On a sunny morning in October 2025, 42-year-old Fatima Ibrahim walked into the outpatient department of the Adamawa Specialist Hospital in Yola, north-eastern Nigeria. Fatima had been vomiting for days and felt increasingly weak. She said she believed going to the hospital was the safest option; however, her consultation with the doctor was brief. After asking a few questions and checking her vitals, the doctor gave her a handwritten prescription and asked her to collect her medication from the hospital pharmacy. Fatima moved from one pharmacy desk to another within the hospital, each pharmacist struggling to read the illegible handwriting.
Eventually, one pharmacist examined the prescription for a moment and told her, “This prescription is not clear. You will have to go back to the doctor.” Exhausted, Fatima turned back toward the consulting room. As she walked under the midday sun, she became unsteady. A few metres from the hospital entrance, she suddenly lost her balance and fell. A passerby rushed to help her up and guided her to a bench until she was stable.
“I felt very light-headed,” she recounted. “My body was already weak, and the back-and-forth movement made it worse.”
After resting briefly, she went back to see the doctor, who clarified the prescription he had written only minutes earlier. She then returned to the pharmacy for the second time. By 2:30 p.m., nearly four hours after she first arrived at the hospital, she finally received her medication.
Handwritten prescriptions are common in many Nigerian hospitals, especially in Adamawa State. Moses Mathew, a medical doctor at Specialist Hospital in Yola, told HumAngle that on busy days, prescriptions are often written hurriedly due to long patient queues. “All prescriptions are handwritten,” he noted. “After consulting with the patient, I write the diagnosis in the case file and then write the prescription on a card or prescription sheet for the patient to take to the pharmacy.”
Emmanuel Somtochukwu, a pharmacist, said he’s familiar with patients returning to consultation rooms because of illegible prescriptions.
“Illegibility remains one of the most common challenges with handwritten prescriptions. In most cases, they are quite difficult to interpret and dispense,” Pharm. Emmanuel said, adding that prescriptions also frequently arrive with missing details on dosage, strength, duration, or frequency of medication intake.
Dr Mathew acknowledged that while this does not happen often, it can occur on extremely busy days, and the patient may need to return for clarification. “Sometimes it is because the handwriting is not clear. It happens, but it is not usual,” he said.
Recent studies conducted separately in hospitals across northern and southern Nigeria have consistently identified illegible prescriptions as the leading prescriber-related error, leading to incorrect drug dispensing and, in some instances, death.
Pharm. Emmanuel, however, reiterated that the back-and-forth due to illegible writing is common where he works. He claimed that “about one in every ten patients is sent back to the consulting room due to unclear handwriting or missing clinical information, though this often depends on the department or the attending clinician”.
Patients, he noted, often carry handwritten prescriptions from one unit to another, dealing with unclear instructions, queues, and repeated walks within the same facility, even when they are already unwell. These interruptions, Dr Mathew noted, also affect clinical workflow.
“When patients return for clarification, it interrupts consultations,” he said. “Time spent rewriting prescriptions or answering pharmacy queries reduces the number of new patients that can be seen in a day and adds to fatigue.”
A troubling system failure
In August 2025, Aisha Bello, who was pregnant, visited Cottage Hospital in the Girei area of Adamawa State for a routine check-up. She said that the pharmacist could not read the doctor’s instructions and could not dispense her tablets without confirmation.
“I was told I must go back,” she recalled. “I was tired. My legs were aching.”
When she returned, one of the prescribed medications was out of stock. She was asked to take the same handwritten note to a different pharmacy outside the hospital.
“When drugs are unavailable in one unit, patients may experience lost time, delayed commencement of therapy, or even abandon treatment altogether,” Pharm. Emmanuel explained.
What Fatima and Aisha experienced was a system failure; the problem was not the diagnosis but the process they had to follow to receive treatment. In many hospitals in Nigeria, medical care depends heavily on paper moving between disconnected units, forcing patients, many of them weak, pregnant, or elderly, to carry their own medical information.
“Without easy access to a patient’s previous prescriptions, allergies, or medical history, decisions are made with incomplete information,” Dr Mathew noted. “You rely heavily on what the patient remembers or what is written in the paper file. This increases the risk of drug interactions, repeated medications, or prescribing something a patient may be allergic to.”
He suggested digital public infrastructure (DPI) as a solution, enabling health facilities to share information seamlessly with patients. He argued that a digital prescribing system could entirely change patients’ negative experience with handwritten prescriptions.
“Prescriptions would be clear and instantly accessible to pharmacists,” he said. “Doctors would also be able to see past prescriptions, allergies, and drug availability. It would save time and ultimately make care safer and more efficient for patients.”
DPI refers to shared digital systems that enable governments, service providers, and institutions to securely share information and work together efficiently. In healthcare, the infrastructure enables prescriptions, medical histories, insurance status, and laboratory results to move electronically between units, without requiring patients to act as messengers.
The United Nations Development Programme (UNDP) defines DPI as “interoperable, reusable and privacy-respecting digital systems” that enable both public and private actors to deliver services at scale and with greater efficiency. According to UNDP, countries that invest in these shared digital foundations are better able to expand access to healthcare, social protection, and financial services without duplicating effort or excluding vulnerable populations.
Digital identity is often the starting point for effective DPI in healthcare, experts said, noting that when patients are reliably identified across systems, their records, insurance coverage, and entitlements are easily linked and verified instantly. In Nigeria, the National Identity Management Commission (NIMC) reports that over 120 million National Identity Numbers (NINs) have been issued as of 2024, serving as a major building block for integrated public services, including health insurance and electronic medical records.
Lessons from other countries
Countries with interoperable digital health systems have demonstrated what is possible. Estonia’s health system allows doctors and pharmacists to access patient prescriptions and records through a shared digital platform, reducing prescription errors and wait times. In India, the Ayushman Bharat Digital Mission links digital health IDs, electronic prescriptions, and insurance claims across public and private facilities, enabling near-instant verification for millions of patients.
According to Asor Ahura, a Nigerian-based AI engineer and digital health expert, electronic medical record (EMR) systems, a digital version of a patient’s paper medical file used within a health facility, have become standard globally because of the efficiency they bring to health facilities and digital prescribing. Asor added that these systems improve speed, accuracy, and the integrity of clinical decisions in ways paper-based processes cannot match.
Across Nigeria and other parts of Africa, private health-tech startups are attempting to close the digital divide. One such company, Helium Health, says it has digitised operations for more than 500 healthcare providers in Nigeria and Kenya. However, these efforts remain fragmented, and the broader challenge of system-wide integration persists.
Why Nigeria’s health sector struggles with interoperability
Nigeria’s health sector is undergoing digital reform, but interoperability remains largely aspirational rather than operational. Most public hospitals still rely on paper records or isolated digital tools that do not communicate with one another. Handwritten prescriptions remain vulnerable to legibility errors, while paper records degrade over time. Digital records, by contrast, can be preserved, duplicated securely, and retrieved instantly.
“Physicians are not known for great penmanship, which leads to the legibility issues associated with paper-based prescriptions that often cause pharmacists to dispense wrong regimens to patients. Furthermore, paper is relatively more destructible than digital information; even with careful handling, the former erodes in quality while the latter can persist indefinitely,” Asor noted.
In 2024, the Federal Ministry of Health and Social Welfare launched the Nigeria Digital in Health Initiative (NDHI), which is designed to create a national digital health backbone that supports interoperable electronic medical records, shared data standards, and secure health information exchange across public and private providers. However, the initiative is still in its early stages. Many state hospitals, including those in Adamawa, are yet to benefit from the infrastructure, funding, training, and governance structures required to make interoperability routine in daily clinical practice.
According to NDHI, scaling digital health systems requires coordination across federal and state governments, regulators, technology vendors, and health workers. Asor argues that a key missing shift is the adoption of hospital-wide EMR systems, noting that digitising prescriptions alone, without integrating laboratories, radiology, and clinics, still results in poor patient experiences and care.
Another major barrier to interoperability is the slow development and enforcement of national standards and legal frameworks for digital health. While Nigeria has articulated a vision for digital health transformation, binding requirements for interoperable systems, electronic prescribing, and patient data portability are still evolving.
Ridwan Oloyede, a tech policy consultant and Co-founder of Tech Hive Advisory, said the digital health services bill seeks to address some of these gaps by defining rules around digital health platforms, data protection, system accreditation, and interoperability standards. Corroborating, Asor noted that countries with seamless data sharing rely on Fast Healthcare Interoperability Resources (FHIR), a global standard for storing and exchanging medical data. He said Nigeria would need to adopt a national implementation guide and mandate FHIR compliance to avoid creating new digital silos.
For patients like Fatima and Aisha, the absence of interoperability is not an abstract policy/implementation gap. It translates into longer waiting times, repeated walks across hospital compounds, delayed treatment, and increased physical strain, especially for pregnant women, the elderly, and those already unwell.
“Personnel training is key,” Asor added. “Basic digital skills are a must for all health facility personnel if the benefits of digitisation are to be realised. Government needs to implement recurrent training of its staff along with provision of infrastructure, including computers, internet and local network connectivity as a precursor to the implementation of the EMR.”
This report is produced under the DPI Africa Journalism Fellowship Programme of the Media Foundation for West Africa and Co-Develop.
