Local Innovation or Donor-Driven Solutions? Governing Digital Health Transformation in Tanzania

In recent years, technology companies and donor agencies have made substantial investments in the development of digital technologies to improve health outcomes in low- and middle-income countries (LLMICs) with weak public health systems. These investments include applications and artificial intelligence tools to enhance public health surveillance, diagnostics and the treatment of a range of conditions; as well as digital financial services for healthcare. However, growing concerns that high costs, weak regulatory frameworks and designs poorly attuned to local contexts have prompted a series of global policy initiatives aimed at supporting ‘local innovation’ to better meet the needs of end-users and national health systems. For example, the Digital Public Goods Alliance, supported by the Norwegian Agency of Development Cooperation aims to ‘fundamentally alter power balances’ to enable LLMICs to drive their own digital transformation processes and grow vibrant local ecosystems to create, maintain, implement and incubate digital technologies. The paper will present emerging findings from ongoing research into how such initiatives are shaping the digital transformation of Tanzania’s health system. As in other parts of Africa, Tanzania’s digital health landscape is often seen as suffering from poor coordination and an over-reliance on financial capital. These conditions have raised concerns about a fragmented, pilot-driven digital healthcare system, digital technologies and algorithms that exacerbate inequities, and challenges related to data privacy and data sovereignty. The Tanzanian government has been a regional leader in responding to these challenges through policy and implementation efforts, including as a partner country in numerous donor-funded initiatives to build capacity for the governance of digital health and to foster local innovation ecosystems. We examine how Tanzanian government institutions work with international partners and investors to promote, facilitate, and build local capacity for digital health innovation. We emphasize the role of the Gates Foundation and its partners and grantees in shaping Tanzanian governance of digital health, including through co-creating the country’s Digital Health Investment Roadmap and Digital Health Strategy, which are regarded as pioneering in the region. Drawing on policy documents and in-depth stakeholder interviews, we explore how actors involved in these initiatives conceptualize local innovation, how they address relevance to Tanzania's health system context and equity goals, and how power dynamics within partnerships between national and international actors shape digital health policymaking. This paper therefore sheds light on what ‘local innovation’ means in practice. Is ‘locally’ created digital health another instance of a donor-driven technological ‘band aid’ to intractable health system problems, or does it offer opportunities to develop contextually appropriate technological interventions capable of strengthening healthcare systems and promoting more equitable health outcomes? The paper is co-authored by Katerini T. Storeng and Brenda Mukungo, University of Oslo