How digital tools can reduce health inequity in low- and middle-income countries

In low- and middle-income countries (LMICs), preventable diseases like respiratory infections, malaria and tuberculosis account for eight of the top 10 causes of death, according to 2021 figures from the World Health Organization (WHO). In high-income nations, by contrast, the primary causes are heart disease, cancer and other noncommunicable diseases.

For decades these areas have battled a trio of related problems – low funding, insufficient staff and underdeveloped infrastructures – that combine to worsen health outcomes dramatically.

The coming years promise even more suffering as the impact of climate change on health disproportionally affects regions with resource limitations. On top of that, a projected shortfall of 10 million healthcare workers by 2030 will hit (LMICs) the hardest, according to WHO data.

Digital health solutions can make a big difference. These tools, which range from remote monitoring devices and electronic health records to telemedicine and mobile health apps, not only increase access to care but also can spur improvements in care delivery. For example, pregnant mothers in (LMICs) who received health-related text messages saw a 174% increase in visits for important prenatal care, according to a study in the journal Reproductive Health. More broadly, an article in the Bulletin of the WHO suggested that greater digitisation of health data and more personalized care could generate nearly $11 billion in savings by 2030.

It isn’t easy to achieve scale, however. To get there, nations must foster collaboration and partnerships across an array of stakeholders, including government agencies, healthcare organizations, funders and innovators.

Ubiquitous in developed nations, digital health tools can be transformative in (LMICs) battling geographic and economic barriers. Some key advantages of these technologies include:

The benefits will grow exponentially as artificial intelligence (AI) is increasingly being embedded into these technologies.

While it is still early days, use cases and success stories are mounting. Consider tuberculosis (TB): more than 80% of TB cases and deaths occur in (LMICs), according to the WHO. Traditional TB management relies on direct observation from a healthcare worker watching a person take each dose of medicine, a regimen that can last between four and nine months. Workforce shortages hamper this approach and often result in poor medication adherence.

Digital technologies have the potential to vastly improve the process. The 99DOTS programme is one example. This low-cost, mobile phone-based strategy enables patients to send a free SMS confirmation to their care team after taking each dose. So far it has been launched in Bangladesh, the Philippines, Tanzania and elsewhere. Although there are upfront and ongoing fixed costs to support programmes like 99DOTS or video-observed therapy, research from the US Centers for Disease Control and Prevention, among other places, shows that these approaches offer a cost-efficient way to monitor patient adherence. In the Philippines, 99DOTS cost $83 per patient, compared with $176 for direct observation.

Another smartphone-based initiative, the "Know Your Lemons" campaign for breast cancer awareness, uses mobile platforms to educate women and their immediate communities about the signs and symptoms of breast cancer so they can recognize potential health issues early and seek timely medical advice. Between 47% and 70% of people in (LMICs) own a mobile phone, according to the International Telecommunication Union. As adoption increases, so will the reach of programmmees like Know Your Lemons.

Electronic health records can also play a useful role. In Angola, an electronic health records system designed for TB programmes has streamlined patient information management, reduced errors and improved continuity of care. The system integrates data on patient registration, diagnostic results, treatment plans and outcomes, enhancing the coordination of TB care and supporting data analysis for better resource allocation and outbreak identification. This is one example of a wider push to adopt electronic health records across (LMICs).

Telemedicine is another promising technology. Management of trypanosomiasis, or sleeping sickness, which primarily affects rural populations in sub-Saharan Africa, is typically hindered by the remoteness of affected areas and limited healthcare infrastructure. In Uganda, telemedicine platforms have connected rural healthcare workers with specialists in urban centres, which could be used to improve the accuracy and timeliness of trypanosomiasis diagnosis. The approach reduces the need for patients to travel long distances for specialized care and enhances the capacity of rural healthcare workers through continuous support and training.

The growing penetration of mobile phones and internet access, even in remote areas of the world, allows for the implementation of cost-effective, scalable solutions. The relative lack of stringent data regulations in these regions creates a flexible environment that enables innovative approaches to data management and patient care. While regulation has started to play a role in some (LMICs), there is an opportunity for industry stakeholders and others to assist countries in tailoring their approaches without being constrained by burdensome regulatory controls. What’s more, the general scarcity of healthcare solutions in these countries provides opportunity for innovators to introduce solutions.

The most significant challenge to scaling digital health is infrastructure. Many (LMICs) still struggle with widespread internet connectivity and electricity capacity. And while the flexible regulatory environment offers some benefits, it also causes challenges for data privacy and security. Protecting patient information is also critical and must be a priority for all stakeholders.

The best healthcare solutions are usually delivered in person. But digital solutions can help disadvantaged nations bridge the wealth divide, improving outcomes and lowering costs for all.