Discussions on technical architecture moved beyond abstract definitions, towards the practical: what does a country need in place, technically and in terms of human capability, to build and sustain digital public infrastructure (DPI) for health?
Participants identified a fundamental gap between health architecture (which is concerned with real-time data sharing, care pathways, and clinical workflows) and technical architecture (which is concerned with platforms, standards, and interoperability layers). The roles that bridge these two domains – often described as health informatics architects or enterprise architects – frequently do not exist in government. Filling this gap was identified as one of the more urgent and actionable priorities, as well as identifying ways of retaining these skills within the government as there can be strong pull from the private sector within and outside the country.
On interoperability, one participant noted that technical interoperability is easier to achieve than human interoperability. Standards and semantics matter, but so do the business rules about how data is stored, accessed, and governed. These require negotiation across institutional boundaries, not just technical alignment. Participants argued strongly for open standards, modular architectures, and the deliberate development of local vendor ecosystems so that governments are not dependent on any single provider and can ensure that they can maintain and evolve DPI systems with local expertise.
Vendor lock-in was identified as a significant and persistent risk: proprietary systems may offer short-term convenience but create long-term dependencies that are difficult and costly to unwind. One participant stressed the need to avoid equating sovereignty with ownership; it is rather about choice – including the right to move to new systems or vendors over time. The importance of negotiating the right to move upfront, the cost of doing so – and who bears these – and the responsibility of different parties in facilitating a switch, was noted as being critical. Governments that define the architecture, technical specifications, interoperability standards, and leverage their mandate to coordinate and ensure procurement mechanisms are aligned, and that each subsequent investment into DPIs and functional applications are conformant to these specifications, will facilitate consistency across the digital health ecosystem.
The experience of the Asia eHealth Information Network (AeHIN) was highlighted as an instructive model for regional capacity building. AeHIN’s training programme covers governance, architecture, project management and standards (GAPS), and has evolved to ensure that participants are not only trained but empowered to act when they return to their countries. The programme has been delivered across multiple countries and is increasingly asking participants to commit to specific, named actions upon return. A convergence methodology workshop approach is being used to reveal country-specific gaps and capability needs.
The World Bank has developed the Digital Health Blueprint Toolkit, providing a comprehensive set of customisable resources designed to move from digital health strategy to implementation by focusing on the development of buildable blueprints contextualised to country health priorities.
Participants identified four interrelated priorities:
- Clarify the distinction between health architecture and technical architecture and create the roles to bridge them.
- Develop a principles-based framework to guide implementation decisions and link them to technical requirements.
- Operationalise WHO guidelines on reference architecture with the training and coaching necessary to do so effectively.
- Build ‘soft’ capabilities – including communications, change management, and advocacy- alongside technical skills.
Participants agreed that countries need a ‘national digital architect’. This could be a role for an individual or a small team, accountable for overseeing the design of the technical building blocks and the reference architecture of health DPI. This is not an IT manager, a vendor, or a donor-funded consultant – it is essentially an accountable designer of ‘systems of systems,’ embedded in government and empowered to make and enforce decisions.