Digital health systems keep failing. The fix isn’t more tech, it’s designing with and for people

By Lara Tabac and Carlie Congdon of Vital Strategies

Governments around the world are pouring resources into digital health and data systems, hoping that better technology will lead to better decisions. From electronic birth registration to real-time mortality dashboards, the promise is appealing: faster data leads to clearer insights and smarter public health policy.

Yet despite major investments, many of these systems remain underused, mistrusted, or disconnected from day-to-day reality and decision making. The problem is rarely technical. It’s that too many systems were designed without considering the people expected to use them.

That lesson became clear last year when eight countries participating in the Bloomberg Philanthropies Data for Health Global Grants Program came together to share experiences strengthening civil registration and vital statistics (CRVS) systems and improving data use for planning and policy making. Conversations focused on interoperability, governance, and digital transformation, but a simpler reality emerged through the technical language: digital systems only succeed when they align with how people actually work.

This is where human-centered design (HCD) becomes essential. Long embraced in consumer technology, HCD remains rarely and inconsistently applied in public health systems. It starts by understanding the lived experiences of parents registering births, health workers reporting deaths, civil servants managing systems, and policymakers using data. Without that grounding, even the most sophisticated digital platforms can fail.

Digital CRVS and data use systems – promises and limits

Digital tools are reshaping CRVS systems worldwide. Electronic registration platforms, mobile applications, and data sharing between health and civil registration agencies have made it easier to record births and deaths. When they work well, these systems can produce more timely, complete, and accurate data, which is critical for public health surveillance, legal identity documentation, and sound policymaking.

In Rwanda, engagement with policymakers and district health managers helped shape a national CRVS dashboard that made data more accessible for planning and resource allocation. Elsewhere, countries are investing in dashboards, data warehouses, and analytics to improve data use. Ecuador linked data across government agencies to identify people eligible for nutrition and cash transfer programs and connect them with nearby services. Sierra Leone is integrating mortality data from multiple sources so decision-makers can see a more complete picture of deaths nationwide.

Digital tools hold incredible promise and introduce risk. Systems that ignore real-world constraints, including limited connectivity, heavy workloads, or unclear incentives, can entrench inequities, frustrate frontline workers, or quietly fall into disuse. Too often, governments discover after rollout that a system works in theory but not in practice.

Why human-centered design changes outcomes

Human-centered design is not about fancy interfaces or more training sessions (though training is certainly key to optimization). It is a methodological approach to understanding people’s needs, constraints, and motivations that involves co-creating solutions with them rather than imposing tools and processes from above. Think of it as the ultimate form of stakeholder partnership.

HCD helps identify practical barriers that technical teams may often overlook, such as unreliable electricity, low digital literacy, low expectations of data quality, or gender-based obstacles to registration.

It forces essential questions: Why does a mother delay registering her child? Why does a health worker skip data entry during a busy shift? What information does a local official actually trust?

When systems reflect these realities, adoption improves. Workflows become smoother, data quality improves, and confidence in the system grows. The most sustainable digital systems are those to which people are sensitized and make their jobs easier, not harder.

Human-centered design also helps ensure that digital reforms do not leave behind populations already underrepresented in official data, including rural communities, certain ethnic groups, women, and groups that have been socially and economically marginalized. Partners in the Data for Health Initiative have worked with governments to identify who is undercounted and why, to ensure systems are designed to close gaps rather than widen them.

Just as importantly, HCD is dynamic and at its core promotes iteration. Instead of treating systems as fixed, it encourages continuous feedback and adaptation. In fast-changing public health environments, static systems quickly become obsolete—those built on principles of continuous improvement survive and thrive.

Lessons from the field

Countries working with the Data for Health Initiative show what happens when human-centered design is overlooked and what changes when it is embraced.

Cameroon has been developing an interoperable system linking the health and civil registration sectors to improve birth and death notification. Although technically functional, the system has struggled with adoption and efficiency. Many frontline workers report difficulty understanding its value or integrating it into existing routines. Interoperability alone did not translate into better data.

Cameroon is now reassessing the system using a human-centered design lens, engaging health workers and civil registrars to identify bottlenecks and redesign workflows. The goal is not just a functioning platform, but one that people trust and use consistently.

Mexico offers a contrasting example. When the National Institute of Public Health developed a digital dashboard for its national health and behavioral risk factor survey, it involved government and civil society stakeholders in deciding which indicators mattered and how results should be displayed. The process took time. It also made the data far more likely to inform policy, and by translating the dashboard into Nahuatl, more far-reaching.

From systems thinking to human thinking

Strengthening CRVS and data systems is often framed as a technical challenge. In reality, it is a human one as well. Data systems are only as effective as the people who operate them, contribute to them, and rely on them to make decisions.

As governments and donors continue to invest in digital health, they should ask a basic question before funding or deploying new tools: Who was this designed for? Were they involved in development? Human-centered design should not be an optional add-on, but a core requirement of digital health investments.

Designing with people at the center will improve outcomes by preventing costly failures, improving equity, and ensuring that digital systems deliver what they promise: reliable data that can be trusted and used to improve public health and save lives.

About the authors

Lara Tabac is the Director of the Global Grants Program at Vital Strategies. Carlie Congdon is the Deputy Director, Program Implementation for CRVS and the Global Grants Program at Vital Strategies. The Global Grants Program has invested over $15 million in financial and technical support to low- and middle-income countries to improve data for public health decision-making, within the Bloomberg Philanthropies Data for Health Initiative.

Article Topics

civil registration  |  CRVS  |  digital ID infrastructure  |  digital identity  |  legal identity  |  Vital Strategies