In 2021, the World Health Organisation (WHO) adopted the Global Strategy on Digital Health (GSDH) 2020-21, which was organized mainly around global collaboration, national digital health strategies, digital health governance, and human-centred systems. With the WHO currently drafting its successive GSDH 2028-33, a critical gap has become apparent and impossible to ignore: WHO frames the issue of ‘equity’ almost entirely on access to technology, while deeper political economy questions of public health outcomes have received scant sustained attention.
After all, who owns and controls digital health infrastructure? Who captures the value it generates? Whose voice shapes digital health? And who bears the risk when it fails?
It was in this context that Third World Network and the Centre for Health Equity, Law, and Policy (C-HELP)—with the Global Digital Justice Forum— convened an online panel discussion on 19 August 2026 titled ‘A People’s Strategy for digital health: Why the WHO Must Move from Technology Deployment to Equitable Value Sharing’. The panel brought together five speakers to examine the issues with the current push towards digitalization in health while ignoring questions of political economy and equity, and what GSDH 2028-33 must include to move from interoperability and standards setting alone, towards a genuine reckoning with infrastructure concentration, hyperscaler dependence, public-private asymmetries, and data extractivism and value capture.
Broadly, three threads emerged through the discussions that this article captures. First, there is an entrenchment of Big Tech’s power in the public health ecosystem, often in ways that replicate older forms of colonial domination. Second, the economic and technological value generated by digital health infrastructures currently flows to a handful of transnational firms, and not into the systems, processes, and populations that helped generate this value. Lastly, digital sovereignty gaps, i.e., the difference between a country’s formal legal authority over its health data and its actual material ability to control it, are a key area of power contestation for the Global South.
The panel progresses from articulating the mechanism by which power is held, to charting its human toll, to investigating the reproduction of power through system design, to finding its infrastructure and value capture, and the role of WHO and civil society actors, and the possibilities and limitations of human rights frameworks in addressing these challenges.
Entrenched power, colonial parallels
×Big Tech has spent decades entrenching its position within global public health and other domains. This must be viewed as an extension of other systemic and structural forms of power that are already deeply entrenched. The same techniques as that of colonialism and other arenas of domination are being used: a lack of transparency about intent and purpose, using language to remain opaque, and adopting a saviour complex.
This has enabled Big Tech’s power to become deeply entrenched, including by wielding material and infrastructural power, and by the creep of power into public sectors including health, and our private lives. Subsequently, we have developed a reliance on Big Tech, and rely on the continuation of the industry’s power, to uphold public health systems. However, civil society has the tools and knowledge from movements such as the HIV movement and access to medicines movement that can support work to dismantle this power. Human rights frameworks are a good starting point for dealing with the entrenchment of Big Tech in public health, and broader political economy issues.
The Digital Health and Rights Project (DHRP) has found that taking a human rights-based approach has been helpful for numerous reasons including that; it goes beyond ‘health’ to connect intersecting issues like privacy, in a fragmented governance landscape, it is helpful to draw on already agreed international standards, and human rights are easily understood and mobilised on within civil society and communities. However, the human rights framework does have limitations and to tackle political economy issues such as the wider entrenchment of Big Tech’s power, we need to take a collective, systems-level approach.
Civil society organisations should engage with the process to agree the next WHO Global Strategy on Digital Health because it will impact national strategies and, without input, risks reinforcing key issues discussed throughout the panel. An example of this is DHRP’s work on national digital health strategies - a study by Warwick University and WHO found that none of twenty national digital health strategies studied referenced gender, equity and human rights. We are now advocating for this at both the global and national level.
There are three recommended levels of engagement for civil society; engaging collectively to increase the voice and platform of civil society within the current WHO strategy process, engaging with member states during negotiations (as they are now closed to non-state actors) and considering longer-term strategy engagement to support implementation, and finally engaging in advocacy outside of this process (recognising the limitations of WHO’s mandate). The WHO should commit to increasing funding and staff capacity toward meaningful civil society engagement and ensure that negotiation processes are transparent, equitable and accessible.
Molly Pugh-Jones
Advocacy Manager — Digital Health and Rights, Stop AIDS
Molly is a health justice advocate with over seven years of experience leading advocacy at the intersection of global health, digital rights, and social justice.
If Molly’s intervention names the structural power of Big Tech entrenched in digital health systems through patterns that resemble colonialism, Timothy Wafula makes the effect of that pattern on people and marginalized communities more concrete. He discusses that given these structures of power, who actually benefits, who is excluded, and whose rights are most affected in practice.
From Structural Power to Lived Reality: Ensuring a human rights approach to digital health
×Digital health is promoted as a mechanism for expanding access to information, services and care, but digitalization is not automatically equitable. Whether it advances the right to health depends on how power and resources are distributed within the health system. For instance, digital exclusion is shaped by the cost of smartphones and data, weak internet infrastructure, gaps in digital and health literacy, stigma, and gender inequality. As more health services move online, these barriers do not simply create a technological inconvenience; they can determine who is able to exercise the right to health, privacy, and information in practice.
From the Paying the Cost of Connection study-some participants described being forced to choose between essential household needs and the airtime or data required to access health services. The people most likely to benefit are therefore those who already have affordable devices, reliable connectivity, privacy, digital literacy and social power. Those at greatest risk of exclusion are rural populations, low-income young people, women, people living with HIV, LGBTQ+ people, sex workers, and others who experience stigma or discrimination. The report stresses that these disadvantages intersect.
This is why we need to ask not simply whether a health system is becoming more digital, but whose problems digitalization is solving and who bears its costs. If investment is driven primarily by efficiency, innovation or commercial opportunity, without an equity and human-rights assessment, the interests of governments, funders or technology providers can become more influential than the needs of communities.
As governments increasingly rely on private entities for digital health platforms, data infrastructures and technological systems, preserving public accountability for essential public health functions becomes central for protecting the right to health of people. Governments remain the primary duty bearers for the right to health even when the infrastructure through which that right is realized is designed, hosted, or operated by private companies.
From the Paying the Cost of Connection Study - participants described fears of companies collecting personal information, sharing or selling it to third parties without consent, and using sensitive information in ways users could not see or control. Privacy is particularly significant in health because a loss of trust can deter people from seeking health information or services at all. For people living with HIV and other stigmatized populations, disclosure can also carry risks of discrimination, social exclusion or loss of employment or housing.
So when an essential health function becomes dependent on privately controlled infrastructure, the state cannot outsource its human-rights obligations along with the technology. Governments need to ensure there is strong data-protection laws, effective regulation, transparency requirements and accessible mechanisms for remedy.
Governments should hold technology companies accountable for data protection and human-rights standards, while technology companies themselves should undertake effective human-rights due diligence, prevent and mitigate foreseeable harms and provide access to remedy.
For WHO and governments, therefore, public accountability should mean setting the rules before technologies become indispensable: establishing human-rights safeguards in procurement and partnerships; requiring privacy, accessibility, and equity assessments; ensuring public oversight of data and algorithms; creating enforceable complaints and remedy mechanisms; and ensuring that no population loses access to essential care because a private platform changes its terms, fails, becomes unaffordable, or withdraws its service.
These concerns also point to a broader gap between the people and communities affected by digital health policies and the institutions that make them. People experiencing digitalization most directly frequently understand risks that are invisible from institutional or technical perspectives. Yet historically marginalized communities are still too often treated as beneficiaries or end-users rather than as people with expertise and a right to participate in policy decisions.
Meaningful participation has to go much further than consultation after a policy has already been designed. Communities should participate from agenda-setting and design through implementation, monitoring and evaluation, particularly people most affected by digital divides and digital harms.
WHO and other UN agencies have a key role in helping governments and technology companies remain accountable to human rights. This could be by providing governments with technical guidance on meaningful participation, supporting community-led organizations to influence digital-governance policies and norms, and enabling civil society to participate meaningfully in national and international digital-governance processes. In practical terms, WHO could strengthen this by creating standing community advisory mechanisms rather than one-off consultations; funding participation so that community organizations do not have to subsidize their own engagement; bringing community representatives into the earliest stages of strategy and standard-setting; publishing how community input changed a policy; and establishing feedback and accountability mechanisms after policies are adopted.
A human-rights approach to digital health is not simply about putting human-rights language around digital transformation. It requires redistributing voice, resources and decision-making power. Communities affected by digital health systems must have the ability not only to access those systems, but also to shape, challenge and hold accountable the institutions and companies that govern them.
Timothy Wafula
Associate Director, Programmes & Impact, Kenya Legal Issues and Ethics Network (KELIN)
Timothy is an Advocate of the High Court of Kenya with over a decade of experience driving rights-based health reforms through advocacy, research, and litigation.
Timothy extends Molly’s structural critique to show how concentration of power has distributional consequences and emphasizes that even if a private entity operates essential components of health systems and delivery, the state’s responsibility does not disappear, and that people and communities must have meaningful participation in decision-making. This raises a further question–even if rights protection and accountability mechanisms are accounted for, what happens if the architecture of the system itself is centralized in ways that distances communities from decision-making that affects them? Akshay S. Dinesh discusses precisely this problem and challenges the assumption that scale and interoperability are adequate measures of health system progress.
Beyond Scale and Interoperability
×The concepts of scale in digital platforms—deploying at a national scale—and interoperability are heavily used in Indian digital public infrastructure history. However, the word that is clearly missing is ‘equitable'. We must shift from purely focusing on scale and interoperability to an equitable model. When we do that, we automatically ask what kind of inequities exist — class, caste, and gender.
As it is now, only the software giants build, operate, and govern these architectures. This must shift to decentralized, representative governance where the builders are much more diverse. A healthy society requires fixing social determinants at play, like undernutrition, lack of clean water, and livelihoods. These issues cannot be fixed from a central program; they must be addressed at a decentralized level by local self-governing bodies, who are best positioned to solve issues in health. For example, tuberculosis is a disease of poverty where the public distribution system and livelihoods must be strengthened alongside treatment.
Currently, the focus is purely from a techno-managerial perspective, assuming aggregating all data into state or country dashboards will suddenly fix problems. Meanwhile, those with the most opportunity and agency to fix issues—like anganwadi workers, doctors, and gram panchayat members—cannot even access the insights generated by their own data. There is no interoperability between local departments like water, sanitation, and public distribution. Therefore, technical standards are an insufficient approach.
The WHO should revisit the 1978 Alma-Ata Declaration, which emphasized essential, socially accepted primary health care with full community participation, self-reliance, and self-determination. Rather than getting swept up in continuous technology hype cycles—from dashboards, apps, and blockchain to the current AI hype pushed by billionaires—global bodies must stay clear of this technosolutionism.
The role of organizations like the WHO is to protect people from the harms that multinational big tech can cause through digital deployment. We need to focus on what is practically relevant, building equitable, decentralized health systems that truly address the underlying social determinants of health.
Dr. Akshay Dinesh
Founder, Action for Equity
Akshay is a generalist straddling public health and technology and is involved in creating a political demand for equity and public health in Karnataka, various digital humanities initiatives, data-centric consulting, and open-source, open-data projects.
Akshay draws a distinction between a system that is technically integrated and a socially and politically responsive one. While scale increases reach in aggregate and interoperability allows systems to talk; this does not necessarily establish who has agency within those systems, whose knowledge is valued, or who is able to act on the information generated. This is important as centralization can be masked by the language of public infrastructure and inclusion. A system can be rolled out nationwide, with only a handful of technology actors having the capacity to build, operate and govern it. In this context, the question of equity shifts from access to technology to the governance of the technological architecture itself.
This entails the political economy questions – who makes the infrastructure? Who owns underlying systems? Who writes the standards? Who can switch providers? And when digital health systems have been built using public money, public data and public institutions, who ultimately captures the value? Matheus Z. Falcão shifts the conversation from the design of digital systems to the ownership and governance of the underlying infrastructure.
From Digital Systems to Infrastructural Power
×Digital health can improve access, but its public-health value cannot be assumed when the technologies, data systems and infrastructure are controlled by a small group of corporations whose primary incentives are commercial. Public health systems are accountable for equity, universality, continuity of care, and community participation, while companies are generally oriented towards revenue, market share and proprietary advantage, often with state support. Digital health can therefore produce a form of infrastructural privatization even when healthcare facilities remain publicly owned, particularly when essential functions depend on privately controlled cloud services, software, algorithms and standards and when health data is privately appropriated, even if anonymized, without safeguards or economic regulation.
When public and commercial interests collide, governments should retain decision-making authority, but formal authority does not always translate into effective power. Corporations that control critical infrastructure, technical expertise, data or proprietary systems may gain considerable bargaining power, especially when switching suppliers is costly, operationally risky or impossible due to market concentration. Public policy must therefore preserve the capacity of health systems to govern technology through transparent procurement, strong conflict-of-interest rules, open and interoperable standards, data portability, independent algorithmic assessment, restrictions on secondary data use and enforceable exit provisions.
Public authorities should also be understood as investors and co-producers of digital value, not merely as purchasers of finished products. Governments fund infrastructure, workforce training, system integration, health services and the collection and maintenance of health information. Public financing and procurement should therefore include conditions ensuring that health systems and populations retain a meaningful share of the resulting social, technological and economic value. These conditions could include public access and reuse rights, open standards, the return of data in usable formats, technology transfer, transparent pricing, audit rights and limits on vendor lock-in. Where public investment is substantial, non-exclusive licences, royalty arrangements or other public-return mechanisms may also be appropriate.
A public digital stack offers a practical way to protect digital sovereignty without requiring governments to build every application themselves. Brazil’s Pix payment system demonstrates how publicly governed infrastructure can promote competition and reduce dependence on dominant intermediaries, being currently one of the main topics in dispute in current geopolitical tensions. Proposals by Cecilia Rikap and others similarly (Ref: Reclaiming Digital Sovereignty) emphasise public control of core digital infrastructure, tax measures, open protocols and requirements that privately generated value based on public data and investment be returned to the public system.
The WHO should address these issues as a norm-setter, market-shaper and institutional example, rather than functioning only as a neutral forum for governments and industry. Its next digital health strategy should examine market concentration, proprietary control, vendor dependence and the distribution of economic power; provide model procurement and partnership clauses; support public and regional infrastructure; and strengthen countries’ capacity to negotiate with large technology firms. The Pandemic Influenza Preparedness Framework provides a useful precedent: access to collectively governed information is linked in advance to benefit-sharing commitments. A similar principle could require organizations benefiting from public health data, standards or financing to provide affordable access, public-use rights, technology transfer, capacity building and other enforceable public benefits.
Matheus Z. Falcão
PhD candidate, USP - Universidade de São Paulo, Brazil
Matheus' current work focuses on Digital Health, Global Health, and Health Systems and is the director of the Brazilian Centre for Health Studies (Cebes) and an associate researcher at the Health Law Research Centre of the University of São Paulo.
Matheus shifts the conversation from inclusion to infrastructure. While governments may formally own health systems, their dependence on private entities for cloud, software and standards, turns procurement into dependency. Since public institutions finance, generate, and maintain much of this value, the questions becomes of equitable value sharing. Yet procurement rules alone cannot solve structural inequality in a global digital economy shaped by ownership and colonial histories. Shajoe’s discussion on digital sovereignty takes this conversation forward.
From Dependency to Sovereignty
×We must begin by dismantling the fiction that nation-states exist as naturally independent entities that step onto a blank slate to choose which technologies to accept. Third World scholars have long demonstrated that the modern state was constructed through colonial order to integrate peripheral(ized) territories into global markets while constraining their room for manoeuvre. Digital transformation continues this pattern, continuously remaking states through their deep entanglement with foreign-owned submarine cables, cloud servers and proprietary software. Because total technological self-sufficiency is impossible, the critical issue is not whether a nation is dependent, but what kind of dependence it experiences and whether it possesses any real power over the terms of that relationship.
A government can appear sovereign on paper through data protection legislation while having zero practical control over health databases hosted on foreign servers. This gap between formal independence and material vulnerability, what I have called sovereign digital coloniality, is a universal contradiction. When European states like France and Germany struggle with vendor lock-in and attempt to migrate public infrastructure away from corporations like Microsoft toward domestic clouds and open-source platforms, they expose the reality that even powerful nations experience a particular form of sovereignty.
WHO operates as a powerful political actor whose normative guidance on interoperability and cybersecurity carry direct political-economic consequences. While the WHO can use its convening power to highlight corporate concentration and push for open standards, technical guidelines alone cannot redistribute the ownership of a global digital economy dominated by a handful of tech monopolies.
CSOs must therefore adopt a tactical approach. CSOs should treat privacy protections and data-minimization rules as vital immediate defences–sandbags against the flood–while pushing for systemic structural change. This requires interrogating domestic procurement decisions, building regional alliances across the Global South to negotiate collective technical capacity, and holding international frameworks accountable to meaningful definitions of country ownership. True digital sovereignty is defined modestly as the collective power of people and governments to determine the exact conditions of their digital connection, retain the capacity to govern local systems, and preserve the fundamental right to say no by keeping vital aspects of human life uncollected and unmonitored.
Shajoe Lake
PhD candidate, Centre for Global Health Law, Warwick Law School
Shajoe is a global health law consultant and scholar of international law and political economy, and has supported consumer protection and health and human rights litigation in the Caribbean and Latin America, represented consumers before national standards bodies, and supported petitions to constitutional reform commissions in the Caribbean on the right to health and adequate food.
Shajoe argues that sovereignty cannot mean simply having stronger national laws or creating digital health strategies, nor can it realistically mean complete technological self-sufficiency. The question it entails is whether states and people possess adequate bargaining power, institutional capacity, and collective alternatives to determine the conditions under which dependence operates. While WHO can develop standards, convene member states, influence norms and procurement choices, it cannot, through technical guidance alone, undo the concentration of ownership in the global digital economy. Real change would require action beyond the WHO framework through national laws, public investment, procurement, regional cooperation and collective action by civil society and Global South states.
Conclusion
Unfortunately, the draft GSDH 2028-33, released recently by the WHO, continues to focus overtly on the deployment and scaling up of digital technology, and pays little attention to the underlying questions of the political economy of health, technology, and value creation. On the contrary, the body must use its norm-setting and convening power to address Big Tech concentration, infrastructural dependency, data extractivism and value capture.
It must centre equity that looks at distributive impacts of digitalization, decentralized governance, meaningful participation of communities and populations, and human rights. Governments must translate principles into regulation, procurement and public investment that protect institutional capacity, public health objectives and accountability. Civil society and communities must organize locally, regionally and transnationally, beyond WHO's mandate and processes to challenge corporate power, demand accountability, shape law and policy, and build collective alternatives.
This article draws on insights from the online panel discussion 'A People’s Strategy for Digital Health: Why the WHO must move from technology deployment to equitable value sharing' organized by the Third World Network and the Centre for Health Equity, Law, and Policy (C-HELP) — with the Global Digital Justice Forum.
The members of the Global Digital Justice Forum (GDJF) submitted their response to the World Health Organization’s (WHO) recently released draft Global Strategy on Digital Health (GSDH), 2028–2033, asking that the WHO explicitly include a new strategic principle in GSDH. Read the full submission here.
