Why healthcare needs to be unbundled and rebundled

Rashida’s story

Rashida who is from a village outside Dhaka, is pregnant, diabetic and lives with a husband recently treated for tuberculosis.

She doesn’t know her health status or options. If lucky, a community health worker visits—but her care is split across three vertical programmes: maternal health, NCDs and TB. Individually, these programmes work. Together, they fail. Her diabetes medication isn’t checked for pregnancy safety. Her antenatal record isn’t visible. Her household TB risk is never flagged.

Rashida ends up with incomplete care, while the health worker juggles disconnected protocols and paperwork that rewards reporting, not results. At the health facility, her records don’t follow and her expenses escalate. Local administrators see only partial reports, unable to plan resources effectively.

Each programme is a siloed monolith: isolated, rigid and unable to adapt. When these collide, care fragments and the system falters. Simply digitizing more won’t fix this. AI layered on top will only create more confusion. Only an intentional architectural redesign enabled by technology can solve these problems.

From fragmentation to flow: Redesigning health systems architecture

Healthcare today is fragmented because it is delivered in clunky blocks. These include vertical programmes, community health cut off from facilities, hospitals siloed by department, separate public and private systems and insurers defining narrow benefits. Each clunky block bundles services, protocols and data into its own rigid monolith.

To achieve flow, we must unbundle these monoliths into functional components: discovery, navigation, diagnosis, planning, treatment, monitoring and prevention. Each of these can be modular services that are delivered where and when they best serve the patient. These can then be rebundled with technology to maximize outcomes and efficiency.

Here’s what that could look like for Rashida:

She feels unwell. An AI assistant in Bangla answers her questions, screens for red flags and books the next step. A health worker visits and completes the care protocol using one tool, syncing everything to her record.

Instead of fragmented services, Rashida experiences fully coordinated care. Prescriptions are safety-checked, linked to pharmacies and paid transparently. She receives timely reminders and counselling, abnormal readings trigger proactive outreach, her hospital care plan follows seamlessly and newborn immunisation and postpartum care are integrated.

Dashboards could show the full picture with indicators, supply alerts and outcomes, all while protecting consent and privacy. Financing aligns so payment systems reward prevention and coordination over fragmented, crisis-driven interventions.

This is healthcare rewired: one patient, a unified care plan and a comprehensive payment backbone. It is a health system that follows the patient, not the other way around — and achievable with the right architecture.

The leapfrog opportunity

Other sectors have already transformed. Banking once separated loans, savings and payments, but now integrates them seamlessly around the customer. Telecoms did the same with voice, data and messaging. Healthcare has resisted, leaving rigidity from monoliths and chaos from fragmentation.

It is often assumed that low- and middle-income countries (LMICs) can’t afford to re-architect health systems. The opposite is true. With legacy systems never fully calcified, LMICs can leapfrog challenges to build stronger, patient-centric digital foundations from the start.

Most efforts so far have produced a messy patchwork of vertical apps, partial registries, siloed dashboards and a rush of AI tools layered haphazardly on top. The result is brittle: data does not flow, workflows duplicate and guidance stays locked in binders. Interoperability helps systems “talk,” but on its own it cannot create the foundations of care delivery.

Real transformation needs a shared infrastructure layer. This is the foundation for every program, provider and innovation. Beyond health IDs and registries, they require building blocks: patient profiles, workflow engines, knowledge libraries, payment rails and interfaces for existing apps.

As shared assets governed by open standards, these blocks let monolithic programmes be unbundled into functional services. This must be rebundled around the patient journey. That is the path to resilient, future-ready health systems. In these rebundled systems information drives care, workflows are optimized, knowledge is embedded in every interaction, innovations scale quickly and payments tie to real outcomes.