From the newsletter
Paper records still dominate many clinics in Africa. This situation has at times created challenges in patient care like inaccurate diagnoses. In a guest article, Mike Adeyemi Lawal of Médecins Sans Frontières argues that electronic health records (EHRs) hold the key to accountable and climate-smart healthcare systems across the continent.
“EHRs create a comprehensive record that links vital signs, lab results, medication history, and counselling notes for a patient across multiple visits.” says Mr Lawal.
Electronic health records also make it easier to detect and monitor spikes in diseases linked to climate and connect them to environmental data.
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By Mike Adeyemi-Lawal, Malaria and Infectious Diseases Specialist Advisor at Médecins Sans Frontières (MSF)
In many hospitals and clinics across Africa, it is still common to see patient files piled high along the corridors. For years, electronic health records (EHRs) were viewed as a distant luxury in this setting. Today, however, that perception is shifting as more clinics and hospitals move beyond pilot projects to real, operational implementation.
In 2019, I had an opportunity to work on a pilot project implementing an EHR system designed to help manage non-communicable diseases (NCDs) in clinics located in low-resource settings. The clinics relied heavily on paper files that were often incomplete, medication histories that varied from visit to visit, and follow-up processes that frequently broke down. The aim of the project was to test whether an EHR could provide a single, consistent record that followed the patient through every stage of care: triage, consultation, laboratory, pharmacy, and back again. Firsthand, I witnessed both the challenges of implementing an EHR and the opportunities that emerged from them.
EHRs are essentially digital versions of a patient’s paper records, used within a single healthcare facility. They hold clinical information, including diagnoses, medications, lab results, allergies, and a patient's visit history, enabling healthcare providers to track patient care more efficiently. There are various types of EHR systems, ranging from simple standalone systems designed for individual clinics to integrated systems. In low-resource settings, EHRs are often implemented as modular, open-source tools tailored to priority services such as HIV, TB, or non-communicable diseases, and then gradually scaled up across departments.
Benefits of EHRs
Continuity of Care for Chronic Conditions. For conditions like hypertension, diabetes, and HIV, patients need ongoing follow-up. EHRs create a comprehensive record that links vital signs, lab results, medication history, and counselling notes across multiple visits. Automated defaulter lists identify patients who miss appointments, while digital appointment schedules make follow-up a systematic process rather than relying on memory. This improves patient retention and allows for early interventions when patients miss appointments.
Better Clinical Decisions. By offering real-time prompts at the point of care, EHRs can highlight potential issues, such as high blood pressure, drug interactions, or the need for dose adjustments. Structured order entry ensures that requests to the laboratory or pharmacy are clear and complete, minimising transcription errors that can put patient safety at risk. In the long term, clinical dashboards also identify patterns that help providers refine treatment protocols.
Improve Patient Engagement.
Well-designed EHRs benefit not only clinicians but also extend the clinic's reach to patients' homes. Automated SMS reminders for appointments or medication refills boost adherence, particularly for patients managing long-term conditions. Mobile modules enable community health workers to capture home blood pressure or glucose readings offline and sync them later, keeping the patient's record up to date even outside of the facility walls.
Operational Efficiency. Managers can use EHR dashboards to monitor waiting times, missed appointments, drug stock levels, and laboratory turnaround in real time. Instead of reacting to problems after they escalate, facilities can reassign staff, re-order medicines, or clear bottlenecks immediately. This supports a more patient-centred experience while optimising limited resources.
Financing and Accountability. As more African countries roll out national health insurance, accurate claims data becomes critical. EHRs help by ensuring that encounters are properly documented and coded, reducing rejected claims and speeding up reimbursement. At the same time, routine indicators for public health reporting are automatically generated, eliminating the monthly scramble to compile paper registers and strengthening accountability at the facility and national level.
Growth of Local Tech Ecosystems. Large-scale EHR deployment stimulates demand for new skills. Health facilities need implementers, trainers, support technicians, and data analysts who can configure systems, maintain infrastructure, and extract insights. Universities and training institutes can respond by embedding health informatics into nursing, medical, and public health curricula, creating a pipeline of professionals who sustain systems locally. This reduces dependence on external consultants and builds an ecosystem of innovation around digital health.
EHR Implementation Challenges
Infrastructure Gaps. Many health facilities, particularly in rural districts, still operate with intermittent electricity and limited internet connectivity. Even when servers or computers are donated, frequent power cuts and poor bandwidth compromise reliability. Without stable infrastructure and affordable backup solutions, EHRs risk becoming idle equipment rather than active clinical tools.
High Costs of Ownership. EHRs are often launched as donor-funded pilots, but sustaining them requires long-term investment. Costs include not only initial software and hardware, but also recurrent expenses for connectivity, equipment replacement, licensing (where applicable), and dedicated IT support. For health systems already stretched to cover essential medicines and salaries, these costs can feel prohibitive.
Limited Workforce Capacity. Frontline health workers are often overburdened with large patient volumes. Introducing new data-entry responsibilities can feel like an additional burden, particularly when workflows are not streamlined. Training is frequently one-off and classroom-based, leaving little ongoing support. As a result, staff may default back to paper records, undermining the EHR's intended value.
System Fragmentation. Different donors, NGOs, and private providers often introduce their own EHR systems to meet program-specific needs without alignment to national standards. This creates a patchwork of systems that cannot "talk" to one another, trapping patient information in silos. The result is duplication of effort, incomplete records, and missed opportunities for continuity of care.
Weak Data Governance and Trust. While some African countries have enacted data protection laws, enforcement remains inconsistent. Concerns about patient confidentiality and unclear ownership of health data create hesitation among both patients and providers. Without clear governance frameworks, providers may be reluctant to share data across systems, and patients may be wary of digital records altogether.
What is the Future of EHR in Africa's Healthcare System?
The future of EHRs in Africa will depend less on technology and more on how systems are implemented, governed, and sustained. A successful implementation of EHR requires reliable infrastructure, trained health workers, and strong policies that ensure interoperability and protect patient data.
As national insurance schemes expand, EHRs will become central to financing and accountability. If coupled with local ownership and steady investment, EHRs can evolve from scattered pilots into the backbone of African healthcare.