Fixing our fragmented health data requires institutional leadership

Over the past decade and a half, Bangladesh has invested substantial public resources in digital health systems. Numerous software applications, databases, online platforms, and digital services have been developed. Yet many of these initiatives have emerged as isolated projects. As a result, health information is often scattered across multiple systems. Data have accumulated, but their interoperability and usefulness have not kept pace.

This reality is reflected in the Bangladesh Core FHIR Implementation Guide of the Directorate General of Health Services (DGHS). Systems such as DHIS2, hospital automation, and the Human Resources Information System (HRIS) have evolved separately, often using different data structures and standards. This makes information exchange difficult. Our fundamental problem, therefore, is not a lack of technology. It is the absence of a sufficiently strong institutional mechanism to bring different technologies and systems together within a common framework.

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Digitalisation is not simply about developing more applications, websites, or software platforms. A digital health system is sustainable only when information can move securely across platforms, new investments can build on existing infrastructure, and systems remain functional beyond the life of individual projects. Continuing to invest public money in similar, disconnected systems is not only inefficient; it also makes it harder to build a coherent national digital health ecosystem.

The Bangladesh Digital Health Strategy 2023–2027 addresses digital infrastructure, electronic health records, telehealth, digital health identity, artificial intelligence, workforce capacity, data privacy, cybersecurity, and national health information exchange. However, an essential institutional question remains: who will lead the transformation, coordinate different initiatives, set common standards, and ensure accountability?

South Asian experiences offer useful lessons. India launched the Ayushman Bharat Digital Mission in 2021, with the National Health Authority playing a central role. Rather than requiring every healthcare facility to adopt a single software system, India has focused on creating common digital infrastructure, standards, registries, and an interoperability framework. Digital health IDs, registries of healthcare facilities and health professionals, and consent-based health information exchange are intended to allow different systems to work together. For Bangladesh, the lesson is clear: institutional leadership and a common digital architecture must come before the proliferation of applications.

Pakistan provides another relevant example. Under the Digital Nation Pakistan Act, 2025, the country established the Pakistan Digital Authority (PDA) as a legally empowered institution to oversee the country’s broader digital transformation. Its mandate includes data governance and protection, citizen-centred digital services, interoperability, common standards, national digital planning, and coordination of digital initiatives across government. This approach treats digital transformation as a national institutional responsibility rather than a collection of disconnected projects.

Bangladesh needs to adopt a similar institutional perspective for health. Digital health involves far more than putting hospitals online. It encompasses data governance, privacy, cybersecurity, interoperability, common standards, health information exchange, and the effective use of data for clinical care, public health, and policy. These responsibilities require an institution with the authority, expertise, and continuity to govern the entire digital health ecosystem.

Bangladesh should therefore seriously consider establishing an independent national digital health authority. This should not be another temporary project or a small information technology unit. It should be established through legislation, staffed by professionals, and given adequate administrative, financial, and technical autonomy. Its governance should draw expertise from health, information and communication technology, public health, health economics, cybersecurity, data protection, private healthcare, and academia.

The authority could be responsible for defining the national digital health architecture; establishing and maintaining digital health identity and national registries of healthcare facilities and health professionals; setting data and interoperability standards; facilitating secure health information exchange; and ensuring privacy, data protection, and cybersecurity. It should also provide a clear regulatory framework within which both public and private providers can develop and connect digital services.

Perhaps most importantly, the authority should coordinate public investment in digital health. Before any ministry, directorate, or project develops a new digital health system using public funds, it should demonstrate why the investment is necessary, whether a similar system already exists, whether the proposed system can connect with existing platforms, and who will operate and maintain it after the project ends. A simple principle should guide public investment: no new standalone digital health system should be financed unless it is aligned with the national digital health architecture and designed for interoperability.

This does not mean that the government should develop every application itself. The government should provide the common infrastructure, standards, security framework, and interoperability rules, while public and private organisations remain free to develop innovative applications according to their needs. This approach would encourage innovation without public investment becoming fragmented across competing systems.

The current initiative to develop a national e-health platform offers Bangladesh an important opportunity to make this transition. Before developing another platform, we should first take stock of what already exists. A comprehensive national inventory should identify all digital health systems, the investments made in them, their current functionality and utilisation, areas of duplication, and their potential for integration. Based on this assessment, the government should establish the national digital health architecture and determine which systems should be retained, integrated, upgraded, or phased out.

Digital health has become an essential part of the health system’s long-term infrastructure. Bangladesh must therefore move from a project-based approach to an institution-based approach. A strong institution can provide continuity even when governments, projects, technologies, and development partners change. It can also ensure that today’s investments remain useful tomorrow rather than becoming another set of disconnected digital assets. The choice before Bangladesh is therefore not whether to embrace digital health; we have already made that choice. The real question is whether we will continue to build isolated digital projects or create the institutional foundation necessary for them to work together.

The journey towards a sustainable digital health ecosystem should begin with institution-building. First, establish the institution; then develop the national architecture, common standards, and shared infrastructure; and finally allow software, applications, and innovation to flourish on that foundation. If we get this sequence right, Bangladesh can move from fragmented digital initiatives to an integrated, secure, sustainable, and citizen-centred digital health system.

Dr Syed Abdul Hamid is professor at the Institute of Health Economics in the University of Dhaka and convener of Alliance for Health Reforms Bangladesh (AHRB).

Views expressed in this article are the author's own. 

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