A patient's history is scattered across a primary healthcare centre, a private laboratory, a retail pharmacy and a teaching hospital, none of which can read the others. Every encounter starts from zero, every referral travels on paper, and the state cannot answer basic questions about its own population.

Exchange programmes rarely fail on standards. They fail on identity matching, on terminology nobody owns, and on facilities that have never sent a structured message being asked to send one next quarter.

Architecture on HL7 FHIR R4 and OpenHIE patterns: resource profiling, terminology alignment, a client registry and an identity-matching strategy that survives contact with real Nigerian name and date-of-birth data.

Then the operational half — facility onboarding sequencing, data-quality gates, escalation paths, and the change management that decides whether an exchange carries traffic or carries a launch event.