There is a moment in any complex field when the ground quietly shifts beneath our feet. In global health, that moment has arrived. In this podcast, two seasoned voices, Joy Pumafi, a long-time architect of African health policy, and Dr. Monica Burrell, a physician steeped in public health systems, describe a landscape undergoing a profound transformation. Their insights are not theoretical. They offer a clear-eyed view of what is breaking, what is emerging, and what must be built.

Each, in her own way, points to an unmistakable truth: information itself has become a determinant of health.

This is not a metaphor. It is an operational reality that shapes life and death across villages, settlements, and sprawling peri-urban regions where connectivity is unpredictable and care is uneven. The question is no longer whether digital tools will matter in African health systems, but whose digital tools, and designed for which realities?

The Collapse of a Singular Authority

Joy reflects on an earlier era: “You just took the World Health Organization as the source and that was it.”
Information may have been slow, but it was unified. Today, she observes, multiplicity has supplanted coherence. Global guidance competes with “centers of excellence,” local interpretations, partial truths, and outright fabrications. The result is a system flooded with contradictory signals, too many to reconcile and too few to trust.

When institutional authority fragments, trust does not evaporate; it migrates. In her words, “people listen a lot to the traditional leaders… the religious leaders… the influencers who may not be medical experts, but they understand how to communicate with their people.”

This is not a flaw in African societies. It is a clue. Trust in Africa does not follow the linear, institution-centric pathways assumed by many digital health solutions built elsewhere. It flows through social, relational and intergenerational channels. Chiefs, pastors, youth influencers, and community volunteers who are often the first and sometimes the only credible voice.

A future of African health intelligence must therefore treat trust itself as infrastructure.

The Misleading Comfort of Partial Truth

One of Joy’s most incisive observations concerns misinformation: “It is always mixed with a little bit of truth.”
That sliver of truth is what makes falsehood convincing. Families accept unverified nutritional advice during epidemics because it sounds plausible. Mothers delay facility births because someone familiar assures them they can manage it at home. By the time the health system enters the picture, it often arrives too late and is blamed for the outcome.

This dynamic reveals something deeper: accurate information alone is insufficient. The value lies not only in truth, but in how truth is carried. It’s tone, it’s messenger, it’s timing, it’s cultural weight.

If global digital health tools assume that the right facts will prevail by virtue of accuracy, the African context reveals a different logic. Credibility is relational before it is informational. Any serious attempt to improve health outcomes must therefore enable trusted messengers, local leaders, volunteers, and community figures to carry the right knowledge in the right way.

Meaning the value stream is not content but the movement of knowledge through channels where belief already resides.

Health Literacy Without Means Is an Empty Promise

Monica’s stories from her clinical work reveal the human consequences of information without infrastructure. They underscore a truth often sanitized out of digital health narratives: health information is meaningless if people cannot act on it.

If a digital system tells a patient to seek emergency care, but the nearest facility is three hours away over washed-out roads, the information is correct but irrelevant.

This is why African health intelligence must prioritise actionability in low-resource conditions, not as an afterthought, but as design principle. Information must not only be accurate; it must be possible.

Digital Abundance Meets Material Scarcity

Monica describes the emerging capabilities of generative AI: tools that summarize complex papers, prepare briefing notes, adjust explanations to match a user’s literacy level, and bring high-quality sources to the top of search results. These are powerful leaps forward but they rest on layers of stability rarely guaranteed in African settings.

A frontline worker from Sierra Leone captures the tension succinctly: internet access remains impossible in many rural communities, while paper-based reporting still burdens the workforce.

To build Africa’s future of health intelligence, digital tools must be shaped by constraints, not merely deployed despite them. Value streams must include:

• offline-first architectures,
• low-bandwidth pathways,
• hybrid paper–digital workflows that reduce burden,
• and intelligence systems capable of functioning even when infrastructure falters.

This is not about lowering ambition. It is about matching ambition to the lived conditions where health is won or lost.

The Geography of Health Intelligence

One of the most compelling ideas comes from Monica’s description of a geospatial model that combines population, environmental and facility data into a single analytic fabric – a “fingerprint of a community.” Joy immediately sees its promise for Africa: understanding the interplay between climate, disease patterns, mobility, and environment.

African health realities are profoundly shaped by geography:

• floods that isolate regions,
• climate shifts that redirect mosquito vectors,
• remote communities where travel time determines mortality,
• rural regions where data is sparse and often late.

For the continent, the next generation of health intelligence must be spatial, ecological and predictive. This is not a luxury; it is a necessity. Without it, governments remain locked into reactive cycles, responding only to the crises they can see, while missing those that quietly accumulate in unobserved regions.

A future of African health intelligence will require systems that surface meaning where data is thin, not only where it is abundant.

“We all are global health actors.”

Every choice – what we eat, wear, buy – carries implications for someone’s health elsewhere. The observation gently punctures the illusion that health systems alone can correct structural inequities. It widens the frame to include climate, mobility, commerce, information flows, and the invisible ties that bind lives across continents.

This is where health intelligence must evolve: from sector-specific tools to cross-sector value streams that reflect the true complexity of African societies.

The Path Ahead: Building Differently, Not Later

Joy imagines speaking to future generations:
“We have actually developed tools that will be invaluable for you… We can reduce poverty, reduce ill health, improve education… but only if harnessed in the right way and made available to everybody.”

Her words carry both hope and warning.

Africa cannot rely on external systems that do not recognise its constraints, its trust networks, or its geographies. Nor can it wait for global tools to adapt to its needs. The continent must create solutions that emerge from its own realities—offering precision where others offer generality, resilience where others assume stability, and cultural fluency where others assume homogeneity.

This is why DPE’s mission matters. It is not simply to innovate, but to build systems that elevate community voices, strengthen trust; and ensure that information, the new determinant of health, reaches every household in forms they can understand and act upon.