Bridging digital health gaps in South Africa: A qualitative study of the digital divide, interoperability and health equity

Objective: This study investigates how the interplay between the digital divide and limited interoperability in healthcare technologies contributes to regional disparities in healthcare access and outcomes in South Africa. It further examines how digital health systems might be leveraged to reduce inequities and promote more inclusive development. Methods: The research draws on qualitative interviews with clinicians, digital health experts, policymakers, and implementers across public and private sectors. Data were analysed thematically, with attention to structural conditions shaping digital readiness, institutional capacity, information flow, and user experience across provinces. Results: Findings suggest that structural barriers, such as uneven broadband access, outdated infrastructure, staff shortages and institutional fragmentation, interact with weak interoperability to produce inconsistent digital health experiences. These constraints limit continuity of care, restrict patient mobility across systems and contribute to the existing disparities between better-resourced and under-resourced regions. Participants emphasised that digital tools alone cannot deliver equitable outcomes without coordinated governance, national digital public infrastructure, and sustained organisational readiness. Conclusion: Digital transformation will only advance equity when digital access, interoperability and institutional capacity are addressed as interdependent system-level requirements. Strengthening national digital infrastructure and governance is essential to ensuring that digital health technologies narrow, rather than reproduce, existing inequalities, including persistent regional disparities that manifest within the broader national system. Sustained national investment in digital governance and shared infrastructure is indispensable to ensuring that digital health systems mitigate rather than reinforce deep-seated inequities. Embedding equity in the design and implementation of digital health initiatives is essential for translating technological progress into inclusive health outcomes.