Strengthening digital health systems in the Pacific: The need for interoperability and innovation

Abstract

Pacific Island Countries and Territories face unique challenges delivering equitable health services due to vast geographic dispersion, limited transport infrastructure, workforce shortages, and increasing climate risks. This article aims to highlight the urgent need for interoperable, standards-based digital health systems in the Pacific and to outline practical pathways for strengthening regional collaboration and resilience. Digital health is not merely a technological upgrade but an essential enabler of health equity and system sustainability. While telehealth and mobile health have gained traction, their full potential is undermined by fragmented, non-interoperable systems that restrict data flows, duplicate effort, and limit impact. Recent progress including national strategies in some Pacific countries and new regional frameworks championed by the Pacific Health Information Network demonstrates growing commitment to shared standards and people-centered solutions. A key pillar for digital health in the Pacific is the need to address language access capabilities thus building multilingual interoperability of systems for clinical safety, equity and effective public-health communication. Practical examples show how shared infrastructure and collaboration strengthen connected care and workforce development across dispersed islands. Achieving this transformation requires strong governance, climate-resilient systems, ethical data protections, and sustained partnerships. Countries, partners, and institutions are called to embed interoperability in national strategies, invest in local capacity, and advance regionally coordinated initiatives such as a Centre of Excellence for Telehealth and Interoperability further promoting language access and multilingual standards for shared health services and workforce. Together, these actions can build a digitally connected health ecosystem that bridges distances, strengthens resilience, and delivers equitable care for all Pacific communities.

Introduction

Pacific Island Countries and Territories (PICTs) are some of the most dispersed and isolated nations in the world. ¹ Communities are separated by vast stretches of ocean and often face limited transport infrastructure, ¹ alongside persistent health workforce shortages due to a steady outmigration of qualified health professionals and resource constraints. ² These realities make access to timely and quality healthcare a continuing challenge, particularly for those living on remote outer islands. Against this backdrop, digital health emerges not just as a technological innovation, but as an essential enabler of health equity and system resilience, especially in the face of growing climate-related health risks and disruptions to health systems across the Pacific.^3–5

For many PICTs, the COVID-19 pandemic highlighted the urgent need to invest in digital tools that helped sustain essential health services during lockdowns, travel bans, and supply chain disruptions. Beyond crisis response, digital health presents opportunities to strengthen routine care, expand outreach services, and close gaps between urban and remote communities.

Digital health systems, when built on a foundation of shared standards and interoperability, offer the potential to bridge geographic divides, support real-time access to clinical expertise, and promote data-driven decision-making.^6,7 Telehealth has gained traction in the Pacific as a practical tool for overcoming healthcare access challenges. However, its success depends on more than just internet access or connectivity. Interoperability, the ability of different systems and devices to exchange and use data meaningfully, is foundational to ensuring that digital health can scale, integrate, and deliver its full benefits across the region. ⁶ It encompasses both technical interoperability, such as adherence to shared standards and data exchange protocols, and organizational or political interoperability, which includes governance structures, institutional alignment, and policy coherence. Both dimensions are critical to ensuring that digital health investments translate into tangible improvements in service delivery, data continuity, and health outcomes across diverse Pacific contexts.

To fully harness this potential, however, digital health solutions must be integrated into broader health system strengthening efforts. This means embedding digital strategies into national health policies, ensuring local communities are engaged in their design and use, and addressing barriers such as digital literacy and infrastructure gaps. The Pacific's unique context demands solutions that are not only technologically robust but culturally relevant and adaptable to local realities, so that no community is left behind in the digital transition. In the longer term, this digital transformation contributes to climate-resilient health systems, capable of withstanding shocks and maintaining essential services in the face of environmental change.^8,9

Amid a shifting global landscape and growing interest in digital and mobile health, as well as increasing recognition of the value of standards-based systems and people-centered health services,^6,10 the Pacific is facing a unique window of opportunity. By investing in shared infrastructure, strengthening governance, and supporting regional coordination, PICTs can transform fragmented systems into resilient, people-centered, and future-ready health ecosystems. This article aims to emphasize the critical need for interoperable, standards-based digital health systems in the Pacific, and to highlight practical strategies and partnerships that can help accelerate progress toward more resilient and inclusive health systems across the region.

Why interoperability is the Pacific imperative

Despite growing adoption of digital platforms, many Pacific health systems remain hindered by fragmentation. Some countries still rely on paper-based systems, while others use multiple, unintegrated digital tools that are not designed to communicate with one another. This lack of interoperability restricts the flow of health data, complicates service delivery, and inhibits timely and accurate reporting on health indicators.

These challenges are further intensified by climate-related disruptions. Cyclones, flooding, and rising sea levels regularly interrupt traditional service delivery models. When clinics are damaged or roads and runways are inaccessible, digital solutions become essential for remote consultations, maintaining patient records, and coordinating supply chains and outbreak responses.

Addressing these challenges requires more than upgrading hardware or introducing new apps. It calls for a deliberate shift toward standards-based systems that can link to each other and grow together over time. By prioritizing interoperability, countries can ensure that investments in health information systems and telehealth are future-proofed, scalable, and capable of supporting patient-centered care across diverse health settings. This approach not only reduces inefficiencies but also lays the groundwork for better regional surveillance, coordinated responses to outbreaks, and evidence-informed policymaking.

The consequences of non-interoperable systems are tangible: duplication of effort, clinical errors due to lack of information continuity, inefficient referrals, and missed opportunities for preventive and clinical care. While much of the evidence is currently qualitative or anecdotal, emerging evaluations from the region indicate measurable benefits of connected systems, such as reduced patient referral times and improved reporting completeness. Future work should focus on collecting systematic metrics, including adoption rates, cost-benefit analyses and health outcome improvements, to quantitatively substantiate these observations. Equally important is ensuring that these systems are secure, respect patient privacy, and uphold ethical data governance standards, building trust among communities whose data they hold.

A region working together

Recognizing the urgency and opportunity, Pacific countries are increasingly embracing collaboration as the key to digital transformation. The Pacific Health Information Network (PHIN), comprising PICTs and supported by partners including the Pacific Community (SPC), WHO, and many others, has emerged as a critical platform for regional dialogue and collective progress. ¹¹ During PHIN's regional meeting in March 2025, stakeholders reached consensus on the development of a regional framework for standards adoption and interoperability, designed to harmonize efforts and support the rollout of scalable digital health solutions.

For example, the case of Tuvalu offers a compelling example of the power of connectivity when underpinned by collaboration. ¹² Through the Very Small Aperture Terminals (VSAT) network, Tuvalu's sole hospital, Princess Margaret Hospital (PMH), is digitally linked to eight outer island clinics. With recent enhancements using Starlink, health workers can now consult directly and in near real time with PMH medical staff. Preliminary indicators suggest this connectivity has improved patient management and reduced unnecessary referrals; however, systematic evaluation of adoption outcomes, cost-effectiveness, and clinical impact remains limited. Additionally, the system has become a valuable tool for workforce development by connecting nurses on outer islands with doctors for ongoing education and mentoring.

This spirit of collective action demonstrates the region's commitment to learning from one another and sharing limited resources for maximum impact. Countries with more advanced systems can mentor those at earlier stages of digital health adoption, while pooled investments in infrastructure, training, and licensing can make transformative technologies more accessible. By speaking with a unified voice, PICTs can also advocate more effectively for international support and partnerships that respect Pacific contexts and priorities.

Similar progress is visible elsewhere. Fiji's Digital Health Strategy 2023–2027 ¹³ mandate adherence to digital health standards, the Solomon Islands is integrating multiple platforms including Tamanu, Senaite, and Tupaia to enable seamless data flows. Kiribati and other countries are implementing foundational components such as Master Patient Indexes and immunization information systems to support connected care.

These efforts are bolstered by regionally coordinated initiatives such as the Pacific-Core FHIR Implementation Guide, shared licensing strategies for clinical terminologies, and a growing interest in establishing a regional Patient Summary to facilitate cross-border and telehealth services. Together, these reflect a rising momentum across the Pacific to build systems that are not only nationally owned but regionally interoperable.

What has held us back and what is changing for action

The Pacific's digital-health story is not one of absence but of many pilots and few scaled platforms. Several factors have historically limited scale: fragmented procurement and donor-driven pilots; variable connectivity and power resilience; limited in-country integration skills; vendor lock-in and lack of standards adoption; workforce turnover; and language access gaps that undermine patient comprehension.

Recent momentum through health leaders’ commitments including connectivity upgrades and stronger national digital health strategies shows how these barriers are being committed to address in the region. However, execution details remain critical. Lessons from existing pilot projects highlight where design and operational adjustments were needed, including strengthening interoperability, integrating multilingual workflows, and ensuring workforce continuity. Practical strategies to operationalize this pillar include code-first clinical data with localized displays; a regional terminology and translation service; interpreter-on-demand integration with telehealth; and ethical development of Pacific language corpora.

Language access and multilingual interoperability must be considered a core pillar of Pacific digital health systems. Most Pacific populations and many front-line health staff operate in languages other than English, while today's systems remain unreliable for other languages. Without governed, multilingual workflows, clinical communication, consent and public-health messaging risk failure at the last mile. Integrating these actionable measures would strengthen clinical safety, equity and effective public-health communication. By systematically addressing these historical barriers and integrating lessons learned, PICTs can design and implement scalable, interoperable, and equitable digital health systems that are more resilient, and people centered.

Catalyzing action through regional leadership and partnerships

Achieving digital transformation in the Pacific requires more than deploying technologies—it demands strong leadership, regional coordination, and sustained investment in infrastructure, workforce, and governance. Guided by long-standing regional aspirations such as the Healthy Islands Vision ¹⁴ and the Blue Pacific 2050 Strategy, ¹⁵ digital health must be seen as a foundational enabler of resilient, equitable, and people-centered health systems.

To operationalize interoperability, countries can adopt phased implementation plans that include: (a) establishing governance structures for cross-institutional coordination; (b) designing workforce capacity-building initiatives including digital literacy training and mentorship; (c) developing financing models that combine domestic and development partner support; and (d) integrating monitoring frameworks to track system adoption, data quality, and clinical impact. These practical steps help ensure that interoperability moves beyond an aspirational goal to actionable implementation.

Building these future hinges on a shared sense of responsibility and mutual accountability. Regional leadership must be matched by strong national ownership, with governments taking the lead in developing policies that balance innovation with privacy and security. The role of the private sector, local innovators, and civil society is equally important to foster user-driven solutions, encourage digital literacy, and build trust in new ways of delivering care. By aligning these diverse actors behind clear, shared goals, the Pacific can accelerate its digital transformation journey in a way that is inclusive, ethical, and sustainable.

The SPC, alongside the PHIN, WHO, and other partners, plays a pivotal role in helping countries translate national ambitions into scalable, standards-based solutions. Through technical assistance, policy support, and shared platforms, these institutions offer the foundation for collective progress and knowledge exchange.

Health leaders across PICTs are urged to embed interoperability into national digital health strategies, backed by aligned policies and multisectoral collaboration.^16,17 Strengthening local capacity through training, peer learning, and hands-on support is vital to sustaining momentum. Climate-resilient digital systems must also be prioritized to ensure continuity of care during disasters and emergencies, in line with regional resilience goals.

Development partners should align their investments with national efforts and support must reinforce local leadership and build long-term institutional capacity. Establishing a Regional Centre of Excellence for Telehealth and Interoperability is also critical. Such a hub would serve as a catalyst for innovation, capacity-building, and policy advancement, aligned with the broader sustainable development priorities of the region. Together, these coordinated efforts can unlock the full potential of digital health, not only to transform care and improve equity, but also to realize the shared regional vision of stronger health systems.

Conclusion

The Pacific stands at a pivotal crossroads. Fragmented digital systems are no longer tenable in a region where health equity, climate resilience, and access are critical. Interoperability, encompassing both technical and organizational dimensions, is not just a technical goal but also a moral and strategic imperative. By clearly delineating standards, governance, and operational strategies, countries and partners can translate this imperative into concrete actions that improve health outcomes and system efficiency. By working together across countries, partners, and institutions, the Pacific can forge a digitally connected health ecosystem that delivers smarter, stronger, and more equitable care for all, even in the face of increasing climate-related challenges. The foundation is laid, the commitment is made, and the momentum is real. Now is the time for bold commitments, clear milestones, and sustained collaboration to deliver a healthier, more connected climate-resilient Pacific for generations to come.

Ultimately, success will be measured not only by technological milestones but by the tangible improvements felt by families and communities across islands, whether through quicker diagnoses, better continuity of care, or timely information to tackle emerging health threats. By putting people at the center of digital innovation, the Pacific can demonstrate how technology, when guided by shared values and collective action, becomes a force for resilience, equity, and enduring wellbeing.