Beyond Training: Systems Framework for Sustainable Health Informatics Investment in Africa.

Unlabelled: Across Africa, substantial investment has built national health information systems (HISs), including the surveillance platforms, reporting tools, and digital infrastructure through which health data flow. However, the health informatics capacity needed to sustain those systems remains fragile: trained health informaticians leave for better-resourced organizations, platforms fall into disrepair when donor funding ends, and data systems multiply without connecting. Health informatics is the discipline that designs, governs, and sustains HISs; the two are inseparable, and investment that builds one while neglecting the other cannot produce durable results. This viewpoint, grounded in the authors' direct implementation experience across sub-Saharan Africa and informed by published literature, argues that the cause is a structurally misaligned investment logic: resources concentrate on training health informaticians while the institutional, governance, and infrastructure conditions that determine whether those informaticians can perform are chronically underfunded. We propose that sustainable health informatics capacity requires a functioning HIS ecosystem and that this ecosystem rests on four interdependent pillars: (1) workforce development beyond training; (2) institutional strengthening; (3) governance and data standards; and (4) interoperable infrastructure, including the national HIS platforms, such as the District Health Information Software 2, through which health informatics practice operates. The pillars are interdependent: weakness in any one undermines the others in specific, predictable ways. The framework makes 3 contributions beyond existing World Health Organization (WHO) and Africa Centers for Disease Control and Prevention frameworks: it shows how weakness in one pillar actively undermines the others; it focuses specifically on health informatics and national HISs as the primary investment domain rather than as components of a broader digital health agenda; and it treats the enabling environment, specifically civil service structures, domestic financing, data sovereignty, and artificial intelligence governance, as core investment requirements rather than background conditions. Drawing on illustrative experiences from Ethiopia, Kenya, and Sierra Leone, we show how health informatics capacity succeeds or fails depending on the strength of all 4 conditions. A practical readiness checklist and audience-specific policy recommendations are provided for national health ministries, national public health institutes, regional bodies, and development partners.