Implementing Digital Health Transformation in Zambia: A Case Study of Data Governance and Interoperability (2021–2025)

Digital health systems are central to achieving Universal Health Coverage in low-and middleincome countries, yet many national implementations remain fragmented, donor-driven, and weakly governed.This study examines Zambia's digital health transformation between 2021 and 2025, with a specific focus on interoperability and health data governance.Using a government-led case study approach, the research evaluated four core national platforms: SmartCare Pro, the National Health Insurance Management Authority system, the Zambia Medicines and Medical Supplies Agency system, and the National Data Warehouse.A convergent mixed-methods design combined system performance logs, interoperability testing, stakeholder surveys, document reviews, and governance compliance audits.Findings demonstrate a 78 percent national data exchange success rate, over 90 percent facilitylevel compliance with the Data Protection Act, and an average system usability score of 3.7 out of 5.The study shows that the implementation of a national Interoperability Architecture Framework and Health Data Governance Framework significantly improved system integration, accountability, and evidence-based decision-making.The results contribute practical implementation evidence for low-and middle-income countries seeking to transition from fragmented digital health investments to sustainable, government-owned, interoperable health information ecosystems.