Digital health systems in many countries have grown in a fragmented way. One programme for immunization, another for HIV, another for maternal health, each built separately, often by different partners, on isolated platforms that cannot easily talk to one another. Health workers re-enter the same information more than once. Ministries struggle to see a complete picture of their own health system and every new investment adds another disconnected piece rather than strengthening the whole infrastructure.
The Open Health Stack Software Foundation (OHS-SF), newly established by the Linux Foundation with the support of WHO, Google and a global coalition of health and technology organizations, is designed to help fix this. WHO will be contributing to keep the Foundation’s work aligned with WHO norms, standards and country needs.
Where Open Health Stack came from
The Foundation builds on a collaboration that began in 2020, when WHO identified a practical problem: its SMART Guidelines and other quality-assured clinical and public health recommendations and standards needed to be usable inside real digital health systems, not just published as documents. WHO and Google signed a Memorandum of Understanding to develop open source software code that would make WHO’s guidance easier for countries to adopt, using shared interoperability standards such as HL7 FHIR .
That collaboration became Open Health Stack, launched in 2023 , and with it grew a wider community of developers, implementers, ministries of health and technical partners. Millions of people are now covered by health services running on Open Health Stack tools, from national digital record systems to community health worker platforms, in countries across Sub-Saharan Africa, South Asia and South-East Asia.
To make sure these tools continue to serve the whole global health community rather than a single organization, Google is contributing the Open Health Stack code and assets to a new, independent Foundation hosted by the Linux Foundation.
As Dr Michael Howell, Chief Health Officer at Google, states: “Open Health Stack is a great example of open, transparent, and verifiable infrastructure that helps build truly trustworthy AI in health. We are proud to contribute Open Health Stack to the Linux Foundation, ensuring that developers can build digital tools that clinicians and public health professionals can rely on and that are based on accessible, shared standards. Working alongside the entire community allows us to co-create an ecosystem focused on health care access and innovation.”
Built on open standards WHO already recommends
The Foundation’s work is anchored in the same standards WHO uses across its normative guidance: HL7 FHIR for exchanging health data, and international terminologies like the International Classification of Diseases (ICD), so that a diagnosis or a service recorded in one system means the same thing in another. Open Health Stack tools are built to work directly with WHO SMART Guidelines, the machine-readable versions of WHO’s clinical and public health recommendations. That connection matters in practice: it means the systems countries build on Open Health Stack are already positioned to run WHO-quality-assured content, rather than needing separate work to translate WHO guidance into a usable form.
Implications for countries
The Foundation will maintain and grow open source code libraries, developer tools and reference software that any country or implementing partner can use, free of licensing costs and vendor lock-in. This is the kind of shared, reusable foundation that helps countries move toward what WHO calls Resilient Essential Digital and Data Health Infrastructure (REDDHI): a state in which a country’s essential digital health services and applications, such as shared registries, a lifelong health record, and standards-based exchange between systems, are technically and financially sustainable on their own terms. Open, community-maintained code built on open standards, open technologies, open architectures and open content, the “full-STAC” approach , is part of what makes that sustainability possible, rather than requiring countries to keep rebuilding or re-licensing the same foundational capabilities.
Because the code is open and standards-based, countries and local companies can build on it, adapt it and maintain it themselves, rather than depending on a single vendor. This is central to the shift called for in the Accra Agenda for Action and the Lusaka Agenda: away from externally supplied one-off solutions and toward country-owned systems that local technology ecosystems can sustain, both technically and financially, over the long term. It also supports local production of digital health capacity, strengthening the developers, companies and public institutions within countries that will maintain these systems for years to come, rather than relying on distant sources of software and external support.
Preparing countries for verifiable AI
The Foundation also includes AI Commons for Global Health, a neutral, model-agnostic space, co-developed with WHO, for building the shared tools that safe and effective AI in health will require, including common technical protocols, health-specific skills that AI systems can call on, and evaluation and benchmarking tools. By building on open standards for AI and as part of the ecosystem enabling SMART Guidelines on FHIR, it will give countries a practical route to bring AI into their health systems on infrastructure that is interoperable, auditable and grounded in WHO norms, rather than adopting AI tools that sit apart from, or are inconsistent with, the standards their health systems already depend on.
As Dr Garrett Mehl, Head of Unit for Digital Health and Information Systems at WHO, states: “We have watched too many promising digital health systems collapse when the donor project that funded them ended. The path to resilient national digital health ecosystems runs through country ownership of both the governance and the technical foundations of their systems; governance they control, standards they can test against, and software they are not perpetually dependent on external vendors to maintain. The Open Health Stack Software Foundation is a critical piece of that infrastructure for independence: open, community-governed, not owned by any single actor, and designed to outlast any individual funding cycle.”
How countries and their partners can benefit
For ministries of health and their technology partners, the practical opportunity is to build on tools that are already aligned with WHO norms rather than starting from scratch or committing to a single vendor. WHO SMART Guidelines, WHO’s machine-readable clinical and public health content, are freely available at smart.who.int , and the free open source code, developer tools , reference software that put that content to work in real systems are available at ohs.foundation .
Joining the Foundation is free for non-profit, academic, and government entities, consistent with the Linux Foundation Associate Membership tier. Country technical teams and local implementing partners can contribute to the code as well as use it, building it into national digital health systems, adapting it to local needs, and maintaining it themselves over time. That builds lasting local technical capacity, rather than recurring dependency on external vendors and systems.
