Building Trust and Sovereignty: A Holistic Framework for Data Governance in African Healthcare Systems

The accelerating digital transformation of healthcare in Africa presents both a remarkable opportunity and a profound governance challenge. Across the continent, countries are adopting electronic health records, mobile platforms, and disease surveillance tools that promise to improve service delivery, expand access, and strengthen health equity. Yet these gains remain uneven and fragile because of fragmented governance structures, siloed donor-driven platforms, and limited use of real-time analytics for public health decision-making. Equally pressing is the ethical gap in consent practices, where Western-inspired one-time models fail to reflect Africa’s communal values, linguistic diversity, and varying levels of digital literacy. These issues weaken trust and constrain the continent’s ability to achieve true health data sovereignty. This article introduces the Integrated Data Sovereignty Framework (IDSF), a conceptual model that unites three interdependent pillars: centralized data governance, real-time analytics, and ethically anchored user rights and consent. The article demonstrates how interoperable data hubs, mobile technologies, and culturally grounded electronic consent mechanisms can enhance responsiveness while preserving sovereignty by drawing on African case examples from Ghana, Rwanda, Nigeria, Liberia, and South Africa. The framework is informed by institutional theory, sociotechnical systems thinking, collective benefits, authority to control, responsibility, and ethics, which are referred to as CARE Principles for Indigenous Data Governance, ensuring that it is theoretically robust and contextually grounded. By synthesizing these insights, the article positions the Integrated Data Sovereignty Framework as a strategic response to Africa’s evolving digital health landscape. It highlights pathways for low- and middle-income countries to move beyond fragmented donor-led models toward sovereign, resilient, and trusted data ecosystems. The study concludes with policy recommendations for national reforms, pilot testing of dynamic consent and analytics platforms, and cross-border data collaborations under African Union and Africa CDC initiatives. Ultimately, it argues that digital health sovereignty is not simply technical; it is a moral and political imperative for building equitable, transparent, and sustainable healthcare systems in Africa.