Last week, I wrote about why digital health in Africa won’t thrive without deeper local investment, not only in money but also in capacity, context, and ownership. The response was heartening but also sobering. Across the broader development landscape, similar questions are now being asked, in louder and more urgent tones.
With donor funding shrinking, aid staff being cut, and major development players scaling back, Africa finds itself at a pivotal moment, not just of challenge, but of opportunity. What happens when the external scaffolding starts to shake? What do we build for ourselves in response?
“In this era of dwindling aid, what replaces it must not be more of the same. It must be better, more collaborative, more self-aware, and far more honest.”
We are seeing, in real time, the limits of a model long held up as standard. As Tanzanian MP January Makamba recently said, these aid cuts may be “brutal,” but they may also be “birth pains, not death pains.” A chance to reset. To reimagine.
In digital health, that reimagining is long overdue.
For years, African countries have been the testing ground for imported technologies, often designed elsewhere, funded externally, and assessed through short-term KPIs that rarely capture the full story. Systems are introduced, not incubated. Frontline health workers are handed tools rather than invited into their design. Governments are expected to implement platforms that don’t quite fit and then are asked to explain why they didn’t stick.
It’s a familiar dependency dynamic, only digitised.
But dependency is brittle. And now, with traditional donor support fraying, the cracks are more visible than ever. What’s left standing, what endures, are the systems built from within. The ones sustained by local talent, local trust, and local learning.
We need to stop treating learning as a luxury.
Too often, development gets caught up in the performance of success, the pitch deck, the pilot, and the report. But insight, the kind that shifts practice, emerges only when we slow down and listen. When we examine not only what worked, but also what didn’t. When we ask, why didn’t this platform catch on? What assumptions failed? Who wasn’t in the room when this was designed?
That’s why spaces like the Insights Learning Forum (ILF) matter.
Not because they offer polished solutions, but because they make room for messier, more honest conversations. This year, as ILF 2025 convenes under the theme “Local Investment for Connected Communities,” it arrives at a moment when our sector is being forced to reckon with its blind spots, its fragilities, and its future.
Across the continent, leaders are asking deeper questions about development itself. Has decades of aid delivered the transformation it promised or entrenched a kind of stagnation? As one Somali advisor put it plainly, “The more money we receive, the more pervasive our addiction becomes.”
It’s a harsh truth, but also a timely reminder.
Because if we want digital health to be more than donor-driven infrastructure, it must be locally owned, not just locally implemented. And ownership begins with learning, with creating space for African health workers, technologists, and policymakers to define what digital health should be, not only what funders are willing to support.
Read also: Digital health will not thrive without local investment
That is the spirit of ILF. It’s why we’ve resisted turning it into a showcase. It is not a parade of “success stories.” It’s a working room. A place where a nurse from Nasarawa can challenge a software developer from Berlin. Where a Ministry of Health official can sit across from someone who’s spent years troubleshooting offline data systems with no stable power supply.
And even though global finance leaders debate how to unlock private capital for health, we in this space must be clear: transformation doesn’t happen through billion-dollar announcements. It happens through daily decisions. Through systems that survive power cuts. Through training that sticks.
Through trust built over time.
At eHealth Africa, we’ve tried to put this into practice. We’ve supported regional data hubs, not because they’re trendy, but because they decentralise power. We’ve invested in community technologists, not as a “capacity-building” checkbox, but because they understand the terrain. We’ve aligned with national strategies because scale without sovereignty is not scale. It’s outsourcing.
Still, we know we can’t go it alone.
In this era of dwindling aid, what replaces it must not be more of the same. It must be better, more collaborative, more self-aware, and far more honest.
So, as global institutions trim budgets and development models contract, we are left with both a challenge and a charge: to build something different. Something that listens, that learns, and that lasts.
ILF 2025 is not a silver bullet. But it is a signal that the future of digital health will not be built on dependency but on dialogue. On connection. On investment that begins with listening.
Because when digital health learns to listen, it does more than digitise. It begins to transform.
Ota Akhigbe is a Pan-African development strategist and Director of Partnerships & Programmes at eHealth Africa, where she shapes systems-level solutions at the intersection of health, innovation, and equity. She writes weekly in BusinessDay on structural transformation, local leadership, and the future of development in Africa.
