Overview
Digital transformation in a national health system is not primarily a software deployment challenge. It is an institutional challenge involving government priorities, multiple technology platforms, development partners, implementing organizations, vendors, budgets, procurement decisions, data standards, operating processes, workforce capacity, and long-term ownership.
At USAID/Ethiopia, I served as Senior Digital Health Advisor and senior digital health lead for an approximately $63 million Digital Health Activity. My responsibility was not to manage a single application. It was to help ensure that a large portfolio of digital-health investments remained technically credible, strategically aligned with government priorities, operationally realistic, accountable to USAID, and capable of being sustained within Ethiopia's health system.
The portfolio touched community health, electronic medical records, logistics and supply-chain systems, workforce platforms, regulatory systems, equipment management, health-facility information, analytics, interoperability, and national health-information infrastructure. The work required moving continuously between technical detail and institutional strategy.
The Challenge
Ethiopia had already made substantial investments in digital health. The challenge was increasingly one of scale, coordination, interoperability, and sustainability.
Different digital platforms were being developed or expanded for different parts of the health system. Those systems had different users, data structures, technical architectures, infrastructure requirements, implementation partners, and levels of maturity. At the same time, they needed to support common national objectives and ultimately operate within government institutions rather than as disconnected donor projects.
The work therefore had to answer several connected questions: how to prioritize investments, reduce data silos, govern and sustain national platforms, assess performance beyond software deployment, align partners and procurement with government priorities, and give leaders reliable information before technical or institutional risks became larger program problems.
My Role
I helped manage USAID’s oversight of a complex national activity involving the Ethiopian Ministry of Health, USAID technical and management staff, implementing partners, technology vendors, development partners, academic institutions, and local technology organizations. My portfolio included work across major national platforms such as DHIS2, eCHIS, the Master Facility Registry, eLMIS/Dagu, EMR-related platforms, and other national digital-health systems. This required working closely with both USAID colleagues and the implementing partner to turn broad strategic objectives into specific annual priorities, deliverables, timelines, and expected results.
When priorities changed or implementation assumptions proved unrealistic, I helped identify where plans needed to be adjusted. Part of my role was helping USAID staff understand what digital-health investments meant for their program areas while translating technical issues into language relevant to program management.
Data, Analytics and Decisions
I also worked extensively with analytics, GIS, dashboards, and national health-information data. This included analysis using information from DHIS2, the Master Facility Registry, and EMR environments to help visualize health indicators and support management decisions.
I used geospatial and analytical approaches to help answer management questions such as:
- Where are services underperforming?
- Where are implementation gaps concentrated?
- Which facilities or geographic areas require attention?
- Are digital systems actually generating usable data?
- What should leadership prioritize?
The purpose was not to produce more dashboards. It was to improve the quality of decisions.
Government Ownership
The activity existed to strengthen Ethiopian institutions, so engagement with government counterparts was fundamental. I worked with senior Ministry of Health officials and technical teams to help align USAID-supported investments with national priorities. My role also required balancing immediate program needs with the longer-term question of government ownership.
That changed how I evaluated projects.
For every major system, sustainability raised questions such as:
- Who will own it?
- Who will administer it?
- Who will pay recurring costs?
- Who will provide technical support?
- Where will the data be hosted?
- What skills must remain inside government?
- What happens when donor financing declines?
These were not secondary questions. They were central to whether the investment would ultimately succeed.
Scale and Evidence
The broader portfolio included systems touching community health, facility care, logistics and supply chain, health workforce management, pharmaceutical regulation, equipment management, health information, analytics, and interoperability. The most important measure was not the number of applications, but the effort to get them working together as one national health system.
What This Experience Taught Me
National digital transformation cannot be managed as a collection of technology projects. Technology is only one layer. Underneath it are decisions about institutional ownership, governance, data, procurement, infrastructure, workforce, financing, accountability, and operating models.
A technically sophisticated platform can still fail institutionally. A modest technology investment can create significant value if it solves the right operational problem and becomes embedded in how an institution works. That distinction continues to shape how I approach infrastructure, enterprise GIS, digital public systems, and technology strategy.
What This Case Demonstrates
- National-scale transformation across multiple systems and institutional actors
- Executive advisory and decision support for government and donor leadership
- Technology judgment across architecture, interoperability, GIS, analytics, and digital systems
- Portfolio leadership connecting strategy, budgets, procurement, partner performance, risk, and sustainability
- Institutional thinking designed around government ownership and long-term operating capability
Digital transformation succeeds when technology, institutional ownership, governance, and operating models evolve together.