Prioritarian principles for digital health in low resource settings

Abstract

This theoretical paper argues for prioritarianism as an ethical underpinning for digital health in contexts of extreme disadvantage. In support of this claim, the paper develops three prioritarian principles for making ethical decisions for digital health programme design, grounded in the normative position that the greater the need (of the marginalised), the stronger the moral claim. The principles are positioned as an alternative view to the prevailing utilitarian approach to digital health, which the paper argues is not sufficient to address the needs of the worst off. As researchers of digital health, we must ensure that the most globally marginalised are not overlooked by overtly technocentric implementation practices. Consequently, the paper concludes by advocating for use of the three principles to support stronger critical reflection on the ethics involved in the design and implementation of digital health programmes.

Stakeholder perspectives and requirements to guide the development of digital technology for palliative cancer services: a multi-country, cross-sectional, qualitative study in Nigeria, Uganda and Zimbabwe

“…basic mobile phones alongside smartphones) and the need to consider capacity to support non-users of digital technologies. Recent principles have emphasised that current approaches to digital technology design, development, implementation and evaluation may be problematic for the worst off [ 51 ]. Continued stakeholder engagement in the development of digital technologies should ensure participation of the marginalised in programmes to ensure an understanding of sociotechnical complexities of implementation.…”

The Sociotechnical Ethics of Digital Health: A Critique and Extension of Approaches From Bioethics

“…The first type of contribution to the bioethics of digital health literature that we identify we refer to as “ applying ethical theory .” In this body of literature, scholars adopt the perspective of an existing ethical theory and assess a subset of normatively relevant issues in digital health from that perspective ( 21 , 26 ). The most common is some form of principlist approach, one that relies on a series of bioethical principles to guide assessment of the ethical implications of any given area of human activity ( 23 , 24 , 27 , 28 ).…”

“…Contributions in the “applying ethical theory” category have illuminated various dimensions of a set of well-defined normative issues in digital health from the perspectives of commonly known bioethical theories. These normative issues most prominently include privacy, security, data governance, and the distribution of benefits and burdens arising from the use of digital health technologies ( 16 , 26 , 30 ).…”

“…The harms identified in this category of contribution range in their proximity to the technology itself. Harms include issues closer to the technology, such as privacy or trust in digital health technologies ( 25 , 31 ), and others farther from the technology itself such as the unequal resources available to procure and implement digital health technologies around the world ( 26 ). Although the focus of this type of contribution is primarily on the harms, issues or challenges of digital health ( 32 ), these are often also linked with the positively stated concepts that can address harms.…”

Multiple Disease Hotspot Mining for Public Health Informatics in Resource Starved Settings: Study of Communicable Diseases in Punjab, Pakistan

“…increasing prevalence of communicable and non-communicable diseases all over the globe has made public health policy management and resource allocation a challenging task [1]. Particularly in resource-limited locations, as common in lower and middle income countries, it becomes of high importance that appropriate policies and intervention programs be designed to target areas fairly and efficiently [2]. Traditional diseases surveillance programs are an effective way to collect such information [3]- [5].…”