Digital Governance and Social Inclusion in Primary Healthcare: Lessons from the Use of Artificial Intelligence in Sri Lanka

Abstract

Digital health and artificial intelligence (AI) are increasingly promoted as tools to improve efficiency, access and continuity of care in health systems. In Sri Lanka, these technologies are being introduced within a health sector that already faces challenges such as workforce pressure, rising service demand, uneven digital infrastructure and persistent rural-urban disparities. Although digital health can strengthen primary healthcare, its benefits are not automatic. Without inclusive governance, AI-enabled and digital services may unintentionally exclude older adults, rural communities, low-income households and disaster-affected populations. This position paper examines how digital governance can promote or limit social inclusion in primary healthcare in Sri Lanka. A structured narrative position paper approach was used, informed by selected peer-reviewed literature, international guidance, national policy documents and reflective observations from primary healthcare practice in rural Sri Lanka. Sources were reviewed using predefined thematic criteria related to AI in health, digital governance, primary healthcare, equity, data protection, accountability and social inclusion. The analysis identifies four major areas of concern: unequal access to digital infrastructure, low digital literacy among vulnerable groups, limited public trust in data use, and weak mechanisms for accountability when AI-supported decisions affect care. Ethical concerns were organised using core principles of autonomy, beneficence, non-maleficence, justice, privacy, transparency and accountability. The paper argues that technology alone cannot address healthcare inequality; rather, inclusive governance is required to ensure that digital transformation strengthens social trust and does not create new forms of exclusion. The paper recommends locally validated AI tools, human oversight, multilingual and low-literacy design, community participation, stronger data protection, role-specific training for primary healthcare workers and hybrid service models that preserve non-digital access. Inclusive digital governance should be treated as a public health requirement, not only a technical or administrative concern.