Between the hype and harm: does artificial intelligence in health offer solace or further exclusion for marginalised populations in Sub-Saharan Africa? A scoping review.

Artificial intelligence (AI) is increasingly being integrated into healthcare systems and has the potential to improve health outcomes. In Sub-Saharan Africa (SSA), however, concerns remain that AI may either reduce or exacerbate existing health inequities depending on how it is developed, governed, and implemented. This scoping review aimed to map and synthesise the existing evidence on the implications of AI for health equity among marginalised populations in Sub-Saharan Africa. PubMed, Web of Science, Scopus, and selected grey literature sources were searched between February and March 2026. Peer-reviewed and grey literature examining AI applications, governance, or implementation in healthcare involving marginalised populations or health systems within SSA were eligible for inclusion. The review followed the Arksey and O'Malley methodological framework and the PRISMA-ScR reporting guideline. Two reviewers independently screened sources of evidence and extracted data using a standardised charting form, and findings were synthesised thematically. Twenty-three sources of evidence met the inclusion criteria. Two dominant narratives emerged. AI may reinforce existing inequities through digital infrastructure gaps, algorithmic bias, under-representation of African datasets, weak governance, and data colonialism. Conversely, AI has the potential to improve health equity by expanding healthcare access, strengthening disease surveillance, supporting health system planning, and improving access to specialised services. Across the literature, AI's impact consistently depended on equitable infrastructure, inclusive governance, and context-specific implementation. AI has considerable potential to advance health equity in SSA. However, achieving equitable benefits requires investment in digital infrastructure, representative data systems, ethical governance, and inclusive policies.