DE-COLONIALISING – Colonialism in the new digital health agenda

by Sharifah Sekalala, Tatenda Chatikobo

BMJ Global Health Volume 8 – Supplement 3 – Climate Crisis and Health


The advancement of digital technologies has stimulated immense excitement about the possibilities of transforming healthcare, especially in resource-constrained contexts. For many, this rapid growth presents a ‘digital health revolution’. While this is true, there are also dangers that the proliferation of digital health in the global south reinforces existing colonialities. Underpinned by the rhetoric of modernity, rationality and progress, many countries in the global south are pushing for digital health transformation in ways that ignore robust regulation, increase commercialisation and disregard local contexts, which risks heightened inequalities. We propose a decolonial agenda for digital health which shifts the liner and simplistic understanding of digital innovation as the magic wand for health justice. In our proposed approach, we argue for both conceptual and empirical reimagination of digital health agendas in ways that centre indigenous and intersectional theories. This enables the prioritisation of local contexts and foregrounds digital health regulatory infrastructures as a possible site of both struggle and resistance. Our decolonial digital health agenda critically reflects on who is benefitting from digital health systems, centres communities and those with lived experiences and finally introduces robust regulation to counter the social harms of digitisation.

Summary box

Neoliberal policies have led to digital health data being viewed as an asset for multinational corporations and philanthropic foundations in the global north, which we describe as a form of digital health coloniality.

Although digital health initiatives are perceived to have the potential to transform health systems in the global south and act as an instrument for health justice, they often embed digital coloniality.

Digital health initiatives entrench discriminatory border politics and racial hierarchies through software, hardware and storage and drastically increase the marketisation and commercialisation of health.

A decolonial approach to understanding global health enables us to recognise how digital health coloniality affects the global south’s health outcomes and lived experiences and presents opportunities for reimagining digital health in ways that are restorative and transformative.

Our decolonial agenda for digital health applies alternative decolonial lenses, such as indigenous African philosophical thought, that focus on centring community health experiences in developing robust and locally aligned digital health regulatory infrastructures as a mechanism of resistance to digital health coloniality.