When code meets care: rethinking emerging digital health technologies for sustainable primary health systems

This study aimed to investigate the impact of emerging digital health technologies on the sustainability of primary healthcare systems in Tanzania, focusing on operational, institutional, social and environmental dimensions.

A convergent mixed-methods design was employed in Tanzania. Quantitative data were collected from 240 healthcare workers across 204 primary healthcare facilities using a structured questionnaire. Regression analysis identified predictors of sustainability outcomes based on the technology-organisation-environment (TOE) framework. In parallel, qualitative data were gathered through 25 semi-structured interviews with health professionals and administrators. Thematic analysis was employed to explore perceptions, experiences and institutional challenges associated with digital health implementation.

Usability, system reliability and staff capacity were significant predictors of operational sustainability (R2 = 0.760), while training availability, leadership support and policy support were strong predictors of institutional sustainability (R2 = 0.844). Environmental sustainability received the lowest overall rating (mean = 2.41, SD = 0.78), reflecting constraints such as unstable electricity, limited funding and a lack of maintenance planning. Qualitative findings reinforced these patterns, with participants reporting improved workflow and data visibility but raising concerns about digital exclusion, weak governance and inequities between urban and rural facilities. The integration of findings highlighted the need for coordinated investments beyond infrastructure, including sustained training, policy coherence and targeted support for under-resourced health centres.

This study extends the TOE framework to a multi-dimensional sustainability context, integrating operational, institutional, social and environmental perspectives in a low-resource primary healthcare setting. It provides evidence that sustainable digital health implementation requires not only technological functionality but also organisational readiness, inclusive policies and attention to environmental resilience.