Why Healthcare Software in Africa Is Different

The recent and recurring outbreaks of diseases and other public health emergencies have undeniably strained healthcare systems, particularly across Africa. These challenges have not only necessitated thinking beyond traditional approaches but have also prompted the development of innovative pathways to ensure communities are better prepared and less vulnerable to such emergencies.

It is essential to note that digital networks are not only supporting healthcare delivery in Africa, but they are also fundamentally reshaping how public health interventions are conceived, designed, and implemented. It is no surprise that the African digital health market was valued at approximately US$3.8 billion in 2023 and is projected to reach US$16.6 billion by 2030. Indeed, these are not just figures; they represent real lives and communities being impacted and transformed by digital networks.

Increasing the adoption of digital health tools could lead to at least a 15% improvement in efficiency by 2030. This marks significant progress, even amid ongoing challenges such as digital inequity, limited local investments, and infrastructure gaps. Nevertheless, public health stakeholders continue to play their roles to ensure that even primary healthcare facilities in the remotest locations are being reached by the digital revolution currently reshaping the health sector.

This digital transformation has significantly improved access to healthcare through telemedicine and virtual consultations, reducing the risks associated with long travel distances and delays in reaching healthcare facilities. Beyond improving access, healthcare facilities themselves are receiving substantial boosts, especially in the areas of drug supply, vaccines, and essential goods. For instance, digital solutions like the Logistics Management Information System (LoMIS), deployed by eHealth Africa, have ensured the timely delivery of essential medicines and reduced stockouts. The deployment of this solution for vaccine distribution across over 300 Primary Healthcare facilities in Sokoto State has proven to be a game-changer.

Hospital Information System: The Backbone of Modern Clinical Data Management

What Is a Hospital Information System? A Hospital Information System is a comprehensive digital platform designed to bring all aspects of hospital operations together. From patient admission to discharge, diagnostics to billing, HIS helps manage clinical, administrative, and financial workflows in a more organized and consistent way. Think of it as the hospital’s digital operating system—keeping departments connected, data accurate, and decisions supported. The Value HIS Brings to Clinical Data Management In the world of healthcare, every decision counts—and those decisions depend on access to accurate, timely, and complete information. Here’s how HIS contributes to better clinical data management: 1. Centralized Patient Information No more digging through files or making extra calls to check a patient’s medical history. HIS keeps patient demographics, lab results, physician notes, prescriptions, and discharge summaries in one system. This ensures everyone involved in a patient’s care is viewing the same information, reducing the chances for oversight. 2. Better Coordination Among Departments Whether it’s the lab, pharmacy, radiology department, or administration, HIS helps those teams work more closely. When a doctor orders a lab test, the request flows directly to the lab without requiring manual intervention. Once completed, the result is added to the patient’s digital record, reducing wait times and keeping things moving. 3. Improved Accuracy and Reduced Errors By digitizing data entry and using standardized formats, HIS helps avoid duplicate entries and transcription mistakes. Medications, allergies, diagnosis codes—all are documented clearly, helping caregivers deliver care with more confidence and precision. 4. Simplified Administrative Tasks Managing appointments, billing, insurance claims, and discharge summaries becomes far easier with HIS in place. Through system-wide interoperability, staff no longer need to toggle between paper forms and different platforms. This approach improves consistency while allowing administrative teams to focus on patient service and operational planning. 5. Reliable Data for Decision-Making HIS systems can generate reports and performance insights that hospital leaders can use to examine trends, understand resource usage, and assess key service areas. This supports thoughtful planning and helps identify areas that may need adjustment or support.

Common reasons for insurance claim denials

Health insurance claim denials and rejections happen when insurers refuse to cover or pay for medically necessary services. Some common reasons for these denials include incorrect or duplicate claims, a lack of medical necessity or supporting documentation, absence of prior authorization, or claims submitted after the required deadline. Additionally, complex denials, such as those categorized as experimental, investigational, or non-covered, are also frequently denied. Providers should not become discouraged when faced with denials or rejections. These setbacks do not necessarily mean the claim is lost. Mistakes can be corrected, or the claim can be resubmitted with supporting documentation to confirm its eligibility for coverage. Additionally, it is important to refer to the negotiated contract, payer policy, or other clinical criteria that support evidence-based clinical protocols for managing denials. Why insurance claims are denied Understanding the reason behind the denials (CARC and RARC) is crucial to streamlining the reimbursement process and optimizing your claim reimbursements. Trends behind insurers’ claim denials include: Protections against fraud put into place by insurance companies employ rigorous checks, sometimes flagging legitimate claims for further review and leading to temporary denials. Evolving payer policies and guidelines require providers to stay informed and continuously meet all new and updated requirements. Increased scrutiny of claims by payers can cause even minor discrepancies to lead to denials, making accurate documentation and coding that much more critical. The complexity of healthcare billing, with numerous codes, regulations, and policies to adhere to, can inadvertently lead to claim denials. Misunderstandings or lapses in communication among healthcare providers, billing teams, and patients can cause claims to be submitted inaccurately. Most common denial of claim reasons What are the most common reasons insurance companies reject claims? The most common denial of claim reasons include: Missing or incomplete information or documentation Clear and comprehensive documentation is the backbone of any successful insurance claim. Missing or inaccurate details about a diagnosis, treatment, or procedure can cause a denial. Information on or submitted with a claim must be accurate and complete. This includes: Patient information including name, date of birth, address, and insurance policy number(s) Provider information including name, address, and National Provider Identifier (NPI) number Codes including procedure (must match the provided service or treatment), diagnosis (must be medically necessary and supported by the medical records), and place of service (must match the location where the service or treatment was provided) codes Documentation including medical records, prescriptions, and referral forms COB (Coordination of Benefits) Issues COB denials occur when a patient has two or more insurance policies, and there is confusion or lack of clarity about which plan is primary and which is secondary. Many factors can contribute to COB denials, including: Complex payer COB policies that can be difficult to understand Incomplete or inaccurate information on the claim form, like the patient’s insurance information and the dates of coverage for each plan Communication errors between payers to determine and agree on which plan is primary and which is secondary (or tertiary, etc.) Lack of medical necessity or supporting documentation Insurers may deny a claim if they believe that the service or treatment was not medically necessary, if the medical documentation does not adequately support the service, or if the claim does not meet their MCG (Milliman) or InterQual criteria. For instance, they may determine that the patient could be effectively treated with physical therapy instead. These denials often require appeals that provide: Additional documentation that may include medical records, prescriptions, or referral forms Comprehensive justifications for any treatments or tests ordered Incorrect coding More detailed information about the visit or condition Information specific to that policy’s coverage criteria “Gold Standard”’ Information from The Academy of Ortho Surgeons or American College of Cardiology. A “Letter of Medical Necessity” from the physician Failure to obtain prior authorization Providers often struggle to obtain prior authorization due to various factors, and the frequent updates to payer policies exacerbate the issue. Some insurance policies require prior authorization for certain procedures, medications, or medical equipment before these services or treatments can be provided. Examples of services that may require prior authorization include: MRI and CT scans Certain medications Specialist referrals Elective surgeries Durable medical equipment Coverage exclusions or limitations Insurance plans have specific guidelines on which services or treatments they cover and which they don’t. Common examples of non-covered services or treatments include: Elective surgeries Durable medical equipment New or experimental procedures Chiropractic care Physical therapy Dental or vision care Hearing aids Most policies also have defined limitations, such as a set number of visits or procedures – for example, a set number of physical therapy visits – allowed per year. Duplicate claims A duplicate claim denial occurs when a claim is submitted multiple times for the same service or procedure performed on the same day. This can happen for reasons such as: A provider submitting a claim multiple times by mistake – more likely to occur when claims are sent manually A billing software or system inadvertently submitting the same claim multiple times Glitches in a payer’s system resulting in duplicate claims processed You may also see denials for services not paid separately, meaning that service or procedure was included in the payment or allowance for another service or procedure that has already been billed, processed, and paid. Timely filing A timely filing denial occurs when a claim is submitted after the deadline, typically 120 to 180 days from the date of service, set by the insurance company. Reasons a claim may be filed late include: Delays in receiving patient information or other necessary documentation from the patient Inaccurate or incomplete claims returned to the provider for correction Administrative errors such as typos or miscoding Lack of knowledge of, or failing to keep up with, the timely filing deadlines for each insurance company (even rare or out-of-state payers) Denials are not always the fault of the provider To reduce the rate of denials, providers should analyze the 80/20 rule (or Pareto Principle) applied to claims denials which means that 80% of claim denials problems are caused by about 20% of the issues. A crucial first step is to perform a root cause analysis to discover issues caussing denial, rather than just focusing on individual incidents. Clear communication, accurate documentation, and staying informed about payer policies are key elements in navigating the complex landscape of insurance claims and avoiding denials. You can also invest in claims management software and training to help you identify and avoid potential denials or consider utilizing a partner who specializes in complex claims.

Considering Bahmni for Your Private Hospital? 7 Things to Evaluate

If you are researching hospital information systems, there is a good chance you have come across Bahmni. Bahmni is an open-source hospital information system that brings together several established open-source technologies, including OpenMRS for electronic medical records, OpenELIS for laboratory management, Odoo-based functionality for billing and accounting, and other components for areas such as radiology and imaging. The platform is designed to provide an integrated hospital system, particularly in low-resource settings. For hospitals considering an open-source HMIS, Bahmni can be an interesting option to evaluate. But private hospitals have a particular challenge. The question is not simply: "Does the system have an EMR, laboratory, pharmacy and billing?" Most modern hospital systems can demonstrate those capabilities. The more important question is: How well does the system support the connected workflows that make a private hospital operate every day? This distinction becomes especially important once you move beyond the core patient record. From our experience working with healthcare information systems and Bahmni-based environments, some of the most difficult requirements are not about recording a patient's diagnosis or printing an invoice. They are about connecting clinical care with laboratory equipment, inventory, payments, insurance, multiple facilities and financial operations. Here are seven areas we recommend evaluating carefully before choosing Bahmni, or any other HMIS, for a private hospital. 1. Laboratory and Analyzer Integration A hospital laboratory is more than a screen where laboratory staff enter results. Many private hospitals operate chemistry analyzers, hematology analyzers, immunoassay systems and other diagnostic equipment. These machines can generate large volumes of results, and manually transferring those results into an HMIS introduces additional work and opportunities for error. Bahmni provides laboratory management through its OpenELIS component. Its documentation describes workflows for laboratory orders, samples, tests, validation and referrals, with laboratory orders created in the EMR being sent to the laboratory system and results returned to the EMR. However, when evaluating an HMIS, it is worth going one step further. Ask: Can our specific laboratory analyzers integrate with the system? What communication protocols are supported? Can results automatically flow from the analyzer into the laboratory system? How are results mapped to the correct tests and analytes? How are abnormal or critical results handled? Can laboratory staff review and validate results before they reach the clinician? What happens when an analyzer is replaced? Who maintains the integration? How much configuration or custom development is required? For example, imagine a doctor orders a full blood count. Ideally, the workflow should look something like: Doctor orders test → laboratory receives order → sample is collected → analyzer processes sample → result returns to laboratory system → laboratory verifies result → result becomes available in the patient's record. The HMIS is most valuable when that entire workflow is connected. The same principle applies to chemistry, immunoassay and other laboratory equipment. The question to ask Don't only ask: "Does the HMIS have a laboratory module?" Ask: "How will our laboratory actually operate from order to verified result?" That is a much more useful evaluation question. 2. Multi-Clinic and Multi-Facility Operations A private healthcare organization may start with one clinic and eventually operate several facilities. That changes the requirements considerably. A multi-facility organization may need: shared patient records facility-specific users and permissions facility-level billing facility-level inventory inter-facility referrals laboratory services across facilities centralized reporting consolidated financial reporting facility-specific pricing shared or separate pharmacies centralized procurement movement of stock between facilities cross-facility patient histories Consider a simple example. A patient visits Clinic A, but Clinic A does not have a laboratory. The doctor orders a laboratory test and refers the patient to Clinic B, which is part of the same healthcare organization. The ideal workflow might be: Clinic A → Doctor creates laboratory order → Patient referred to Clinic B → Clinic B receives the existing order → Laboratory performs the test → Result is recorded against the original order → Patient is billed for the laboratory service at Clinic B → Other services remain associated with Clinic A. This sounds straightforward. But technically and operationally, there are several things to get right. Who owns the order? Which facility performs the service? Where does the revenue belong? Which price list applies? Who can access the patient's information? How does the referral appear to the receiving facility? How is the patient's bill split? How does reporting handle the transaction? These questions become increasingly important as healthcare organizations expand. Bahmni is designed to support different hospital workflows and can be configured and extended for specific needs. Its documentation also describes it as modular and adaptable. That flexibility is useful, but it also means that a hospital should evaluate its actual multi-facility operating model, rather than simply confirming that multiple facilities can technically be represented. The question to ask "Can the system support how our organization operates across facilities, rather than simply allowing us to install the software at multiple locations?" Those are two very different requirements. 3. Approval Workflows and Controlled Operations Healthcare organizations have many workflows where a user should not be able to simply make a change. Consider inventory. A nurse station may need medication or supplies from the pharmacy. A basic inventory system might allow someone to move stock from one location to another. But a hospital may actually need: Request → Review → Approve → Issue → Receive → Update inventory → Audit For example: A nurse station requests 20 units of a medication. Pharmacy reviews the request. Pharmacy approves the requested quantity. Pharmacy issues the stock. The receiving department confirms receipt. Inventory balances are updated. The transaction remains available in an audit trail. This is different from simply recording a stock transfer. The same principle applies to many hospital processes: procurement approvals purchase orders stock transfers discounts refunds credit notes billing adjustments write-offs high-value procedures changes to pricing financial approvals user access exceptional clinical or operational requests When evaluating an HMIS, look beyond the existence of a feature. Ask how the workflow works. The question to ask "Can the system enforce the controls our organization needs, or will important processes continue to happen outside the system?" If staff have to use WhatsApp, spreadsheets, paper forms or verbal approvals to complete important operational processes, the HMIS may only be digitizing part of the workflow. 4. Payments and Payment Gateway Integration Billing and payments are closely related, but they are not the same thing. An HMIS may be able to generate an invoice and record that an invoice has been paid. A private hospital may need considerably more. For example: Invoice → Payment gateway → Payment confirmation → Receipt → Invoice balance updated → Reconciliation Depending on the market, this could involve: mobile money bank payments cards online payment gateways payment links electronic receipts refunds partial payments payment reconciliation The important question is not simply whether the HMIS has a payment screen. It is whether the system can participate in the hospital's actual payment ecosystem. This becomes particularly important in markets where patients increasingly expect to pay digitally. It is also important for finance teams. If payments are happening through several channels, the hospital needs to know: what was paid when it was paid through which channel against which invoice whether the payment was confirmed whether the transaction has been reconciled whether a refund occurred what remains outstanding The question to ask "How does money move from the patient's payment method into the hospital's financial records?" That is the real payment integration question. 5. Insurance, Tariffs and Co-Payments Insurance introduces another layer of complexity. A patient may not be responsible for the entire bill. Imagine a patient receives services worth MWK 100,000. Their insurer covers MWK 80,000, while the patient is responsible for MWK 20,000. The hospital therefore needs to understand the bill as two related financial responsibilities: Insurer: MWK 80,000 Patient: MWK 20,000 This becomes more complicated when you introduce: insurer tariffs negotiated prices benefit limits exclusions authorizations non-covered services deductibles co-payments different payer contracts partial approvals rejected services changing payer rules A system might be able to identify an insurer on a patient's account. That is not the same as supporting the complete insurance workflow. For private hospitals, insurance is often deeply connected to revenue management. A service is provided. The service is priced. The payer determines what it will cover. The patient pays their portion. The hospital submits the claim. The payer processes the claim. The hospital receives payment. The hospital reconciles what was expected against what was actually paid. The HMIS should help connect these steps. The question to ask "Can the system represent the financial relationship between the patient, the hospital and the payer throughout the entire care and billing process?" 6. Claims Management: From Submission to Payment Insurance claims are one of the areas where the difference between an HMIS feature list and real-world hospital operations becomes particularly obvious. Creating a claim is only one part of claims management. A typical workflow might look like: Services delivered → Invoice generated → Claim prepared → Requirements checked → Claim submitted → Payer processes claim → Claim accepted/rejected → Corrections made → Claim resubmitted → Payment received → Claim reconciled Consider a rejected claim. The important question is not simply: "Does the system show that the claim was rejected?" The hospital also needs to know: Why was it rejected? Which service caused the rejection? Can the problem be corrected? What information is missing? Can the claim be resubmitted? Has it already been resubmitted? How much remains outstanding? Was the claim partially paid? What patterns are appearing across claims? This is where claims intelligence becomes important. For example, an HMIS could identify potential problems before submission. Perhaps a required authorization number is missing. Perhaps a service is not covered. Perhaps a tariff does not match the payer's expected tariff. Perhaps required documentation is missing. Perhaps a patient's insurance information is incomplete. Catching these problems before submission can be considerably more useful than discovering them weeks later in a rejection report. The post-submission workflow matters just as much. A hospital needs to move from: Rejected → Correct → Resubmit → Track → Receive payment → Reconcile rather than simply recording a rejection and leaving the finance team to manage the rest manually. The question to ask "Does the HMIS manage the lifecycle of a claim, or does it simply create and submit claims?" 7. The Operational Layer: Connecting the Hospital Together The six areas above point to a broader issue. An HMIS is not just an electronic medical record. The patient record is at the center of healthcare delivery, but a private hospital also has to manage: patients clinicians appointments clinical documentation laboratory radiology pharmacy inventory billing payments insurance claims procurement multiple facilities reporting financial reconciliation These functions are connected. A doctor orders a laboratory test. The laboratory performs it. The patient is billed. The insurer may pay part of the bill. The pharmacy may dispense medication. Inventory decreases. The patient may pay a co-payment. The insurer later processes the claim. The finance team reconciles the payment. The hospital manager reviews revenue and operational performance. That is one connected healthcare workflow. The value of an HMIS increasingly comes from how well it connects these processes. Bahmni itself is designed around this integrated concept. Its official feature set spans patient registration, clinical services, laboratory, inpatient management, stock management, billing/accounting and reporting. So when evaluating Bahmni, or any other HMIS, it is worth moving beyond the traditional checklist of modules. Instead of asking: "Does it have billing?" ask: "How does billing interact with clinical services, insurance, payments and finance?" Instead of: "Does it have a laboratory?" ask: "How does a clinical order become a verified laboratory result, including integration with our actual equipment?" Instead of: "Does it support inventory?" ask: "How does inventory move through our approval and operational workflows?" That shift in thinking can significantly improve an HMIS evaluation. Open Source vs. Managed HMIS There is another decision that is sometimes overlooked when selecting an HMIS. It is not only about which software you choose. It is also about how you want the software to be operated. Bahmni is open source. Its components and integrations are available under their respective open-source licenses, and organizations can deploy, configure and modify the system according to their needs and the applicable licenses. Bahmni's current installation documentation supports deployment using Docker and also describes cloud deployment options. This creates flexibility. But flexibility also creates decisions. Who will: provision the infrastructure? manage the servers? monitor availability? perform backups? manage upgrades? manage security? troubleshoot integrations? maintain laboratory interfaces? configure workflows? train users? support facilities? maintain customizations? respond when something breaks? A hospital can manage these responsibilities internally. It can also work with an external implementation or technology partner. Another approach is to use a managed HMIS, where the healthcare organization subscribes to the platform and the technology provider takes responsibility for much of the underlying technology operation. Neither approach is automatically right for every organization. The important question is: How much of the technology platform does your hospital want to own and operate? For an organization with a strong internal technology team, extensive customization requirements and a desire for direct control over its infrastructure, an open-source/self-managed approach may be attractive. For an organization that would rather focus its internal resources on healthcare operations and have the technology platform managed as a service, a managed HMIS may be worth considering. The decision should be based on the hospital's capabilities, requirements, budget, risk tolerance and long-term operating model. Where Sigma Fits Sigma takes the managed-platform approach. Instead of asking a hospital to assemble and operate its own HMIS environment, Sigma provides a healthcare information system as a managed service. The goal is to bring the clinical, financial and operational parts of healthcare delivery into one platform while reducing the technology-management burden on the healthcare organization. Sigma HMIS covers areas including: patient registration and records clinical documentation billing insurance and claims pharmacy laboratory inventory reporting and analytics multi-facility operations operational workflows integrations with external systems The underlying philosophy is simple: Healthcare organizations should be able to run their hospitals without having to build an entire technology operation around their HMIS. That does not mean an open-source system is the wrong choice. It means there are different ways to operate a hospital information system. One organization may want to own and operate its technology stack. Another may prefer to consume the HMIS as a managed service. Both are legitimate approaches. The important thing is to make the choice deliberately. A Practical HMIS Evaluation Checklist If you are currently evaluating Bahmni, OpenMRS, Sigma or another hospital information system, consider taking your evaluation beyond the feature list. Ask these questions: Clinical Can clinicians document the workflows we actually use? Can the system support our consultation and encounter processes? Can clinical information follow the patient across facilities? Laboratory Can our analyzers integrate? How do orders reach the laboratory? How do verified results return to the patient record? Who maintains the integrations? Pharmacy and Inventory Can stock be managed across multiple locations? Can departments request stock? Are approvals supported? Is there an audit trail? Can inventory movements be reconciled? Billing Can the system handle our pricing and billing workflows? Can patients make partial payments? Can discounts and adjustments be controlled? Can payments be reconciled? Insurance Can multiple payers be configured? Can payer-specific tariffs be managed? Can co-payments be calculated? Can authorization requirements be managed? Can non-covered services be handled? Claims Can claims be prepared and submitted? Can potential problems be identified before submission? Can rejected claims be corrected and resubmitted? Can partial payments be reconciled? Can outstanding claims be tracked? Multi-Facility Can multiple facilities operate within one organization? Can patients move between facilities? Can orders and referrals move between facilities? Can billing be attributed correctly? Can management see consolidated and facility-level reporting? Technology Who hosts the system? Who manages backups? Who manages upgrades? Who handles security? Who supports users? Who maintains integrations? What happens when the hospital needs a new workflow? Commercial What is the total cost over three to five years? What internal staff will be required? What infrastructure will be required? What happens when the system needs customization? What does ongoing support cost? How will the system evolve as the hospital grows? The Real Question Is Bigger Than "Which HMIS?" Bahmni is an important example of what an open-source hospital information system can provide. It brings together several established technologies into an integrated hospital platform and has been used across a wide range of healthcare environments. But choosing an HMIS should not start and end with a software demonstration. The real evaluation is about the hospital. How does the laboratory operate? How does inventory move? How are approvals handled? How does money move? How does insurance work? How are claims managed? How do multiple facilities work together? Who operates the technology? And what happens when the hospital grows? These are the questions that determine whether an HMIS becomes part of the hospital's operating infrastructure or remains another piece of software. For private hospitals in particular, the difference can be significant. The goal is not simply to digitize the patient record. The goal is to connect care, operations and revenue. Evaluating Bahmni? Consider the Operating Model Too If you are evaluating Bahmni or OpenMRS for a private hospital, it is worth considering both the software and the operating model around it. Ask: What does the hospital want to own? What does the hospital want to manage? What does the hospital want a technology partner to manage? How will the system integrate with the hospital's existing equipment, payers and payment systems? How will it support the organization as it grows from one facility to several? And perhaps most importantly: What happens after the HMIS goes live? That is often where the real difference between approaches becomes visible. Looking for a Managed HMIS? Sigma HMIS is a managed hospital information system designed for healthcare organizations that want their clinical, financial and operational workflows connected without having to build and operate the entire technology platform themselves. If you are currently evaluating Bahmni, OpenMRS or another HMIS, Sigma is another option worth evaluating alongside them. Explore Sigma HMIS → Request a demo → Compare your current HMIS requirements with Sigma → The objective is not simply to choose software. It is to choose an operating model that works for your hospital.

Why Healthcare Software in Africa Is Different

More to read

Hospital Information System: The Backbone of Modern Clinical Data Management

Common reasons for insurance claim denials

Considering Bahmni for Your Private Hospital? 7 Things to Evaluate

Why Healthcare Software in Africa Is Different

More to read

Hospital Information System: The Backbone of Modern Clinical Data Management

Common reasons for insurance claim denials

Considering Bahmni for Your Private Hospital? 7 Things to Evaluate