The Real Cybersecurity Threat to African Digital Health Isn't Hackers—It's Vendors -By Aisha Arigbabu

Across African healthcare systems, a pattern is emerging. As digitization accelerates, the greatest cybersecurity threat isn't sophisticated ransomware gangs like the one that crippled South Africa's National Health Laboratory Service in June 2024. It's the vendors we're trusting with patient data.

As African healthcare systems accelerate digital transformation—with Nigeria's Federal Government launching its Digital in Health Initiative, Interswitch deploying electronic medical records (EMR) systems across federal hospitals, and private providers racing to digitize patient records -we're inheriting a critical weakness that has plagued Western healthcare for over a decade: vendor-introduced cybersecurity vulnerabilities.

Recent data published this month by Black Book Market Research confirms what security professionals have been warning about: 74% of Chief Information Security Officers now identify EHR and AI vendors as their top emerging cyber risk. Among African healthcare leaders surveyed, 71% in South Africa reported that third-party EHR or billing platforms were involved in major security incidents. Perhaps most alarming; 91% believe current risk management practices are inadequate for modern digital health environments.

The question isn't whether African healthcare organizations will adopt EMR systems and digital health platforms. Digital transformation is inevitable and necessary. The question is whether we'll demand adequate security from vendors before deployment, or whether we'll learn these lessons the expensive way—through breaches that compromise millions of patient records and cripple healthcare delivery.

The Vendor Security Gap Nobody Talks About

Through my research on cybersecurity governance and healthcare security, I've observed a predictable pattern: organizations implement sophisticated technology while overlooking fundamental security governance in their vendor relationships. Procurement teams focus on features and cost, compliance teams check regulatory boxes, and security teams get involved too late—if at all.

This dynamic becomes catastrophic in healthcare, where vendor access to patient data creates cascading vulnerabilities across entire healthcare networks.

Consider Medical Informatics Engineering, a US-based EHR software vendor whose 2015 breach affected 3.9 million patients across 239 healthcare clients. Cybercriminals used compromised credentials to access MIE's servers and maintained undetected access for 19 days. One vendor vulnerability exposed hundreds of healthcare organizations simultaneously.

Or Newkirk Products, a healthcare identification card issuer, whose server compromise affected 3.8 million patients, including multiple branches of Blue Cross Blue Shield, America's largest health insurer. A single vendor breach cascaded across the entire US healthcare ecosystem.

More recently, OneTouchPoint, a mailing and printing vendor serving over 30 US healthcare organizations, suffered a breach affecting 2.6 million people. The incident sparked class-action lawsuits from medical firms claiming OneTouchPoint failed to safeguard sensitive information and delayed breach notifications for months.

The pattern is clear: vendors with access to healthcare data become single points of failure that can compromise entire networks. Yet procurement processes rarely demand adequate security assurance before granting this access.

What African Healthcare Buyers Should Demand

As Nigerian healthcare organizations evaluate EMR vendors, whether international players like Epic and Cerner or local solutions, security due diligence cannot be an afterthought. Here's what a technically-credible vendor security assessment looks like:

Penetration Testing: Evidence Demand recent third-party penetration testing reports; not internal assessments, but independent security audits from recognized firms. These reports should test for common vulnerabilities such as  SQL injection, cross-site scripting, authentication bypasses, and privilege escalation. If a vendor cannot provide recent penetration testing evidence, that's a red flag.

Incident Response Plans: Request detailed incident response documentation. How quickly can the vendor detect unauthorized access? What's their protocol for breach notification? Who bears liability costs? When South Africa's NHLS suffered its ransomware attack in June 2024, recovery took two months because backup systems were also compromised. Vendors need tested disaster recovery plans that account for ransomware scenarios where even backups may be targeted.

Encryption Standards: Verify that patient data is encrypted both in transit and at rest using current standards (AES-256 minimum). Critically, ask about encryption key management. Who controls the keys? Where are they stored? Can the vendor access unencrypted patient data? Advocate Health Care's 2013 breach affecting 4 million patients occurred because stolen computers stored unencrypted medical information, a basic security failure that resulted in a $5.55 million fine.

Access Control Architecture: Understand exactly how the vendor's system manages user authentication and authorization. Is multi-factor authentication (MFA) mandatory for all administrative access? Broward Health's 2022 breach, affecting 1.3 million patients, resulted from a compromised third-party device that wasn't implementing MFA. This isn't optional, it's fundamental.

Beyond MFA, examine role-based access controls. Can vendors limit which staff members have access to specific data types? Can they provide audit logs showing exactly who accessed what information and when?

Supply Chain Security: Most vendors don't build everything themselves; they rely on sub-vendors for components, hosting, or services. Trinity Health learned this the hard way when its vendor's backup provider, Blackbaud, suffered a ransomware attack affecting 3.3 million patients. Ask vendors to map their entire technology supply chain and demonstrate how they assess security risks in their sub-vendors.

Compliance Certifications (But Don't Stop There): ISO 27001, SOC 2, and HIPAA compliance certifications provide baseline assurance but aren't sufficient on their own. These certifications confirm that vendors have documented security policies, not that those policies are effective against current threats. Use certifications as a starting point for deeper technical discussions, not as final proof of security.

Breach History and Transparency: Research the vendor's breach history. Have they suffered previous incidents? How did they respond? Vendors with transparent breach disclosure practices and documented improvements demonstrate mature security cultures. Vendors who hide past incidents or delay notifications should raise immediate concerns.

The African Context: Unique Challenges Require Adapted Solutions

African healthcare organizations face constraints that Western entities don't: limited cybersecurity talent, smaller security budgets, and infrastructure that often bridges legacy systems and modern platforms that can create unique vulnerabilities.

This means African buyers need to be more demanding, not less, when evaluating vendor security. We cannot afford the extensive incident response capabilities that American hospitals employ after breaches. We cannot rely on cyber insurance markets that barely exist in many African countries. We need to prevent vendor-introduced breaches before they occur.

This also means favoring vendors who understand resource constraints and build security into their architecture rather than requiring extensive ongoing security management. Adaptive security frameworks that use machine learning to detect anomalies and automatically respond to threats are more sustainable than models requiring 24/7 security operations centers that most African healthcare organizations can't afford.

What Regulators Must Require

Individual healthcare organizations conducting vendor security assessments are necessary but insufficient. Nigerian healthcare regulators—the National Health Insurance Authority and Federal Ministry of Health—should establish minimum security standards that all EMR vendors must meet before deployment in Nigerian healthcare facilities.

These standards should mandate:

● Annual third-party security audits with public reporting of findings

● Mandatory breach notification within 72 hours of discovery

● Minimum encryption standards for all patient data

● Required cyber insurance coverage

● Contractual liability for vendor-introduced breaches

● Regular security training for vendor staff with access to Nigerian patient data

Kenya's Data Protection Act provides a model here, establishing clear accountability for data controllers and processors. Nigeria's own Data Protection Act creates a foundation, but healthcare-specific vendor security requirements are essential.

The Window of Opportunity

The advantage African healthcare systems have is timing. We're digitizing now, while vendor-introduced vulnerabilities are well-documented in Western healthcare systems. We don't need to experience billion-dollar breaches to understand that vendor security is critical infrastructure.

The EMR vendors entering African markets right now are competing for long-term contracts that will define healthcare data management for decades. This is our leverage moment—when we can demand robust security as a condition of market access rather than retrofitting security after deployment.

But this window won't stay open. Once vendors establish market presence and healthcare organizations depend on their systems, the leverage shifts. The time to demand security is now, during procurement, not after breaches, when switching vendors becomes prohibitively expensive and disruptive.

Moving Forward

For African healthcare technology leaders evaluating vendors: treat security due diligence as a technical requirement, not a compliance checkbox. Demand evidence, test claims, and walk away from vendors who can't demonstrate mature security practices.

For vendors seeking to serve African healthcare markets, understand that security skepticism isn't hostility, it's learned wisdom from watching Western healthcare systems suffer preventable breaches. Transparency about your security architecture, honest disclosure of past incidents, and documented evidence of security investments will differentiate you from competitors who treat security as marketing rather than engineering.

For regulators: establish vendor security standards now, before widespread deployment makes them harder to enforce. The cost of requiring security upfront is minimal compared to the cost of managing healthcare system breaches that compromise millions of patient records and interrupt critical care delivery.

Even as African healthcare systems face direct cybersecurity threats like the ransomware attack that compromised South Africa's NHLS, the data shows that vendor-introduced vulnerabilities represent a more pervasive systemic risk. The dozens of vendor-caused breaches in US healthcare and the growing evidence of inadequate risk management all point to the same conclusion: the real cybersecurity threat to African digital health isn't just sophisticated criminal gangs. It's inadequate vendor security that we can address before deployment if we choose to demand it.

 

Aisha Arigbabu is a cybersecurity researcher and PhD candidate at the University of the Cumberlands, focusing on AI governance and healthcare security. Her lead-authored research on AI-enabled healthcare systems has been cited 76 times, with her broader body of work accumulating over 130 citations from researchers globally.