Designing digital health for women who need it most

By Medinat Kanabe

As governments increasingly embrace digital technology to improve healthcare delivery, one critical question is often overlooked: who are these digital solutions really designed for?

The conversation is especially important in maternal healthcare, where access to timely information and services can mean the difference between life and death. In Nigeria, where many women still contend with long distances to health facilities, poor internet connectivity, language barriers and limited digital literacy, technology cannot simply be innovative, it must also be accessible.

These issues are at the heart of Designing Health Apps for Women in Rural Areas: An Accessibility-First Approach, a paper by Senior UX Designer and Product Leader Kehinde Agbaje.

Drawing examples from Nigeria, Ghana, India, the United States and Scotland, Agbaje argues that the women who are most likely to experience poor maternal health outcomes are often the least considered when digital health platforms are designed.

He paints a vivid picture of a pregnant woman in rural Nigeria who may share a mobile phone with her husband, speak Yoruba, Hausa, Igbo or Pidgin more fluently than English, live several kilometres from the nearest health facility and struggle with unreliable mobile network coverage.

According to him, similar challenges exist in rural America, Scotland, northern India and Australia, where distance from healthcare facilities, weak connectivity and limited health literacy continue to affect access to maternal care.

His central argument is that accessibility should not be treated as an optional feature added after a health application has been developed.

Instead, it should guide every stage of design, ensuring that technology responds to the realities of those it seeks to serve.

The argument is particularly relevant to Nigeria, which continues to face one of the world’s highest maternal mortality burdens despite significant investments in healthcare and digital innovation.

While governments and development partners have introduced several technology-driven health initiatives, the effectiveness of these platforms ultimately depends on whether they can reach women with the greatest need.

Lagos State’s Ilera Eko health insurance scheme offers an important opportunity to examine this question.

Established to expand access to affordable healthcare through the Lagos State Health Management Agency (LASHMA), the scheme has embraced technology in enrolment and service delivery as part of the state’s drive towards universal health coverage.

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Yet accessibility extends beyond creating an online platform.
Can a pregnant woman living in Epe, Badagry or other riverine communities enrol without difficulty? Does a market woman with limited digital skills understand how to register? Can users who are more comfortable communicating in Yoruba or Pidgin easily obtain information? Are services designed to accommodate those using older phones or facing poor internet connectivity?

Agbaje’s paper suggests that answering these questions is essential if digital health programmes are to fulfil their promise.

He highlights Ghana’s MOTECH programme, which delivers maternal health information through voice messages in local languages rather than relying solely on text-based applications.

He also points to India’s Kilkari programme, which provides weekly prerecorded voice calls to women throughout pregnancy and the first year after childbirth.

While both programmes demonstrated the value of voice-based communication, they also exposed persistent challenges, including unequal access to mobile phones among women with lower levels of education and those from marginalised communities.

These examples illustrate an important lesson: technology alone does not eliminate inequality.

Unless digital services are intentionally designed to address barriers such as literacy, language, connectivity and device ownership, they risk excluding the very people they are intended to support.

For Ilera Eko, this raises important policy considerations.

Beyond digital enrolment, could voice-based reminders help expectant mothers remember antenatal appointments? Should health information be routinely delivered in Yoruba and Pidgin alongside English? Could offline functionality improve access for communities experiencing unreliable internet service? And can community health workers become a stronger bridge between digital platforms and women who require face-to-face support?

Agbaje recommends an accessibility-first model built around plain language, voice and audio options, local languages, low-data and offline functionality, and active involvement of community health workers.

He also argues that women from underserved communities should participate in designing digital health platforms so that developers understand their everyday realities rather than making assumptions about how they use technology.

These recommendations are not only relevant to maternal health applications; they also provide useful guidance for health insurance platforms such as Ilera Eko as they continue to expand across Lagos State.

The true measure of digital innovation is not the sophistication of an application or the number of online registrations it records. Success should be measured by whether the woman with the greatest barriers to healthcare can use the service confidently and benefit from it.

As Nigeria continues its digital transformation in healthcare, policymakers, technology developers and health institutions should recognise that accessibility is more than a design principle. It is a public health necessity.

Kehinde Agbaje’s accessibility-first framework offers a timely reminder that effective digital health systems are not built around technology itself. They are built around people.

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For Lagos and indeed Nigeria, ensuring that every woman, regardless of where she lives, the language she speaks or the phone she owns, can access quality healthcare may be the most important innovation of all.

  Medinat Kanabe writes from Lagos

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