One in four people worldwide lack reliable access to essential medicines. This underperformance is not just the result of scarce resources; it also reflects fundamental weaknesses in how public health supply chains (SC) are designed, operated, monitored, and governed. In LMICs, complex ecosystems require strong coordination to function, yet information asymmetries and fragmentation of health, finance, and SC data leaves stakeholders out of sync. Data fragmentation drives cascading failures in health supply chain financing (HSCF) – a critical and underappreciated bottleneck. Our research into 311 unique digital systems across 47 LMICs quantifies the extent of this fragmentation. Only one country (Thailand) manages a functioning, interoperable bridge between finance and SC, despite many having the technological capacity to do so. Almost half of all systems are government-built or bespoke donor-projects, 34% have no documented standards, and six software model archetypes dominate. Most systems focus on SC delivery and monitoring, leaving upstream planning, budgeting, market-shaping, and prioritisation functions thinly covered. Persistent data fragmentation is not a technical hurdle, but rooted in political economy, stemming from historical verticalisation, misaligned incentives, vendor lock-in, and unresolved data sovereignty issues. Applying a use case-driven approach to HSCF can better align information system investments with health sector goals; we outline four that best represent country experience and feasible improvements. Further, we present six policy opportunities to strengthen governance, information infrastructure, and systems intelligence. These include specific actions to institutionalise and incentivise data exchange, finance sustainable architecture, and expand access to market intelligence.
