By Lyla Latif, Lai’Latif & Co Advocates

Introduction

Mobile health apps have become integral to healthcare across Africa. With smartphone penetration over 50% in Kenya, Nigeria, and South Africa, health apps have seen significant adoption among urban, young, and middle-class populations. The apps extend beyond medical advice, offering insurance coverage, prescription ordering, and medication delivery through drones and boda bodas (motorcycle taxis) to remote areas.  However, their usage remains limited among rural communities, older adults, and those with lower digital literacy and amidst the excitement surrounding these technological innovations, the crucial aspect: the human side of the equation – the user experience (UX), often gets overlooked.

UX covers users’ interactions with health apps, including perceptions, emotions, and behaviours within their socio-cultural context. As health apps become mainstream, UX also becomes fundamental to promoting the right to health. Under the International Covenant on Economic, Social and Cultural Rights (ICESCR), this right includes access to healthcare without discrimination and to health determinants like information and education. Health apps have the potential to support this right by providing actionable health information, connecting users with healthcare providers, and enabling informed decisions about health.

However, for health apps to truly promote the right to health, they must be designed and implemented in a way that considers the diverse needs, preferences, and contexts of their target users. This is where UX comes in. By prioritising UX, we can ensure that health apps are not only technically sound but also culturally appropriate, linguistically accessible, and aligned with the values and beliefs of the communities they serve. A positive UX can lead to increased engagement, trust, and adoption of health apps, which in turn can contribute to better health outcomes and the realisation of the right to health.

The Importance of Understanding User Experience

Despite the growing popularity of health apps in Africa, there is limited research investigating UX with these technologies. Most studies on health apps have focused on their technical functionalities, clinical effectiveness, or potential to improve healthcare access and delivery^[1] overlooking how users perceive, and engage with the apps daily. Research into UX is needed to fill this gap by exploring the subjective, contextual, and often intangible aspects of users’ interactions with health apps that goes beyond mere usability testing to consider the broader social, cultural, and emotional factors that shape users’ attitudes, behaviours, and decision-making processes.

User Experience and the Right to Health

UX is critical for promoting the right to health under ICESCR. While states remain primary duty-bearers, private entities develop most health apps, raising questions about state oversight. These apps advance Article 12(2)(a)’s goal of reducing infant mortality through maternal health information, and Article 12(2)(d)’s aim of ensuring medical service access in underserved areas. These apps support the right to health by providing health information, connecting users with healthcare providers, and empowering them to make informed decisions about their health. However, apps must be designed and implemented in a way that is accessible, acceptable, and appropriate for diverse populations in resource constrained countries. This is where research on UX comes in. By understanding the needs, preferences, and contexts of different user groups, app developers can create health apps that are more likely to be adopted, engaged with, and valued by their intended audiences. This is particularly important in low- and middle-income countries, where health apps have the potential to bridge significant gaps in healthcare access and delivery, but also face unique challenges related to infrastructure, literacy, and cultural diversity.

For example, the M-TIBA app in Kenya addresses a critical gap in the country’s healthcare financing system, where out-of-pocket payments remain high and health insurance coverage is limited, particularly among informal sector workers. The app provides users with a mobile health wallet that allows them to save, send, and pay for healthcare services using their mobile phones, effectively addressing the barrier of unexpected healthcare costs that often prevent people from seeking care. By enabling users to access and afford quality healthcare services through micro-savings and facilitating direct provider payments, M-TIBA has the potential to support the realisation of the right to health for millions of Kenyans, particularly those in low-income and rural areas. However, the success of M-TIBA in promoting the right to health depends not only on its technical functionality but also on its ability to meet the needs and expectations of its target users. This includes simple registration processes that accommodate varying literacy levels, clear explanations of healthcare costs in local languages, and trust-building features such as transparent transaction histories and direct connections to familiar local healthcare providers. While M-TIBA has successfully addressed many of these requirements through features like vernacular language support and integration with widely-used mobile money systems like M-PESA, challenges remain in reaching the most vulnerable populations, particularly those without reliable mobile phone access or those who require more intensive support in navigating digital health services. This requires a deep understanding of the social, cultural, and economic factors that shape UX and decision-making processes. It also requires designing the app in a way that is culturally appropriate, linguistically accessible, and aligned with users’ values and beliefs.

Similarly, the Safe Delivery app in Ethiopia provides healthcare workers with evidence-based guidelines and decision support tools for managing obstetric emergencies in low-resource settings. Directly addressing Article 12(2)(a) of ICESCR’s emphasis on reducing stillbirth rates and promoting healthy child development, the app has been designed to tackle Ethiopia’s high maternal mortality rates through improved emergency obstetric care. By improving the quality and timeliness of obstetric care, the Safe Delivery app has the potential to reduce maternal and newborn mortality rates and promote the right to health for women and children in Ethiopia. However, the impact of the Safe Delivery app on health outcomes, as argued by Lund et al., (2016) depends not only on its clinical effectiveness but also on its usability and acceptability among healthcare workers. This requires understanding the unique challenges and constraints that healthcare workers face in their daily practice, such as high workload, limited resources, and cultural barriers to care. It also requires designing the app in a way that is intuitive, efficient, and compatible with existing workflows and protocols.

Conclusion

UX is  fundamental to realising the right to health through health apps. The Kenyan proverb, “Asiyefunzwa na mamaye hufunzwa na ulimwengu,” (Those who are not taught by their mothers will be taught by the world) underscores the importance of learning from the experiences and wisdom of others, and is relevant in the context of health app development and implementation. To truly understand how health apps are perceived, adopted, and used by diverse populations, we must prioritise UX research and design. This involves conducting comprehensive studies that explore the subjective, contextual, and often intangible aspects of users’ interactions with these technologies. By gathering rich, nuanced data on users’ perceptions, attitudes, and behaviours, researchers can identify the key factors that shape engagement with health apps, as well as the barriers and facilitators to sustained use.

In doing so, we can work towards a future in which the right to health is realised for all, regardless of who they are or where they live. As Nelson Mandela once said, “A nation should not be judged by how it treats its highest citizens, but its lowest ones.” Similarly, the success of health apps should not be judged solely by their technological sophistication or market penetration, but by their ability to meet the needs and aspirations of the most marginalised and underserved populations. This is to be understood by inquiring into how users perceive, engage with and derive value from health apps, which ultimately establishes a nexus with the right to health. By understanding and addressing the unique challenges and barriers faced by marginalised communities in accessing and using health apps, we can ensure that these technologies are designed and deployed in ways that promote health equity and fulfil the fundamental human right to the highest attainable standard of health.

References

^[1] Adu MD and others, ‘Users’ preferences and design recommendations to promote engagements with mobile apps for diabetes self-management: Multi-national perspectives’ (2018) 13(12) PLoS ONE e0208942; García-Gómez JM and others, ‘Analysis of mobile health applications for a broad spectrum of consumers: A user experience approach’ (2014) 20(1) Health Informatics Journal 74; Hyzy M, Bond RR and Mulvenna M, ‘Objectively Assessing and Comparing the User Experience of Two Thousand Digital Health Apps’ (Design, User Experience, and Usability – 12th International Conference, DUXU 2023, HCI International Conference 2023); Kaveladze BT and others, ‘User Experience, Engagement, and Popularity in Mental Health Apps: Secondary Analysis of App Analytics and Expert App Reviews’ (2022) 9(1) JMIR Human Factors e30766, and Omaghomi T and others, ‘Health apps and patient engagement: A review of effectiveness and user experience’ (2024) 21(2) World Journal of Advanced Research and Reviews 432