Why Plug-and-Play Works Where Systems Don’t

Spend enough time working across healthcare, development, or public institutions in the Global South, and a strange pattern becomes impossible to ignore.

Individual technologies often work remarkably well. A portable diagnostic machine transforms a clinic. A digital payment app reaches millions overnight. A vaccination drive achieves impressive coverage. Telemedicine connects remote patients to specialists. Solar kits light up villages that waited decades for grid power.

Yet attempt something more ambitious, build integrated referral pathways, reform education outcomes, streamline supply chains, or coordinate social services and progress slows to a crawl. Plans multiply. Committees convene. Platforms are launched. But real, sustained change proves elusive.

The paradox is that components succeed, whereas systems struggle.

The usual explanations come quickly: lack of resources, governance failures, corruption, and political instability. All are real. But they don’t fully explain why modular, stand-alone solutions consistently outperform carefully designed systemic reforms.
A deeper reason lies in how institutions actually function in many postcolonial societies.

Put simply, when coordination is fragile, plug-and-play beats integration.

Not because people lack intelligence or vision but because the environment punishes interdependence.

Every system depends on handoffs. Between departments. Between professionals. Between budgets and operations. Between data collection and decision-making. Each handoff is an opportunity for delay, distortion, or failure. The more handoffs a reform requires, the more fragile it becomes.

In high-capacity countries, these interfaces are held together by boring but essential things: stable staffing, predictable funding, interoperable records, professional norms, and credible accountability. When something breaks, there are mechanisms to notice and fix it.

In much of the developing world, those supports are partial or absent. Institutions often inherit bureaucratic architectures designed for control rather than coordination. Ministries operate vertically, not laterally. Learning loops are weak. Maintenance budgets vanish. Political cycles are short. Bad news struggles to travel upward.

Under such conditions, integration becomes risky.

So, people adapt.

Policymakers favour visible projects. Organisations seek vertical control. Professionals rely on personal networks. Funders support interventions with measurable outputs. Everyone learns quietly, that modularity is safer than systems.

This is not incompetence. It is rational behaviour in a hostile operating environment.

That is why plug-and-play technologies flourish. They deliver value without requiring the surrounding machinery to work. They localise responsibility. They bypass weak interfaces. They fit short political horizons. They tolerate noise.

By contrast, integrated systems demand trust, continuity, and alignment across multiple actors. They require incentives to be synchronised and information to flow freely. They depend on institutions that can learn.

Those are precisely the things in shortest supply.

Nowhere is this clearer than in healthcare.

A patient’s journey is inherently systemic. Symptoms lead to consultation. Consultation leads to diagnosis. Diagnosis leads to referral. Referral leads to treatment. Treatment leads to discharge. Discharge requires follow-up and rehabilitation.

No single hospital or doctor owns this entire pathway.

Good care emerges not from isolated excellence but from continuity across boundaries.

Yet in many mixed public–private health systems, referral pathways are fragile or non-existent. Patients bounce between facilities. Tests are duplicated. Records don’t travel. Families act as couriers of information. Informal negotiations replace formal protocols.

Meanwhile, private hospitals compete fiercely, for visibility, for star consultants, for high-end equipment. Investment flows into branding and technology. Far less attention is given to shared protocols, outcome tracking, or referral coordination.

Why?

Because revenue is tied to volume rather than appropriateness. Because consultants often function as independent micro-enterprises. Because quality is difficult to measure and even more challenging to compare. Because data is power. Because handing off patients feels like surrendering control.

Even ethical actors get pulled by these incentives.

People sometimes ask: why don’t hospitals form consortia like airlines do, sharing infrastructure, coordinating referrals, reducing costs, and improving outcomes?

It’s a fair question. But airlines exchange passengers. Hospitals exchange clinical responsibility and revenue streams. Airlines move standardised seats. Hospitals manage complex human journeys with high liability and emotional weight.
Collaboration in healthcare threatens established hierarchies and income flows. It exposes performance differences. It requires data sharing. It demands trust.

So instead of networks, we get silos.

The tragedy is that clinicians and administrators often understand these problems deeply. The obstacle is not insight, it is structure.

Imported “best practices” rarely help. Countries copy the visible forms of successful systems digital platforms, governance frameworks, organisational charts, without acquiring the invisible functions that make them work elsewhere: disciplined procurement, honest audit, stable staffing, credible regulation, and long-term budgeting.

The result is modern-looking shells with fragile interiors.

This leads to a familiar disappointment: “We tried that model. It doesn’t work here.”
But what failed was not the idea. It was the assumption set.

So where does that leave us?

Not in cynicism, and not in blind imitation.
The way forward is staged systems building.

Start with modular interventions that deliver real value. Use them deliberately to build operational trust. Introduce shared services, including procurement, laboratories, maintenance, and training. Create small islands of reliability. Begin tracking outcomes for a handful of clinical pathways. Establish clear referral rules. Protect learning spaces where failure is analysed rather than punished.

Only then increase integration.

Systems cannot be imposed wholesale. They must be earned through accumulated competence.

This reframes development itself.

Progress is not about leaping from fragmentation to integration overnight. It is about recognising that in low-coordination environments, plug-and-play solutions are stepping stones, not endpoints. The task is to use them consciously to convert modular success into institutional capability.

Healthcare teaches us this lesson with painful clarity.

You can buy scanners. You can install software. You can build hospitals.
But without continuity, without shared accountability, without ownership of the patient journey, you don’t have a health system. You have expensive islands.

Real systems emerge not from grand design, but from boring reliability, maintained interfaces, aligned incentives, and the slow accumulation of trust.

That is the hard work.

Until we face it honestly, plug-and-play will continue to prevail not because it is better, but because it is easier.