1. The promise of digital health

Digital health is widely promoted as a transformational force for health in the Global South, due to the proliferation of user-friendly apps, cloud-based systems and increasingly functional mobile handsets (Olu et al. Reference Olu, Karamagi and Okeibunor2023; Holst et al. Reference Holst, Sukums, Radovanovic, Ngowi, Noll and Winkler2020; Yang and Van Stee Reference Yang and Van Stee2019). The COVID-19 pandemic accelerated these trends as governments rapidly expanded telemedicine, digital surveillance and vaccination apps (Agarwal et al. Reference Agarwal, Jain, Pathak and Gupta2020; Kamerow Reference Kamerow2021; Okereke et al. Reference Okereke, Babatunde, Samuel, Ogunkola, Mogessie and Lucero-Prisno2021). Post-pandemic, enthusiasm persists, with digital health framed as essential for pandemic preparedness, health system resilience and realising universal health care (UHC) (Al Dahdah and Mishra Reference Al Dahdah and Mishra2023; Ibeneme et al. Reference Ibeneme, Karamagi, Muneene, Goswami, Chisaka and Okeibunor2022; D’Anza and Pronovost Reference D’Anza and Pronovost2022). For instance, digital health innovations can help alleviate existing health inequalities through access to health information for particular populations, such as contraception information for women, providing mental health support at scale for vulnerable populations and increasingly using large-scale databases for health surveillance (Rousseau et al. Reference Rousseau, Godineau, De Casabianca, Begue, Tessier-Cazeneuve and Legendre2019; Koh et al. Reference Koh, Tng and Hartanto2022; Stifani et al. Reference Stifani, Peters, French and Gill2023). The use of digital data for equitable health access has also received increased global attention from international organisations such as the World Health Organization (WHO), which recently launched the Health Inequality Data Repository (Hosseinpoor et al. Reference Hosseinpoor, Kirkby, Bergen, Schlotheuber and Antiporta2023), which aims to standardise disaggregated data collection for global monitoring and track progress toward the Sustainable Development Goals (SDGs).

2. Digital inequalities

However, digital health does not exist in a vacuum. The digital divide remains a central concern, closely linked to socio-economic status and geography (Heeks Reference Heeks2022; König et al. Reference König, Krukowski and Kuntsche2023). Nearly one-third of the global population still lacks internet access, with women and rural communities disproportionately affected; in Africa, for instance, only 31 per cent of women use the internet compared to 43 per cent of men (International Telecommunication Union 2024). While internet and smartphone use has grown in low- and middle-income countries (LMICs), affordability and infrastructural deficiencies continue to constrain access (McCool et al. Reference McCool, Dobson, Whittaker and Paton2022; Hui et al. Reference Hui, Abdulla and Ahmed2022). Reviews consistently show that digital health interventions are more effective for affluent and digitally literate users, reproducing inequalities along lines of gender, class, age and disability (Cornejo Müller et al. Reference Cornejo Müller, Wachtler and Lampert2020; Western et al. Reference Western, Armstrong, Islam, Morgan, Jones and Kelson2021; Szinay et al. Reference Szinay, Forbes, Busse, DeSmet, Smit and König2023). Less-privileged groups, including those with lower education, lower income, older age or from rural and minority communities, are less likely to initiate or sustain use, even when interventions are available (Chae Reference Chae2018; Chesser et al. Reference Chesser, Burke, Reyes and Rohrberg2016; Rodgers et al. Reference Rodgers, Raine, Thomas, Harden and Eastwood2019).

3. Tech design and intersectional harms

Critical accounts complicate the assumption that extending digital access equates to empowerment. Scholars have drawn attention to how the design of digital health tools can reproduce intersectional harms. Many of these technologies are developed by corporations or research teams in the Global North, often with limited consideration of local health priorities, languages or cultural practices (Sekalala and Chatikobo Reference Sekalala and Chatikobo2024). The expansion of digital infrastructures thus cannot be disentangled from the structural violence that is exacerbated by gender, class, socio-economic status, race and geography (Serra et al. Reference Serra, West, Simms and Davis2024). Scholars also point to algorithmic bias, where AI systems trained on narrow datasets reproduce existing inequalities (Panch et al. Reference Panch, Mattie and Atun2019). Heeks (Reference Heeks2022, p. 688) introduces the concept of ‘adverse digital incorporation’, in which participation in digital infrastructures generates new dependencies and vulnerabilities. For instance, evidence from perinatal care shows that while AI chatbots can increase maternal knowledge and clinical engagement, their reliance on limited datasets and cultural assumptions raises questions about bias and exclusion (Amil et al. Reference Amil, Da and Plaisimond2025). Similar issues emerge in chronic disease management, where systematic reviews emphasise predictive gains but note persistent inequities in data representation and interpretability (Chen et al. Reference Chen, Hao, Sun, Li, Zhang and Qian2025).

Tech design is hugely reliant on experimentation that creates sites in the Global South as testing grounds for interventions that may be of enormous benefit but are still untested. For instance, in mental health, reviews identify a growing reliance on machine learning and natural language processing, while also documenting unresolved concerns over safety, ethics and professional practice (Milasan and Scott-Purdy Reference Milasan and Scott-Purdy2025). The result is that digital health infrastructures reproduce vulnerabilities rather than resolve them, becoming vectors through which discrimination and structural inequities are reinscribed into care (Birhane Reference Birhane2020; Neal and Morse Reference Neal and Morse2021; Chin et al. Reference Chin, Afsar-Manesh and Bierman2023). In this context, digital health tools marketed as empowering often expose already marginalised populations to new forms of surveillance, violence and exclusion embedded in technological design.

4. Colonial continuities and neoliberal rationalities

Digital colonialism provides a critical lens for analysing how digital infrastructures enact forms of extraction consistent with colonial histories, through the capture of everyday life through infrastructures that transform human activity into data flows for global markets (Couldry and Mejias Reference Couldry and Mejias2019). Kwet (Reference Kwet2019) extends this analysis to Africa, showing how US-based technology firms dominate platforms, infrastructures and standards, creating dependencies that echo prior imperial projects. Further scholarship has also highlighted the ways in which digital colonialism shapes regulation: by subordinating national frameworks to donor-driven priorities (Biruk Reference Biruk2018), by embedding epistemic hierarchies in data practices (Tichenor Reference Tichenor2024) and by naturalising extractive models of value.

In health, this dynamic is visible in the large-scale collection of digital data from the Global South, often repurposed to fuel innovation and commercialisation elsewhere (Couldry and Mejias Reference Couldry and Mejias2019). Sekalala and Chatikobo (Reference Sekalala and Chatikobo2024) demonstrate how African states have become sites of rapid digital health expansion without corresponding regulatory frameworks, leaving governance subordinated to donor priorities and corporate agendas. Large-scale health surveillance in many parts of the Global South for pandemic preparedness is being done digitally and reinforces narratives in which the post-colonial world is considered a site of disease. This is enabled by corporations that have the capacity to collect, store and process enormous amounts of health care data. Ruckenstein and Schüll (Reference Ruckenstein and Schüll2017) describe ‘the datafication of health’ as a process that aligns patient monitoring and self-tracking with corporate logics of surveillance capitalism (see also Zuboff Reference Zuboff2019). More recent work highlights how Femtech and digital reproductive health apps commodify intimate data, often without meaningful consent, turning bodies into sources of value while exposing users to risks of surveillance discrimination and increased violence (Lupton Reference Lupton2016). These accounts underscore how digital health is enmeshed in wider capitalist transformations, where regulation is not only a technical matter but also a key site of contestation over profit, sovereignty and justice. Additionally, they illustrate that digital health infrastructures are not neutral but are shaped by the colonial continuities that reproduce dependency, hierarchy and asymmetry in the present.

Intrinsic to digital colonialism are the neoliberal rationalities that frame the expansion of digital health. Sekalala et al. (Reference Sekalala, Rawson and Andanda2025) critique how data infrastructures in East Africa are increasingly commercialised under conditions of weak accountability, embedding profit-driven logics within systems ostensibly organised around care. Global South countries are increasingly positioned as testing grounds for ‘responsible AI’ where the rhetoric of innovation obscures the reproduction of inequality (Sinha et al. Reference Sinha2025, p. 1). Similar contradictions are noted in rural health research, where digital technologies are promoted as solutions to entrenched service gaps, yet infrastructural deficits and inequities continue to shape uptake (Moloney et al. Reference Moloney, Rubio, Palencia, Hollimon, Mejia and Seixas2025). In effect, digital health has become a site through which neoliberal imperatives of efficiency, commodification and corporate expansion take precedence, and the role of governance in this space becomes highly contested.

5. Privacy and consent

Alongside concerns over contextual design, Figueroa et al. (Reference Figueroa, Murayama, Amorim and von Vacano2022) highlight regulatory fears surrounding privacy. The pace of technological innovation often far outstrips the capacity of governance frameworks to respond effectively to sophisticated attempts by tech companies to sidestep privacy concerns and harvest huge amounts of data (Al Meslamani Reference Al Meslamani2023).

This dynamic was starkly illustrated by the 2021 data breach at Planned Parenthood Los Angeles, California, which exposed the records of 400,000 patients (Knutson Reference Knutson2021), and a data breach at Biomedical, the largest laboratory in Jamaica, in early 2025, which resulted in the online publication of over 70,000 patients’ data (Barrett Reference Barrett2025). In Sexual and Reproductive Health and Rights, these dynamics are especially acute. Femtech applications, in particular, have come under scrutiny for inadequate consent frameworks, data sharing with third parties and the reinforcement of gender stereotypes that perpetuate epistemic injustice and lead to the regression of women’s rights globally (Jacobs and Evers Reference Jacobs and Evers2023). These tools frequently collect highly sensitive data, such as menstrual cycles, geolocation and sexual activity, without adequate safeguards, leaving users vulnerable to surveillance and misuse (Yao et al. Reference Yao, Zhang, Evans, Cao, Rui and Shen2022). A recent study found that 84 per cent of period tracker apps share data with third parties (Walker Reference Walker2022). Communities, especially those in the Global South, are routinely incorporated into experimental health projects with limited ability to consent meaningfully, and accountability mechanisms are often absent or ineffective.

6. Research gaps

A growing body of scholarship turns attention to how regulation is framed in relation to justice and sovereignty. Shaw and Sekalala (Reference Shaw and Sekalala2023) articulate health data justice as a framework that situates equity and accountability at the centre of governance debates. Cordes et al. (Reference Cordes, Bak and Lyndon2024) emphasise Indigenous data sovereignty, showing how collective claims to ownership and control directly contest universalist norms of openness embedded in global infrastructures. Arora (Reference Arora2024) develops the idea of creative data justice, foregrounding decolonial approaches and epistemic diversity as crucial to understanding the politics of digital health regulation. These interventions underscore that governance is not simply a technical exercise but a contested domain in which questions of power, legitimacy and epistemic authority are at stake. Regulation, in this sense, becomes a lens through which broader struggles over sovereignty, inequality and justice are refracted, particularly in the uneven geographies of the Global South.

Despite these critical interventions, significant gaps remain in the literature on digital health regulation. First, there is limited work examining the specific nature and format of regulatory infrastructures in the Global South, or how North–South dynamics shape their design and outcomes. Second, while debates on digital colonialism have gained momentum, there is still insufficient attention to how regulation itself is embedded within global inequalities and the asymmetrical power relations that sustain them. Third, scholarship has yet to fully interrogate the role of political rhetoric and neoliberal logics in shaping regulation, particularly in contexts where corporate actors exercise disproportionate influence. These lacunae suggest that regulation is often approached as a technical matter, obscuring its entanglement with histories of coloniality, capitalist rationalities and structural inequality.

7. Approach

Socio-legal studies have long examined how law, science, technology and society dispense power and agency through their discursive constructions and institutional practices (Faulkner et al. Reference Faulkner, Lange and Lawless2012; Latour Reference Latour and Elliott1988). In the digital health context, legal agency is shaped and co-determined by the normative power of technology corporations, their networks and the techno-scientific knowledge they mobilise (Turner and Wiber Reference Turner and Wiber2022). We propose that understanding digital health coloniality requires attention to how regulation itself enables extractive practices, producing normative orders that reinforce structural inequalities. These inequalities are not incidental but are sustained by the entanglement of capitalist interests and neoliberal logics with regulatory infrastructures. While vaccine technologies are subject to transnational intellectual property regimes, the cross-border transfer of health data promoted under digitisation agendas remains largely unregulated. This regulatory vacuum, we argue, cannot be understood outside the dynamics of digital coloniality.

Our approach therefore draws on a socio-legal analysis of digital health regulatory frameworks informed by science and technology studies (STS), feminist theory and decolonial thought. These perspectives highlight regulation not as a neutral safeguard but as a social and political practice shaped by histories of power, knowledge and inequality. STS foregrounds the relational and material dimensions of digital infrastructures, showing how technologies, standards and institutions co-produce regulatory orders (Latour Reference Latour2004; Jasanoff Reference Jasanoff2010). Feminist theory and legal studies interrogate how gendered hierarchies are embedded in digital systems and how embodied experiences of health are mediated through regulation (Harding Reference Harding1993; Lupton Reference Lupton2016). Decolonial theories, particularly the coloniality of power and knowledge, situate these dynamics within longer histories of extraction, dispossession and epistemic hierarchy (Mignolo et al. Reference Mignolo, Segato, Walsh and Quijano2024; Quijano Reference Quijano, Mignolo, Segato and Walsh2024). Taken together, this interdisciplinary framework grounds our analysis of how sub-Saharan countries regulate, or fail to regulate, the transnational transfer of digital health data within broader structures of coloniality and global inequality.

8. Our Special Issue contribution

Digital health infrastructures, from apps, platforms, databases to cloud storage, are assemblages that encode political and economic priorities. Many of the corporations that are increasingly involved in this space are not health providers in the traditional sense, yet they increasingly mediate care delivery, data storage and knowledge production. While corporate influence has long shaped global health, digital health intensifies this capture, extending the logics of surveillance capitalism into spaces where consent, privacy and equity are at stake (Zuboff Reference Zuboff2019). Infrastructures thus operate simultaneously as technical systems and instruments of governance, determining whose health is rendered visible, whose data becomes valuable and whose vulnerabilities are magnified (Kwet Reference Kwet2019; Sekalala and Chatikobo Reference Sekalala and Chatikobo2024; Couldry and Mejias Reference Couldry and Mejias2019). These dynamics present distinctive regulatory challenges, since corporate profit motives often conflict with public health goals, and infrastructures are increasingly governed by private standards rather than public accountability.

Scholarship on health and coloniality has long traced how infrastructures were deployed to manage populations and extend imperial control (Mignolo et al. Reference Mignolo, Segato, Walsh and Quijano2024; Sekalala Reference Sekalala2025; Sirleaf Reference Sirleaf2024; Erondu et al. Reference Erondu, Dhar Sharma and Mulumba2025). Digital health presents new challenges, revealing how coloniality is no longer confined to territorial or state-based logics but operates through infrastructures, standards and transnational flows of data. Regulation, in this context, risks becoming a vector of capture that entrenches asymmetries of power. At the same time, this recognition opens the question of resistance: if law itself is a colonial and capitalist construct, can digital health regulation nonetheless be re-imagined as a site of contestation and health justice?

Most existing work on digital health regulation has concentrated on privacy, data protection and ethics, often framed through technical or biomedical perspectives (Reich Reference Reich2024; Cordes et al. Reference Cordes, Bak and Lyndon2024; Heeks Reference Heeks2022; Agrawal et al. Reference Agrawal, Kickbusch, Medhora, Ndili and Holly2024; Kickbusch et al. Reference Kickbusch, Piselli and Agrawal2021). While this literature is vital, it tends to treat regulation as a neutral corrective to innovation, focusing on individual rights rather than structural inequalities. What remains underexplored is how regulatory infrastructures themselves are shaped by colonial legacies and neoliberal logics, and how these dynamics are mediated through digital health in the Global South. By foregrounding these dimensions, this Special Issue departs from accounts that frame regulation primarily in terms of compliance or oversight, instead situating it as a terrain of power where asymmetries are reproduced but also where resistance and health justice may be articulated.

This Special Issue, thus, intervenes by approaching digital health norms as products of the symbiotic relationship between technology corporations and states’ neoliberal agendas, examining how this nexus plays out in post-colonial contexts. Our contribution is to operationalise digital coloniality as both an analytic and empirical frame for regulation, showing how law and governance not only reproduce inequalities but may also be mobilised for resistance and reconfiguration. Unlike existing work that treats regulation as a neutral safeguard, we situate it as a constitutive process shaped by colonial legacies, capitalist logics and the infrastructures that sustain them. By extending debates on coloniality to the digital sphere, the Special Issue foregrounds how infrastructures in the Global South remain entangled with histories of extraction, yet also function as contested terrains where alternative futures of regulation, data sovereignty and health justice can be imagined.

The term Global South is far from uncontested. Critics point to its heterogeneity, its flattening of diverse contexts and its risk of reproducing binaries that obscure complexity (Dirlik Reference Dirlik2007; Sparke Reference Sparke2007; Lopez Reference Lopez2007). Yet, as Sundhya Pahuja argues in her discussion of the Third World, abandoning such terms altogether risks erasing the structural inequalities they name (Pahuja Reference Pahuja2011). For Pahuja, the value of the category lies not in its descriptive precision but in its capacity to illuminate enduring asymmetries in law, economy and power. We adopt Global South in a similar spirit: as a relational, political category that foregrounds the legacies of colonialism, dependency and marginalisation (Haug et al. Reference Haug, Braveboy-Wagner and Maihold2021). Within digital health, the term marks the uneven infrastructures, regulatory vacuums and corporate dependencies that shape health governance. Using the Global South as an analytical lens allows us to expose these inequalities while holding space for the multiplicity and contestation that characterise the regions and peoples it invokes.

9. Introducing the articles in our Special Issue

Applying work on infrastructures as forms of regulatory ordering, Sekalala and Chatikobo provide a socio-legal critique of the ways the commodification of digital health data in a post-colonial context can reproduce racialised colonialities. The authors analyse the commodification of health and wellness by a financial services company providing health insurance in South Africa. In their article, Digital health for shared value: a critique of legal infrastructures in a post-colonial context, the authors offer insights into how digital health data infrastructures and forms of legal access can configure relational interactions between corporations, the state and citizens that can advance vulnerabilities. Sekalala and Chatikobo’s article also reflects on health regulatory reforms in South Africa, such as the new National Health Insurance, and possibilities for recalibrating public health benefits in a context where health data is perceived to have significant value. By using a coloniality lens to study digital health data infrastructures, Sekalala and Chatikobo’s paper offers critical insights into how the pursuit of data, while sustained by law, can limit the emancipatory potential of regulatory reform. This can then impede the ability of the state to provide equitable access to health care.

Grounding the coloniality framework within a feminist perspective of digital health data in another post-colonial context, Malala examines the capacity and limitations of consumer law in accounting for the increasing platformisation of health. In her article, Health Applications: The consumer law and politics of vulnerability in Kenya’s digital health economy, she looks at the Kenyan digital ecosystem while focusing specifically on two emergent health apps, Zuri Health and BYON8. With claims to empowerment through self-monitoring, personalisation and intimacies, Malala contends that the lack of regulatory oversight of digital health apps is reframing health care as an individualised responsibility through commercial-consumer relationships. Malala’s article also reflects on how Kenya’s consumer protection framework could be re-imaged to address the harms that arise from what she calls the ‘appisation’ of health. Malala’s work reveals the urgency for legal imagination in an era of digital health data coloniality, and for expanding individualistic notions of protections to a more collective model that also considers intersectional vulnerabilities.

Applying the coloniality framework to a more global normative dimension, Kolfschooten, Parwani and Perehudoff draw parallels with the offshoring of clinical trials to provide an analysis of how the European Union’s GDPR, AI Act and Medical Devices Regulation might lead to AI ethics dumping in Global South contexts. In their article, Accounting for EU External Effects: From Clinical Trials to Data Colonialism to AI Ethics Dumping, the authors argue that the increasing need for health data, with corporations moving to exploit weaker regulatory environments outside of the EU, exacerbates vulnerabilities and harm. The authors provide proposals for counteracting AI ethics dumping, including considerations for internationally binding legal instruments, as well as expanding the scope of the recent European Health Data space regulations. Kolfschooten, Parwani and Perehudoff’s analysis offers insight into how legal responses to data harms can reproduce colonialities between countries and regions.

Using an STS approach, Chan analyses digital health regulatory choices in Singapore, with particular attention to the social and political dimensions that influence legal preparedness during public health emergencies. In her article, Legal preparedness in implementing digital contact tracing apps in managing public health threats: the Singapore experience, Chan offers insights into the delicate responsibility of the government to balance economic interests with collective public health benefits. Given the competing government, public and commercial interests, Chan provides regulatory strategies for an informed approach to handling data for health emergency preparedness in ways that advance health realisation and protect citizens from surveillance capitalism. Chan’s work reveals the need to understand health data issues not as homogeneous but contextual and situated, and to consider how relations between the state and citizens have a bearing on trajectories for digital health data regulatory responses.

The articles above pay attention to the ways in which interests over health data, whether from corporations or the state, have material implications for and through the law. The authors contextualise such dynamics through the lenses of data colonialism and surveillance capitalism. Rawson’s article, Health Data Justice, Epistemological Delinking and Vernacularisation: Reclaiming knowledge, rights, and representation, seriously considers the question of how to resist digital health data coloniality from the margins, with a particular focus on health data governance norm-making. Adopting a decolonial data justice lens on digital health regulation, Rawson explores the role of rights as a mechanism for digital health justice in vernacular contexts by analysing Transform Health’s equity- and human-rights-based ‘Health Data Governance Principles’. She investigates how diverse human rights actors in the Global South are challenging, contextualising and reformulating digital health rights norms as a form of epistemological delinking. Rawson’s paper offers empirical insights into the complexities of adopting global digital health standards in local contexts, illustrating the importance of centring contexts in regulatory responses.

10. Conclusion

Given the commonalities between digital health regulation and other domains of digital governance, this Special Issue has resonance across disciplines. The transfer of digital health norms – around consent, sovereignty or fairness – into adjacent regulatory fields underscores how health is both exemplary and foundational for understanding digital regulation more broadly. This collection looks at how law and regulation (and their absences) shape digital health across contexts in the Global South. Using contextual examples from Africa and Asia, the pieces attempt to think about the way in which law is structured to reproduce digital health harms in the Global South. Our collection also reflects on the imaginative potential of digital health rights and justice, showing how grass-roots movements in the Global South can promote situated regulatory reforms. By synthesising socio-legal, feminist and decolonial perspectives, the collection offers a novel critical contribution to global health law, digital governance and regulation studies, opening important lines for future research.