Navigating Organizational Challenges of Digital Transformation: A Qualitative Study of Meso-Level Public Health Officers in an Indian High-Priority Aspirational District

Background: Digital transformation is reshaping public organizations worldwide, yet in low-resource contexts, its success is constrained by weak infrastructure and governance. In India, programs such as the Ayushman Bharat Digital Mission and the Aspirational Districts Programme rely on meso-level officers who act as key managerial intermediaries, but their organizational challenges remain understudied. Aim: This study examines sub-district health and nutrition officers’ experiences, organizational barriers, and adaptive strategies in implementing digital reforms. Methods: Eight in-depth interviews were conducted with Medical Officers in Charge (MOICs) and Child Development Project Officers (CDPOs) across urban, semi-urban, rural, and flood-prone blocks of Muzaffarpur, Bihar. Data were transcribed, translated, and thematically analyzed using Braun and Clarke’s approach, informed by organizational and technology adoption theories. Results: Officers valued digital tools for transparency and real-time monitoring but faced systemic barriers, including hardware decay, poor connectivity, fragmented platforms, and limited fiscal autonomy. Despite these, they displayed managerial agency through informal infrastructures such as WhatsApp, peer mentoring, and parallel records. COVID-19 accelerated digital use while widening inequities. Conclusions: Meso-level officers are critical enablers of organizational resilience. Their experiences highlight how leadership, governance, and adaptive management shape digital transformation in resource-constrained settings.