The Hidden Divide: Development Inequities in Global South m-health (Preprint)

UNSTRUCTURED Mobile health (m-health) is widely promoted as a solution to health service gaps in the Global South; yet, its development remains structurally inequitable. Prior research has focused largely on barriers to implementation, with far less attention to upstream constraints that shape who designs, owns, governs, and sustains digital health technologies. Drawing on a literature review and a case study of a smartphone-based intervention developed in Kenya for women experiencing intimate partner violence amid climate-related stress, this viewpoint identifies six domains of development-stage inequity: financing and ownership; connectivity and mobile-data structures; data governance and sovereignty; platform gatekeeping; digital divides and safety-critical design; and sustainability. We show how Global North–centered funding models, platform rules, and data governance structures reproduce control over technologies intended for Global South contexts. Achieving equitable m-health requires greater Global South leadership in development, ownership, and governance, supported by coordinated action from funders, platforms, and regulators.