JMIR Publications

ABSTRACT

Background:

Recent crises involving zoonotic diseases (Ebola, COVID-19, Mpox) have highlighted the limitations of fragmented public health systems for the prevention and response to health emergencies, at the international, continental – particularly in Africa – and more specifically in the Democratic Republic of Congo (DRC). In this context, the One Health approach and its extension One Digital Health (ODH), articulated with the FAIR (Findable, Accessible, Interoperable, Reusable) principles, offer a framework for rethinking the digital transition in health in the DRC. This study analyzes the reality of this transition in Kinshasa and questions the feasibility of ODH in this context.

Objective:

This study aimed to (1) identify the structural, institutional, and technical constraints hindering digitalization and data interoperability across health sectors in Kinshasa; (2) examine how current digital governance and cross-sectoral practices facilitate or obstruct collaborative data sharing; and (3) analyze the sociotechnical and systemic conditions required for the successful implementation of the One Digital Health (ODH) framework.

Methods:

A qualitative study was conducted in Kinshasa (DRC) between 10 and 25 November 2025, combining 22 semi-structured interviews with key actors (health professionals, administrative officials, digital experts, and engaged citizens) and a documentary analysis of strategic and regulatory texts in digital health in the DRC. The data were analyzed using a thematic approach to identify the representations, uses, and constraints related to digital health and the operationalization of ODH in the DRC and, more broadly, in Africa.

Results:

Twenty-two stakeholders participated (40.9% human health; 36.4% animal health; 18.2% environmental health; 4.5% digital sector), predominantly male (68.2%) and mainly in operational roles (54.5%). Three interrelated topics emerged. First, a dual-track digital ecosystem characterized by the coexistence of formal platforms (eg, DHIS2, electronic records) and informal tools (eg, WhatsApp), with persistent paper-digital double entry generating inefficiencies. Second, structural and governance bottlenecks, including electricity instability, limited connectivity, software incompatibility, external data hosting concerns affecting sovereignty, and institutional silos privileging human health over animal and environmental sectors. Third, prerequisites for operationalizing ODH, emphasizing foundational infrastructure (energy and internet), sustainable capacity building beyond one-off training, interoperable “bridges” between fragmented systems, and high-level political leadership. These elements were synthesized into an ODH-FAIR DRC conceptual model structured around three enabling pillars linking sectors for integrated zoonotic surveillance.

Conclusions:

Operationalizing ODH in DRC requires addressing foundational enablers beyond tools: synchronized energy-digital policies, decompartmentalized governance, and context-adapted capacity building. These insights inform LMIC digital health strategies, urging donors and ministries to prioritize interoperability over isolated pilots to achieve sustainable zoonotic surveillance.