The Bahamas’ geography and strained resources make it well-positioned to benefit from a large-scale digitalization of its public health services. Evidence shows that embedding interconnectivity as the foundational requirement strengthens institutional knowledge and improves overall service delivery.
Small Island Developing States (or SIDS) face structural vulnerabilities that make equitable and resilient public service delivery difficult. Their small, dispersed populations, undiversified economies, and exposure to hurricanes, flooding, and rising sea levels can reverse years of progress, constrain investment, and disrupt essential services. These pressures are particularly acute in healthcare, where geographic isolation and resource shortages limit access.
Digitalization offers a potential path forward, but adoption alone does not guarantee better outcomes. Tuvalu’s digital initiatives, for example, identify connectivity, governance, and people as essential transformation pillars. In the Maldives, however, nurses report difficulties using electronic health records (EHRs) to support patient safety, illustrating the gap between adopting technology and using it effectively.
The Caribbean – the largest SIDS region – faces similar challenges. Health systems remain fragmented and unequal, particularly for remote populations, even as regional digital health platforms emerge. At the same time, the investment and human resources needed to implement these technologies are often precisely what SIDS lack. Barbados is advancing digital health transformation through initiatives such as its ‘public health datathon’, showing how digital tools can support more connected and responsive health systems. In Guyana, the government is exploring AI-enabled healthcare to improve efficiency, service delivery, and access. Innovation can reshape development pathways, but digital health can also widen existing inequalities if designed without considering the context.
The Bahamas’ fragmented digitalization
The Bahamas, a 700-island archipelagic nation, exemplifies this challenge. Its Public Healthcare System (PHS) faces communication barriers between departments, facilities, and islands. Although the PHS provides healthcare to citizens and residents at minimal or no cost, beneficiaries often face long waits, travel requirements, or reliance on private providers to access services. Many of these challenges are exacerbated for people living outside the capital, Nassau.
Fragmentation creates practical costs. Handwritten patient records may reach other facilities without clear information about who created them or when, forcing staff to repeat intake processes and delaying treatment. Hurricanes and flooding can destroy physical records entirely, compromising patient care and legal documentation. Communication failures, lost records, duplicated work, and poor coordination therefore become everyday consequences of a disconnected system.
The Bahamas has already begun addressing these gaps. The National Health Insurance Authority’s digital program has enrolled more than 100,000 beneficiaries and connected 87 facilities, 140 providers, and 18 laboratory providers to a shared EHR system. Hurricane Dorian and COVID-19 further exposed existing weaknesses in the country’s healthcare system. In 2021, the Inter-American Development Bank approved $40 million to strengthen the system, through digital information systems, tele-medicine, and EHRs.
Consolidating the fragmented Bahamian Public Healthcare System through digitalization
The Bahamas’ geography makes physical consolidation challenging. Research on inter-island air transport shows that geographic dispersion, low population density, and financial constraints challenge connectivity in the fragmented archipelagic context. For healthcare, this type of dispersion unearths problems of isolation, limited capabilities, and reliance on off-island emergency referrals.
Our research identifies interconnectivity as one of the five ‘affordances’ of digitalization that could address this problem. Interconnectivity is about connecting employees, departments, clinics, hospitals, and islands through a centralized platform.
This then enables effective communication, allowing stakeholders to share accurate, real-time information without relying on physical movement between facilities. In The Bahamas, the Perinatal Information System (SIP+) enabled data exchange between departments and health facilities, supporting peer-to-peer communication. Similarly, in Tuvalu, satellite-enabled data exchange between remote health facilities improved communication and reduced costly overseas medical referrals.
Interconnectivity also supports standardization of knowledge, whereby centralized data give healthcare professionals access to consistent, up-to-date information, supporting common protocols and informed treatment decisions. This aligns with findings from the Maldives, where reliable information sharing was identified as essential to high-quality patient outcomes in a comparably dispersed SIDS health system.
Interconnectivity also supports capacity maximization which is about reducing communication failures, lost records, duplicated work, and coordination problems (all of which are exacerbated by dispersion). The resource constraints and off-island referrals that have been documented in previous research demonstrates the importance of making remote expertise available across islands, instead of reproducing capacity on every island. Research in The Bahamas has also emphasized the importance of capacity in the context of emergency management in light of promoting equitable access and social inclusion.
Finally, data security refers to ensuring records remain accessible when natural hazards disrupt individual facilities, which is particularly important in hurricane-prone environments. Hurricane Dorian in 2019 exposed significant vulnerabilities in public health infrastructure and the medical supply chain across The Bahamas. Evidence from hurricane-prone health systems shows that EHRs can help protect and transfer patient data when physical infrastructure is damaged or lost. Establishing an off-island backup site in a location with lower hurricane risk could further strengthen resilience by safeguarding records during region-wide disasters and supporting coordinated supply chain prioritization.
What does this mean for policymakers, administrators and researchers?
Taken together, we suggest three priorities:
First, interconnectivity should be treated as a foundational infrastructure in archipelagic environments. Second, digital systems should be designed to cope with disruption as well as everyday practice. Efforts in this regard should include geographically separate backups and system-wide integration of digitalized content. Third, digital transformation alone cannot overcome fragmentation. Healthcare professionals and digital transformation experts should work together to co-develop appropriate systems reflecting the needs of healthcare professionals on the ground and patients, particularly of those living furthest from population centers.
Administrators and digital transformation experts should also define clear performance indicators to measure the practical impact of the affordances of digitalization, including reduced duplication, record accessibility, and user experience. While current research provides a valuable foundation for practice, we implore researchers to build on these findings through further empirical studies in the Bahamian and wider SIDS context to establish whether digitalization can deliver its promised benefits, for whom, and under what conditions.
