Unpacking social and digital determinants of health in Africa: a narrative review on challenges and opportunities

Abstract

Background and objective: Social and digital determinants of health are increasingly recognized as critical drivers of health outcomes, particularly in Africa, where economic disparities, geographic divides, and evolving digital infrastructures present unique challenges. Addressing these determinants is crucial for reducing health inequities and improving access to healthcare across the continent. This review synthesizes the current understanding of social and digital determinants of health within the African context, emphasizing their regional variations, research gaps, and potential interventions.

Methods: A narrative review approach was adopted, conducting a targeted search of literature from databases such as PubMed and Google Scholar, alongside grey literature from organizations like the World Health Organization (WHO). The review focused on studies published between 2000 and 2023, covering social determinants like socioeconomic status, education, and healthcare access, as well as emerging digital determinants such as digital literacy and mobile technology use. Thematic analysis was performed to categorize findings and identify regional variations, particularly in North, sub-Saharan, Eastern, Western, and Central Africa.

Key content and findings: The review highlights significant disparities in both social and digital determinants across African regions. Urban-rural divides, economic inequalities, and limited healthcare infrastructure pose persistent challenges. Digital determinants are increasingly influencing health outcomes, with countries like Kenya leading in mobile health innovations, while others, particularly in rural areas, struggle with poor internet penetration. Research gaps were identified, particularly the need for longitudinal data and integration of digital determinants into health surveillance systems like health and demographic surveillance systems (HDSS).

Conclusions: Social and digital determinants of health significantly impact health outcomes in Africa. Addressing these disparities through targeted interventions, improved infrastructure, and digital health innovations is essential for reducing inequities. Further research, particularly longitudinal studies, is critical for understanding the evolving role of digital determinants in African healthcare systems and shaping effective public health policies.

Keywords: Africa; Social determinants of health (SDOH); digital determinants of health (DDOH); digital health interventions; health inequities.

Figure 1

Diagram illustrating the Dahlgren-Whitehead model with African context.

Figure 2

Classification of digital health interventions based on the WHO framework (103). WHO, World Health Organization.

Figure 3

Diagram illustrating the interplay between social and digital determinants of health.

Figure 4

Diagram illustrating the interplay of the different methodologies for gathering data and monitoring progress of the social and digital determinants of health. GIS, geographic information system; HDSS, health and demographic surveillance systems.