Transitioning to digital systems in Tanzanian public primary healthcare: an electronic medical records approach

Purpose This study aims to examine the factors sustaining the parallel use of paper-based and electronic medical records (EMRs) in six public primary healthcare facilities (PHC) in Tanzania and proposes strategies to guide a phased transition to a fully digital system. Design/methodology/approach A qualitative design was used, incorporating nonparticipant observations, document reviews and in-depth interviews with 41 healthcare professionals including doctors, nurses, laboratory technicians, accountants, pharmacy technicians and medical records staff across two Tanzanian regions. The data were analyzed using thematic analysis to identify patterns and categories related to EMR implementation and usage. Findings Organizational, technical and individual-level barriers limit EMR uptake, including poor information technology infrastructure, unstable networks and limited digital literacy. These challenges drive continued reliance on paper-based tools such as manual registers and prescription forms. Recommended strategies include strengthening data backup and recovery protocols, enhancing governance and accountability, building targeted information and communication technology (ICT) capacity, improving infrastructure and system integration, adopting structured change management and fostering active stakeholder engagement. Research limitations/implications The findings provide actionable guidance for policymakers, healthcare managers and implementers on reducing operational inefficiencies caused by dual systems. Addressing infrastructural gaps, investing in inclusive capacity-building and strengthening governance can improve EMR reliability, data quality and service efficiency, while promoting equitable access, transparency and trust in healthcare delivery, particularly in underserved areas. Originality/value This study offers context-specific evidence on managing the transition from hybrid to paperless medical record systems in resource-limited settings, contributing practical, policy and governance recommendations to advance digital health integration in Tanzania’s PHC.