Assessing Digital Health Maturity in Nigeria: Evidence from a Sub-national Assessment across ten (10) states and strategic imperatives for the health sector

Abstract Digital health technologies are pivotal for strengthening health systems and accelerating progress toward Universal Health Coverage (UHC). In Nigeria, while digital health interventions have been widely introduced, disparities in maturity and effectiveness are evident across different states. This study comprehensively assesses digital health maturity across ten Nigerian states, leveraging the Global Digital Health Index (GDHI) framework and the UN Foundation/ICT4SOML maturity model. Employing a mixed-methods approach that includes key informant interviews, document reviews, and quantitative scoring, the analysis evaluates seven core domains: leadership and governance, strategy and investment, legislation and compliance, standards and interoperability, infrastructure, workforce, and services and applications. The analysis also situates surveyed states along a maturity spectrum from experimentation to mainstreaming. Findings reveal substantial variations in digital health readiness among the ten states. Lagos emerged as the most advanced, demonstrating robust governance structures, interoperability initiatives, and strategic investments in ICT infrastructure. In contrast, states like Gombe, Niger, Bauchi, Sokoto, Borno, Nasarawa and Yobe were the least matured, hindered by weak workforce capacity, poor infrastructure, and a lack of standardized interoperability. The assessment further identifies heavy reliance on donor-driven projects, limited state ownership, and fragmented governance as key barriers to sustainable digital health implementation. To address these gaps, the study recommends establishing a National Digital Health Observatory for benchmarking and peer learning, alongside targeted state-level capacity building and infrastructure investments. The findings highlight the urgent need for stronger political commitment, structured governance, and the domestication of national digital health policies at the sub-national level. By mapping states on a digital health maturity spectrum, this study offers a clear framework for targeted interventions, optimized resource allocation, and accelerated progress toward a resilient, interoperable digital health ecosystem across Nigeria’s states. Competing Interest Statement The authors have declared no competing interest. Funding Statement Yes Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethical approval was obtained from the National Health Research Ethics Committee at the Federal Ministry of Health (FMOH). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability All data supporting the findings described in this manuscript are available in the article, Supplementary Information, or from the corresponding author upon request (emeka{at}dpdafrica.com)