Background: In 2026, digital health transitioned from a series of experimental pilot projects to a fundamental infrastructure for achieving Universal Health Coverage (UHC). This momentum is driven by the World Health Assembly’s recent extension of the Global Strategy on Digital Health through 2027, with a follow-up framework already in development for 2028–2033.
This strategy calls on countries to develop national digital health strategies covering governance, infrastructure, workforce, services, and interoperability (WHO, 2021). South Africa released the National Digital Health Strategy 2019-2024 to guide the digital transformation of its health system, aligning with national goals and global trends.
Objective: This study evaluates South Africa’s digital health strategy as a policy, using the categories from a 2025 comparative African strategy analysis by Sylla, B. et al. (2025), and examines real-world evidence of implementation to revise how the strategy’s goals have been realised in practice.
Methods: We conducted a document analysis of the South African strategy, coding the content according to four dimensions (context, content, priority actions, innovation) used in the Nature article by Sylla, B. et al. (2025). We also reviewed World Health Organization (WHO) guidelines and collected literature and reports on the implementation of digital health in South Africa. We summarised strengths, gaps, and examples, and evaluated whether each example supports or contradicts the strategy.
Results: The South African strategy clearly defines a vision aligned with “better health for all South Africans enabled by digital health,” anchored in national health priorities (National Department of Health (NDoH), 2019) and is also aligned with WHO-recommended components. It is notably comprehensive in addressing enabling environment factors, including leadership, stakeholder engagement, investment, governance, interoperability, workforce, and policy frameworks. However, several objectives and actions are articulated at a high level and lack baseline indicators or measurable targets, thereby limiting their evaluability. The strategy also signals the importance of innovation but provides limited operational detail on how innovation will be integrated. The implementation evidence indicates mixed progress. There has been measurable advancement in some foundational building blocks and selected digital services, like 68 million individual records in the Health Patient Registration System (HPRS) identifiers (NDoH, 2025). On the other side, persistent bottlenecks, particularly uneven facility connectivity, and continued fragmentation of major information systems, have constrained interoperability and system-wide scale-up by the end of the strategy period (Global Fund, 2025; NDoH, 2025).
Conclusion: South Africa’s digital health strategy is a strong and comprehensive policy document that aligns well with international guidance and positions the country as a potential leader in digital health strategy design in the Global South. Nonetheless, the realisation of system-wide impact has been uneven, underscoring the need for the next strategic cycle to strengthen measurement, prioritise practical interoperability, and address infrastructure and adoption constraints through sustained investment and adaptive governance.