A new commentary published in Discover Social Science and Health by Augustus Osborne of the Institute for Development in Sierra Leone, Abdirasak Sharif Ali of SIMAD University in Somalia, and Umaru Sesay of the African Centre for Disease Control confronts this question head-on. The authors argue that digital health embodies a dual potential: in some contexts it has expanded access, improved efficiency, and strengthened system resilience, yet in others it has exposed and exacerbated longstanding inequities. Universal health coverage, as defined by the World Health Organization, means that all people can obtain the health services they need, when and where they need them, without financial hardship. Digital technologies, from telemedicine and electronic health records to AI-powered diagnostics and wearable sensors, could accelerate progress toward that goal, but only if deployment is deliberate, inclusive, and attentive to the barriers that leave vulnerable populations behind.

The promise is real and measurable. India’s eSanjeevani telemedicine service facilitated more than 100 million consultations by 2023, many in rural districts where physician density is low. In sub-Saharan Africa, mHealth initiatives have used basic mobile phones to deliver antenatal care reminders, HIV medication adherence support, and outbreak alerts to communities with sparse physical infrastructure. For marginalized groups, including people with disabilities and those facing stigma, digital platforms offer a discreet and flexible route to care; telepsychiatry, for example, became a critical mental health lifeline during the pandemic for people reluctant or unable to seek in-person help. Efficiency gains add to the appeal: electronic health records can reduce duplicated tests and streamline referrals, while AI-assisted triage tools help frontline workers in resource-limited settings make faster, evidence-based decisions even without specialists on site. In Rwanda, the Babyl digital health platform, deployed in partnership with the government, registered over two million users and cut waiting times for primary care consultations.

Less visible but equally transformative is the role of digital systems in health intelligence. Real-time data collection enables faster outbreak detection, more accurate planning, and better allocation of resources. During the pandemic, Singapore and Taiwan used digital contact tracing applications and integrated data dashboards to inform targeted interventions. The District Health Information Software 2, known as DHIS2 and now used in more than 70 countries, has improved immunization tracking, maternal health surveillance, and outbreak response through digital data aggregation and visualization. These capabilities matter deeply for universal health coverage, which depends on the ability to identify and close gaps in coverage and quality. Remote monitoring of chronic conditions such as hypertension and diabetes has also been shown to reduce hospital admissions and improve disease control, easing pressure on overstretched facilities.

Yet the benefits are strikingly uneven. The most glaring barrier is the digital divide itself: nearly 2.6 billion people worldwide remain offline, most of them in low- and middle-income countries, rural areas, or marginalized urban settlements. In sub-Saharan Africa, internet penetration stood at just 29 percent in 2023, compared with 89 percent in Europe. The divide extends beyond physical access to affordability of data and devices, availability of electricity, and reliability of connectivity. In rural Bangladesh, women are 33 percent less likely than men to own a mobile phone, a gap driven by financial constraints and social norms. Even where connectivity exists, digital literacy, the ability to navigate and critically engage with digital platforms, is unevenly distributed. A United Kingdom study found that while 95 percent of adults aged 16 to 24 used the internet daily, only 54 percent of those over 75 did so, with many reporting anxiety or confusion when using digital health tools.

Systemic limitations compound individual barriers. In many low- and middle-income countries, unreliable electricity, weak telecommunications networks, and limited technical support undermine the rollout and sustainability of digital health programs. In Nigeria, frequent power outages and internet disruptions have been identified as major obstacles to the consistent use of electronic health records and telemedicine. Many digital health solutions are deployed as pilot projects or vertical programs with limited integration into broader health system architecture, producing duplication, inefficiency, and data silos. Privacy and trust present further hazards: platforms collect sensitive information, including medical histories, geolocation data, and biometric identifiers, and breaches have already affected health systems in both rich and poor settings. Marginalized populations who already mistrust state or private actors, such as undocumented migrants or people living with HIV, may avoid digital platforms altogether for fear their data could be shared with authorities or used against them.

These barriers intersect and compound. A rural, elderly woman living with a disability may face physical, economic, and social obstacles to digital access, compounded by low digital literacy and limited trust in platforms. Case studies illustrate the pattern starkly. In the United States, telehealth visits increased by more than 1500 percent in the early months of the pandemic, but urban populations benefited disproportionately thanks to better broadband access and device availability. In rural Maharashtra, India, patients often relied on neighbours’ phones or local kiosks to reach telehealth services, introducing privacy concerns and logistical challenges, while complex interfaces and language barriers limited meaningful engagement. The United Kingdom’s digital COVID-19 vaccination booking systems revealed stark gaps, as elderly people, people with disabilities, and those with limited English proficiency struggled with poorly designed portals, contributing to lower vaccine uptake. In South Africa, contact tracing apps saw low adoption among informal settlement residents, many of whom lacked smartphones or feared data misuse. Syrian refugees in Lebanon reported difficulties using telemedicine due to a combination of limited internet access, language barriers, and privacy fears.

The commentary also connects digital equity to social, cultural, and nature-based prescribing, pathways through which health workers connect people to non-clinical community services such as arts-on-prescription and green social prescribing. Digital systems can support referral, community asset mapping, follow-up, and equity monitoring in these models, but they may exclude people with limited connectivity, low digital literacy, disability, language barriers, or mistrust of digital platforms. The authors therefore call for hybrid models in which digital referral systems are complemented by telephone, paper-based, in-person, and community-health-worker-supported pathways. Encouraging counterexamples show what inclusive design can achieve. In Kenya, the mHealth service M-TIBA lets users save, send, and spend healthcare funds via basic mobile phones, bypassing the need for smartphones or internet access, and its simplicity, local-language content, and integration with community health workers have driven high uptake among low-income and rural populations. Bangladesh’s Aponjon program delivers maternal and child health information through SMS and voice calls tailored to literacy levels and local languages, reaching more than two million women, many without internet access or formal education.

To ensure digital health acts as a bridge rather than a barrier, the authors refine a set of evidence-based policy recommendations. They advocate inclusive design processes that co-create solutions with marginalized users from needs assessment through implementation, featuring multilingual content and accessibility features such as screen readers and voice commands. They urge public investment in broadband, electricity, and affordable devices, citing models like India’s BharatNet project, alongside digital literacy programs embedded in schools, community centres, and health facilities, and engagement of young people as both beneficiaries and stakeholders. Robust data protection regulation, clear consent processes, data minimization, and redress mechanisms are needed to keep pace with technological change and prevent commercial exploitation or algorithmic discrimination, while open-source platforms could prevent commercial monopolies and enhance trust. Community engagement through trusted intermediaries, such as community health workers, and equity-focused monitoring using real-time, disaggregated data on gender, age, geography, and socioeconomic status round out the agenda. The authors acknowledge that, as a commentary, their analysis is interpretive rather than systematic and that the recommendations require empirical validation in specific contexts.

The stakes are framed by the 2030 deadline for universal health coverage under the Sustainable Development Goals and the World Health Organization’s forthcoming Global Strategy on Digital Health for 2026 to 2030. The commentary’s conclusion is deliberately unsentimental: digital health is not a panacea, and its impact on equity depends on deliberate, context-sensitive strategies that centre the needs of the most vulnerable. Without intentional action, the digital divide risks becoming an insurmountable chasm and a new axis of exclusion, leaving the poor, the elderly, rural residents, people with disabilities, and marginalized communities further behind as health systems become digital by default. But the successes in Kenya, Bangladesh, and elsewhere demonstrate that equity-driven design, public investment, and community engagement can turn technology into an engine for inclusion. The question the authors insist every health system must keep asking as it digitizes is deceptively simple: who benefits, and who is left behind?

Subject of Research: The role of digital health technologies in advancing or undermining universal health coverage and health equity

Article Title: Digital health in pursuit of universal health coverage and equity challenges

Article References: Osborne, A., Ali, A. S., & Sesay, U. (2026). Digital health in pursuit of universal health coverage and equity challenges. Discover Social Science and Health, 6(1), Article 101. https://doi.org/10.1007/s44155-026-00447-x

Image Credits: AI Generated

DOI: 10.1007/s44155-026-00447-x

Keywords: digital health, universal health coverage, health equity, digital divide, telemedicine, mHealth, digital literacy, data privacy, social prescribing, low- and middle-income countries, COVID-19, health policy