate, and sustain beyond external financing and technical support.

The dialogue also sharpened the nature of the risk. At the scale of investment now being contemplated, the risk is no longer limited to unsuccessful pilots. Rather, it is linked to long-lived architectural lock-in, fragmented governance arrangements, and operating models that embed dependency and recurring cost structures without building durable domestic ownership. This framing raised the stakes of the conversation and gave urgency to the three interconnected pillars that structured the dialogue: governance and institutional capacity, technical architecture and country capability, and financing and economic logic. Participants converged on the view that these pillars are mutually dependent – governance determines who has authority to enforce standards and coordinate across sectors, architecture defines what shared services exist and how they interoperate, and financing determines whether those services can be operated and evolved over time.

Participants were honest about the barriers, including some that the field has been reluctant to name directly: the perverse incentives that reward silos, the limitations of donor-driven programme cycles, the persistent gap in enterprise architecture and translation capacity within government, and the failure to connect DPI advocates with the political and financial decision-makers who ultimately control investment. Critically, many of the levers that matter most for DPI in health – identity, payments, public financial management, cybersecurity, and national interoperability governance – sit outside the Ministry of Health. Sustainable DPI for health requires cross-sector decision rights and enforcement mechanisms that most governance arrangements do not yet provide.

Participants emphasised that countries will only adopt and sustain DPI for health if they are convinced it is in their interest and if the conditions for success are genuinely in place. The role of the international community is not to push DPI onto governments, but to help create the enabling conditions: shared governance frameworks and readiness assessments, credible value narratives grounded in evidence, peer learning platforms, training and coaching programmes, and financing instruments aligned with how infrastructure scales across different country contexts and digital transformation maturity.

Lesley-Anne Long and Henry Mark

Wilton Park | February 2026