Introduction

Properly implemented e-health holds tremendous potential to improve the lives of people in Tanzania, and this is best achieved through understanding the mechanics and lessons of previous attempts to realise it. This
paper aims to share insights from several Human Development Innovation Fund (HDIF) partners on how to design and implement e-health interventions for scale and sustainability with a focus on putting the user at the centre, i.e. considering both the creation of user-friendly platforms and digital literacy.

Jamii ni Afya Progam and mLabour have both led recent e-health project implementations in Tanzania, rolling out interventions from SMS messaging platforms through to full-spectrum e-health decision support and
work tools for community health volunteers and health-care workers. Each of these implementations offers insights into enabling particular aspects and identifying barriers and, in some cases, eventual solutions. Common across the projects was an effort to integrate the design with existing government systems as part of the programme design, so that they could later be scaled. Combined, over the 2016–2020 period, D-tree and Dimagi interventions have brought maternal and child health services to thousands of women across rural and urban areas of Tanzania and Zanzibar.

Recommendations

• Stakeholder engagement for immediate adoption and long-term sustainability is much greater when they are part of every step of the design and decision-making process.
• Assessment and inclusion of digital literacy in trainings and support are key to acceptance and a positive user experience.
• Scalability is more likely when actions have been taken to understand users’ needs and demonstrate how the e-health innovation improves processes and outcomes.
• Iterative trainings, peer-mentoring and ongoing local support are best employed to assure programme implementation and sustainability.