Abstract

The digital transformation of African healthcare systems, driven by electronic health records, mobile health platforms, and artificial intelligence, presents substantial opportunities for innovation and efficiency but also poses major governance challenges. The core tension lies between upholding local data sovereignty, the right of countries to govern health data generated within their borders, and dealing with the functional demands of cloud-based AI solutions, which often require cross-border data flows and centralised processing. This paper argues that the fundamental governance challenge for African healthcare infrastructure is balancing sovereignty over health data with the adoption of cloud-based AI. Drawing on a comprehensive literature review of peer-reviewed publications from 2018 to 2026 on data sovereignty, cloud dependencies, AI governance, and African healthcare systems, the paper analyses regulatory frameworks, empirical case studies, and governance models across the continent. The study shows fragmented regulations across 54 African nations, insufficient legal protection for sensitive health data, gaps in ethical consent, infrastructural barriers, and the persistent risk of external control over African health data. Balancing the gains of cloud-enabled AI and the imperatives of privacy, equity, and self-determination is unavoidable. However, hybrid governance models, as demonstrated in Malawi, South Africa, Kenya, and Ethiopia, can reconcile these tensions, enabling innovation without sacrificing sovereignty. The study concludes that African nations must design context-specific governance frameworks that embed data sovereignty within cloud-based health AI from inception. It is recommended that regional data protection laws be harmonised, privacy-preserving AI technologies be adopted, public-private partnerships be established with robust sovereignty safeguards, local data governance capacity be invested in, and participatory models involving local communities be implemented. These strategies are essential for African health systems to realise the benefits of AI-driven transformation while upholding data sovereignty, privacy, and equity.

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