A systems framework for sustainable digital health transformation in Africa: beyond training to enabling ecosystems (Preprint)

UNSTRUCTURED Africa's digital health transformation is among the most consequential health systems strengthening efforts of the twenty-first century, yet its sustainability remains uncertain. Current initiatives emphasize training health informatics professionals, but individual expertise cannot deliver population-level impact without supportive systems. This Viewpoint argues that sustainable digital health transformation requires coordinated investment in four interdependent pillars: workforce development, institutional strengthening, governance frameworks, and interoperable infrastructure. Drawing on illustrative experiences from Ethiopia, Kenya, Sierra Leone, and other countries, we demonstrate how platforms such as the District Health Information Software 2 (DHIS2), national surveillance systems, and public health emergency operations centres succeed or fail depending on the strength of these supporting structures. We align the proposed framework with existing strategies from the Africa Centres for Disease Control and Prevention (Africa CDC) and World Health Organization while integrating equity and political-economy considerations—including career pathways, funding models, and data governance for artificial intelligence—often absent from technical frameworks. We conclude with a practical checklist and policy recommendations for governments, regional bodies, and development partners seeking to move beyond project-based training toward enabling ecosystems where African digital health professionals can apply their skills to address pressing public health challenges.