However, there are three challenges that we need to contend with if we are to realize the benefits of the digital revolution for sustainable health. The first is that a focus on digital technologies risks putting the technology cart before the health horse. After all, technologically driven approaches in developing countries have had, at best, an uneven history. Well-known – and justified – critiques have focused on technological over-optimism and ‘technology transfer’ that consists of little more than development organizations trying to copy and paste tech solutions into developing countries with little attention to context or complexity.
There are also numerous instances where technological development has occurred despite the development sector, which is then left sprinting to catch up. The technology hype cycle is prevalent and damaging for development prospects and ambitions. This seems to be especially the case with digital technologies because the cost of developing apps in the twenty-first century is far less than, say, a tractor or a piece of plant machinery in previous decades.
The second issue is that without due care, digital technologies can and will enhance and exacerbate inequalities rather than address and overcome them. A mobile phone-based system for healthcare delivery will by its very nature exclude the most impoverished and vulnerable – at last count, according to the World Bank, the two billion poorest people in the world have no access to a mobile phone and four billion have no access to the internet. This leaves the majority of the most vulnerable well beyond the scope of digital health innovations.
One could even argue that it will become ever harder to ‘leave no one behind’ if digital technologies become the mainstay of global health efforts. Moreover, the exclusive nature of technological development more generally in health – witness the battles over drug patents that continue to rage – threaten to emerge as a major issue in digital health, with ever greater emphasis on proprietary technologies and monopolistic platforms.
The third challenge concerns the context in many developing countries. The potential of digital health can be far from fully realized because of fragmented and imperfect markets in which many not-for-profit, public and private players work in silos. There’s often a huge amount of duplication, overlap and waste. In such settings, again according to the Global Health Council, “scaling of promising digital health solutions is… impeded by a lack of coordinated funding that aligns with government priorities, limited leadership and peer support, and a lack of support and availability of technologies that could be reused or adapted”.