High-Cost Healthcare Technology Versus Employment Generation: Equity, Evidence, and Influence in Developing Health Systems

Many low- and middle-income countries are spending money on high-tech healthcare, such as simulation centres, pneumatic tube systems, and even robotic platforms. These upgrades are sold as a sign of modernisation and global parity. Yet, people in these places pay a lot out of pocket for basic care, and many end up broke from catastrophic healthcare costs. Notably, most of these technologies do not always deliver real patient-level benefits. They are often underused, incur substantial maintenance, and are usually installed in tertiary care hospitals, leaving the majority of the population behind. When governments spend a substantial amount on these advanced technologies, they have less left towards workforce expansion, creating allied jobs, or helping people actually afford care. Importantly, a significant portion of these investments goes underutilised, limiting their intended system-level impact. In the resource-constrained economies where every dollar counts, what matters more right now is setting the right priorities. Although the digital health and pursuit of high-quality healthcare remain essential, strategic emphasis on core services and investments that strengthen the workforce and generate employment opportunities is equally important for building resilient and sustainable health systems for all. It is not that advanced healthcare technologies are not of any value, but the adoption should be when patient-level value and system feasibility are demonstrated. Further frugal innovation plays a great role in the advancement of health technology and digital health implementation. Nevertheless, low cost does not necessarily mean low impact. Thus, in the absence of robust data on the patient-level long-term outcome benefits, its adoption should be context-sensitive and supported by good evidence on patient outcomes and survival, over and above safety. High-cost health technology investments should be assessed through the lens of cost-effectiveness. The present editorial argues a prioritisation framework balancing equity, evidence, and opportunity cost in the light of digital health, frugal technology adoption in place for high-cost health technologies where feasible, and employment generation.