What would you find inside a Health and Demographic Surveillance System (HDSS) data center?  Perhaps a handful of old desktop computers, a local server humming away (hopefully backed up), or  a shelf full of paper questionnaires from years past. While some sites are more advanced, many HDSS sites in Africa face significant infrastructure and technology gaps, from intermittent internet to limited processing capacity, affecting the quality and reliability of the important data they produce. 

A recent needs assessment carried out by the Implementation Network for Sharing Population Information from Research Entities (INSPIRE) network across 14 Health and Demographic Surveillance System sites in 10 African countries. The assessment was designed to map what these long‑standing population health platforms have, what they need, and where investments-especially in data, skills, and governance-could unlock far greater value for research and policy.

The findings come from a structured, multi‑site study that asked HDSS teams about their current capacities, gaps, and priorities. At a high level, the results show that while these sites hold rich, longitudinal health data and deep community presence, they face persistent constraints in skills, infrastructure, funding, and interoperability. This backdrop helps explain the specific challenges discussed below and underscores why targeted support rooted in real needs rather than assumptions—is essential. It also reflects INSPIRE’s broader emphasis on grounding capacity building and data sharing efforts in thorough, evidence‑based assessments. 

The Hardware Challenges
Due to limited computer power, most HDSS sites are struggling to meet increasing data needs. Only one location claimed completely competent infrastructure, while the rest assessed theirs as incomplete or inadequate. Analyses that should take minutes can take hours, as some sites rely on a single server or a desktop PC, resulting in bottlenecks and single points of failure. Power reliability exacerbates these problems. Many locations are in rural areas with unpredictable electricity; around half have backup generators, some of which are problematic. Power outages halt operations and result in lost data-gathering cycles.

Data storage and backup are other considerations. Most sites keep data on-premises, either on local servers or external hard drives. Only a few reported using encrypted cloud storage for backups. “Secured servers” was the dominant method, meaning data is housed in institutional servers, hopefully with some redundancy. But do they have off-site backups? In some cases, maybe not. If a server room accident or theft occurred, years of data could be at risk. Encouragingly, about 9 in 13 sites said they perform regular data backups and have a disaster recovery plan of some sort. The challenge is whether those plans have been tested and whether backups are stored in a separate, secure location.

Connectivity – The Digital Lifeline
For HDSS sites, being connected unlocks huge potential: sharing data with collaborators, tapping into cloud-based analysis tools, or simply sending timely reports. However, for many sites, internet access remains a persistent concern. Some rely on poor Digital Subscriber Lines (DSL) connections, where uploading a huge dataset can take hours, or on mobile 4G routers that go out when coverage changes. Only a few believed their connectivity was completely stable, while others recognized it was insufficient for normal tasks.

These limitations do more than frustrate staff; they affect how technology can be employed in practice. Many sites have yet to adopt cloud storage or software-as-a-service platforms, not for lack of interest, but because slow or unstable connections and subscription costs make it impractical. Around 60% of sites are not leveraging cloud services, with some staff unaware of the options available. Despite these challenges, progress is visible. Around two-thirds of sites use Microsoft Teams or similar platforms for collaboration, showing that where connectivity is sufficient, modern communication tools can improve teamwork. While bandwidth-heavy tasks remain difficult, HDSS teams are finding ways to stay connected and share knowledge, laying the groundwork for broader technological adoption.

Technology and Security Gaps Across HDSS Sites
Many HDSS sites use older or basic computer stacks. Most rely on Windows systems, with only two using Linux and none using macOS, limiting usage of open-source or advanced data tools. Data management systems are also out of date: numerous sites continue to use OpenHDS, with at least one system failure reported, while others rely on MySQL or Microsoft Access, which may not scale or remain reliable as data quantities expand.

Advanced deployment technologies are mostly nonexistent. Only two sites use Docker, and none use Kubernetes; therefore, efficient, modern application deployment is rare. Similarly, no site uses big-data platforms like Hadoop, and when asked about data lake solutions, several said “none” or “not aware.” While HDSS datasets are not yet “big,” their lack of preparation may cause problems if data sources expand. Security practices are mixed. Most sites have basic security measures in place, such as password protection and access limitations, while 8 out of 13 use data encryption and multi-factor authentication. However, advanced security methods remain limited. Approximately one-third of sites do not have a defined incident response plan, making them vulnerable to data breaches.

Consequences of Technology Gaps
Infrastructure limitations slow down work and expand gaps between sites. Slow or outdated hardware and inconsistent connectivity cause delays in even basic data processing, making it difficult for certain sites to produce annual updates on schedule. Limited exposure to modern technologies also hinders innovation; solutions such as tablet-based data collection or real-time dashboards are difficult to implement without a good internet connection, adequate servers, or proper IT assistance. These gaps also result in hidden costs: tasks that could be automated take many staff hours, faulty systems demand frequent manual workarounds, and lack of remote access forces costly troubleshooting trips. Because each site develops whatever systems it can handle, the landscape breaks.

Signs of Progress
It is not all doom and gloom. There are glimmers of progress and opportunities to leapfrog. Many sites have moved from paper to electronic data capture using tablet apps like ODK or SurveyCTO, improving timeliness and quality. Most sites are doing regular backups, and nearly all have anti-virus and basic network security in place. Several respondents recognized their tech limitations and expressed interest in improvements. Collaboration on the horizon through initiatives like INSPIRE could bring shared technology platforms that many sites would opt into.

Call to Action
Bridging the infrastructural gap requires investment and support. Host institutions may need to budget for hardware updates every few years. Connectivity must be viewed as essential, not a luxury. To make these investments work over the long term, a centralized IT support unit for HDSS networks could manage backups, maintain cloud servers, and provide helpdesk support. In conclusion, while HDSS sites operate in challenging contexts, upgrading their technology backbone is possible and will result in significant benefits. Closing the technology gap will help unlock the full potential of their rich data archives for Africa’s development.