Inclusive digital health policy starts on the frontline: A South African case for cross-sectoral collaboration

GHFutures2030 Blog Series, Health futures: Youth voices at the forefront of digital health governance
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The culmination of the fourth industrial revolution and Covid-19 pandemic has fast-tracked the use of digital technology in healthcare. Mobile Health (mHealth), a wireless medical service accessible by mobile phone, is a rapidly expanding market that is expected to exceed 300 billion U.S dollars by 2025. For instance, the Google Play Store launched over 6,000 new medical applications in 2020 alone.

Remote healthcare increases the reach of health services, especially in rural areas where geography is a significant barrier. In Sub-Saharan Africa, some communities live up to 3 hours away from the nearest health facility. Digital health can also improve the health systems’ capacity. South Africa only has 7 medical doctors per 10,000 people, compared to the United Kingdom or the United States with 58 and 26 doctors per 10,000 people, respectively. Artificial intelligence and machine learning can facilitate task-shifting to maximise healthcare resources.

Although digital health is beneficial, it is often misrepresented as an all-encompassing solution. There is no silver bullet to addressing the healthcare crisis in South Africa, not even digital health. Should we fail to implement the appropriate use of digital health within the African context, due to the lack of digital health governance, we may inadvertently worsen the health inequity.

The healthcare crisis

More than 20 years post-democracy, only 53% of South Africans have full access to healthcare. Irrespective of the government expanding the facility network and subsidising healthcare, research reveals that ‘rural households, less educated, unemployed and black South Africans, are less likely to have adequate access to healthcare’. Digital health can only address health inequity if it empowers the most vulnerable. Paradoxically, the poorest and most marginalised groups in low to middle-income countries face structural barriers to technology such as low smartphone adoption, poor network coverage, and digital illiteracy. The digital transformation of healthcare services can inadvertently alienate vulnerable groups by creating additional barriers to accessing healthcare, which further exacerbates health inequity.