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Paper short abstract

This paper examines how power dynamics and community agency shape digital health adoption in Ghana. It shows how digital tools can widen or bridge gaps and proposes an equity-focused, community-driven approach to building resilient health systems.

Paper long abstract

Efforts to strengthen health systems across the global south intersect with questions of power, digitalisation, and community agency. While digital health innovations promise to expand access and efficiency, their implementation often reproduces existing inequities in financing, governance, and voice, particularly for marginalised populations. This paper examines how power dynamics shape the adoption, use, and governance of digital health technologies in Ghana, with a focus on patient-centred care, community empowerment, and the pursuit of Universal Health Coverage (UHC). Drawing on qualitative evidence from frontline health workers and local administrators, the study analyses how digital tools such as feedback management and electronic medical records are interpreted and negotiated within everyday practice.

The study finds that weak accountability structures, fragmented financing arrangements, and limited community participation can amplify disparities. The study argues that digitalisation does not automatically democratise health systems; rather, its benefits depend on the distribution of digital literacy, infrastructural resources, and decision-making authority. Simultaneously, the study highlights emergent forms of community-led innovation, ranging from informal digital navigation support to locally adapted teleconsultation practices that reassert agency at the margins.

By situating these dynamics within broader debates on governance and health system resilience, the paper proposes an equity-oriented framework for designing and governing digital health interventions in low-resource settings. It recommends shifting from technology-centred approaches to models that emphasize community agency, redistribution of power, and co-creation with service users. This reframing ultimately offers pathways to more inclusive and resilient health systems in an increasingly digital and interconnected global health landscape.