Fostering an enabling environment for health AI innovation and scale: The need for tailored ethics training for innovators in low- and middle-income countries.

Artificial intelligence (AI) is a rapidly evolving technology with transformative potential across many fields, including health. Interest in AI is growing globally, including in low- and middle-income countries (LMICs), but few studies have assessed the knowledge, experiences, and ethical practices of innovators in this space. This study aimed to assess the knowledge, experiences, challenges, and ethical practices of researchers and innovators, involved in AI-driven health research, to support the responsible integration of AI into health innovation. A cross-sectional, semi-quantitative online survey was conducted between February and May 2025 among health AI innovators in LMICs, primarily through the Grand Challenges network and its partners. Fifty respondents from 13 countries participated, the majority (92%) emphasized the importance of ethical principles, and 80% perceived AI-related ethical risks as greater than moderate. However, the majority of respondents (74%) were not sure about their competence in identifying and addressing the risks associated with AI practices and the same proportion reported having received no formal training in AI ethics. Respondents identified key challenges such as weak governance, limited ethics capacity, and risks of bias and data misuse. There was strong demand for training on ethics, bias mitigation, explainability, data governance, and privacy. The findings reveal an encouraging level of awareness but emphasize the need for formal training, clearer guidelines, and context-specific frameworks to ensure ethical AI development and deployment in health research.