Background: Digital health systems are increasingly central to health system performance, yet many low- and middle-income countries continue to struggle with integrating proliferating platforms into coherent national infrastructures. These challenges are often attributed to technical or capacity constraints, but less attention has been paid to how digital health integration is governed in practice. Ghana is frequently cited as an early adopter of digital health in sub-Saharan Africa, but persistent fragmentation raises questions about how national digital health integration is executed.
Methods: We conducted a scoping review in accordance with PRISMA-ScR guidelines to examine governance arrangements, regulatory frameworks, and interoperability provisions that shape the integration of Ghana's national digital health systems. Four bibliographic databases and two search engines were searched for peer-reviewed and grey literature, with no restriction on publication date. Eligible sources included empirical studies, policy documents, strategies, technical reports, and programme evaluations addressing digital health governance, regulation, data governance, or interoperability in Ghana.
Results: Twenty-two sources met the inclusion criteria. Authority for digital health governance is distributed across multiple health and non-health institutions, with no single body exercising comprehensive stewardship or enforcement. Legal and policy instruments articulate principles for coordination, interoperability, data protection, and cybersecurity, but interoperability is consistently framed as a strategic objective rather than a mandatory condition for system deployment or continuation. In practice, governance and interoperability arrangements operate unevenly, characterized by parallel platforms, partial data flows, manual workarounds, and variable compliance with security safeguards. Persistent gaps are associated with fragmented mandates, weak enforcement mechanisms, donor-driven implementations, and constrained subnational capacity.
Conclusion: Ghana's digital health integration challenges reflect a governance execution gap rather than an absence of strategies or technologies. The findings highlight the need to shift from strategy-led coordination toward enforceable, rule-based governance, with broader relevance for countries seeking sustainable digital health integration.
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