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On a sunny morning in October 2025, 42-year-old Fatima Ibrahim walked into the outpatient department of the Adamawa Specialist Hospital in Yola, northeastern 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.

PORTLAND, Conn. — Democratic presidential nominee Bill Clinton on Tuesday pressed his charge that President Bush has mishandled the economy, using a manufacturing plant as his stage to lament the loss of blue-collar jobs and to flesh out a plan to resurrect the nation’s manufacturing base.

At the Standard-Knapp corporation here–and later at a rally outside an East Haven, Conn., restaurant–Clinton sought to place the blame squarely on the incumbent for the ebbing away of America’s once-stalwart manufacturing base.

“The percentage of our workers employed in the manufacturing sector has continued to decline,” despite productivity gains posted by many companies, Clinton told the Standard-Knapp workers, who assemble packaging machines.

He said, “Just in the last four years, we’ve lost 1.3 million manufacturing jobs.”

The federal Bureau of Labor Statistics confirmed Tuesday that the number of U.S. manufacturing jobs has fallen by 1,388,000 since Bush took office in January, 1989, to 18,150,000. Total non-farm employment grew slightly over the same period, increasing 188,000 to a total of 108,517,000 as of last month, with most of the growth in government employment.

Clinton decried the lack of a coordinated national response to the manufacturing sector’s job decline.

“Unlike our competitors, this country has no national strategy, no comprehensive partnership between business and workers and education and government to create the kinds of high-wage, high-growth jobs in manufacturing that I think are critical to our future,” he said.

Clinton’s Tuesday campaign message was meant to build upon his Labor Day efforts to depict Bush as a man who has allied himself with the rich and powerful and has forgotten needy and working Americans.

As part of offering himself as an alternative, Clinton announced what he touted as a new manufacturing policy, which largely tied together proposals he has advanced throughout his presidential campaign.

One new element in the plan calls for establishment of 170 high-tech centers that would serve as incubators for new manufacturing ideas, which would then be shared with small- and medium-sized companies. The centers would be modeled after the agricultural extensions common in rural areas of the country.

Clinton said the centers would solve the “technological gaps” that plague smaller companies, as well as retrain the scientists and engineers previously employed in the dwindling defense industry.

“There are 200,000 unemployed defense workers, technicians, scientists and engineers in California alone today,” Clinton said. “And these people have all this incredible potential to add to our national wealth, but we don’t have a system for moving them from the defense sector into the non-defense sector. The extension centers will help to do this.”

Later, however, Clinton said only 25 of the centers would be “almost exclusively” dedicated to defense workers, and another 25 to the manufacturing industry. Also, it was unclear where they would be located.

In describing his plan, Clinton demonstrated the difficulty of trying to mount a campaign as a “new style” Democrat, who is focused on the technologies and jobs of the future, and still satisfy the desires of organized labor, which has come aboard his campaign vigorously and has provided a sizable portion of the crowds at many of his recent rallies.

For instance, Clinton suggested repeatedly Tuesday that the U.S. should mimic the approaches of its chief economic competitors.

“Everybody knows we’ve lost a lot of auto jobs in the last 10 years and we’ve lost a lot of steel jobs in the last 10 years,” Clinton said. “But if you look at the Germans and the Japanese . . . when they moved people out of automobiles, they moved into other manufacturing technologies with a future. When our people moved out of automobiles, they moved into the unemployment lines.”

At the same time, though, Clinton sought to show that he remains concerned about the plight of the more traditional businesses that organized labor is trying to salvage.

To that end, he scored Bush for staging a Labor Day campaign event that he suggested missed the point.

“Just yesterday, President Bush had a great photo (opportunity) walking across the bridge that connects Mackinac Island to the mainland of Michigan–a bridge that was built with steel from a mill that is closed in the last four years,” he said.

Ultimately, Clinton settled on mixing a stew of Republican and Democratic ideas for reviving the economy.

“We’ve got to get rid of regulations that don’t make sense,” said Clinton, echoing a line that has been standard in GOP rhetoric. Then he added a distinctly liberal element: “And we’ve got to permit our companies to join together . . . as long as it doesn’t affect their competitive pricing here at home.”

At the rally in East Haven, Clinton reiterated his belief that a combination of approaches is needed to solve the nation’s economic woes.

“A lot of the problems we face today don’t fall very neatly in categories of left and right and liberal and conservative and Republican and Democratic,” he said. “We are living in a post-Cold War world where we are fighting and competing for every dollar we get.”

In general, Clinton has pledged to use the U.S. tax code to benefit domestic businesses and has promised to transfer money saved in defense cutbacks to job-creating programs.

He argued Tuesday, as he has throughout the campaign, that existing tax codes propel many companies to set up operations outside the United States, stripping the nation of jobs as a consequence.

He won his only applause from the Standard-Knapp workers when he pledged to “copy our competitors” and put the heft of the government behind businesses.

“The tax system in America should work to benefit Americans without being protectionist,” Clinton said.

The Arkansas governor also promised to streamline export laws to help companies compete overseas and said he would bolster the export offices in U.S. embassies worldwide.

Overall, Clinton said, his plan would cost about $2 billion a year over five years, financed with money now spent on military research.

Today on the Trail . . .

Bill Clinton campaigns in Atlanta and Jacksonville, Fla.

President Bush campaigns in Norristown and Collegeville, Pa., and Middletown, N.J.

Vice President Dan Quayle attends a rally in San Diego and addresses a San Diego Rotary Club luncheon.

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TELEVISION

Clinton is interviewed on WJXT’s “Florida talks to Clinton.” C-SPAN will air it live at 5 p.m. PDT.

Tennessee Sen. Al Gore is interviewed on CNN’s “Larry King Live” at 6 p.m. PDT.

Young resident doctors have gone on strike in the UK, demanding better pay and more training positions that will allow them to continue in their field. Al Jazeera’s Sonia Gallego explains this is the 14th such strike in recent years.