Across East Africa, mobile phones and tablets are increasingly sitting in the hands of community health workers, clinicians, managers and patients. They are being used for a widening range of functions from diagnostics to health insurance to treatment advice, generating hopes for new healthcare futures and establishing the region as an emerging hub of experimentation in digital health. Drawing on our on-going ethnographic and anthropological research in Kenya and Tanzania, this article explores the dynamic, varied, experimental, and increasingly financialised terrain of formal digital health projects. While innovation in digital health is a growing feature of healthcare across the globe, in East Africa it is entering into a region already long characterised by NGOised, fragmented and vertical healthcare systems and heavy dependence on foreign capital. This presents challenges to efforts, including the WHO’s Universal Health Coverage agenda, to foster national and equitable public healthcare systems. In exploring these issues, we recognise the power, and often deleterious effects, of financial capital that foregrounds markets in global digital health, but we also open space for a (still critical) recognition of East African-led digital and data technology movements.
- Digital health innovations targeted at creating or transforming markets are not necessarily inclusive or universal despite claims that they pursue Universal Health Coverage goals.
- The drive for innovation in digital health may distract from other older, often non-digital, solutions.
- The drive for innovation may create a fragmented and short-term digital health system, and thus policy makers must concentrate on coordination, sustainability, regulation, and interoperability.
- Digital health policy makers should carefully consider data privacy issues.
- Local actors, if given authority and control, have the potential to create more appropriate technologies for healthcare systems.