Frugal Innovation for Sustainable Health IT in Kenya: Key Success Factors from a Qualitative Study in Resource-Limited Public Facilities (Preprint)

BACKGROUND Health Information Technology (Health IT) is central to strengthening health systems in low- and middle-income countries (LMICs). However, many digital health initiatives in resource-limited settings fail to remain functional or useful over time due to infrastructural constraints, weak governance, limited technical capacity, fragmented system architectures, and donor-driven pilot approaches. Frugal innovation (FI), which emphasises affordability, simplicity, and contextual fit, offers a promising lens for designing and managing sustainable Health IT systems, yet remains under-theorised within African public-sector contexts. OBJECTIVE This study explores how FI principles can be applied to Health IT project management in resource-limited Kenyan public health facilities and identifies key success factors (KSFs) that support long-term sustainability. METHODS A qualitative, exploratory study was conducted across urban-poor and rural/peri-urban public health facilities in two Kenyan counties. Thirty-two participants, including health professionals, facility and county managers, ICT staff, development partners, and community representatives, were recruited using purposive and snowball sampling. Data were collected through semi-structured interviews and focus group discussions and analysed using a hybrid, grounded-theory–informed approach to derive key themes and KSFs. RESULTS Three interlocking KSFs emerged as critical to sustainable Health IT project management. First, context-aware Health IT solutions enable alignment of digital tools with local infrastructural, organizational, and socio-cultural conditions. Second, public–private partnerships (PPPs) facilitate the pooling of technical, financial, and institutional resources required for long-term system viability. Third, iterative user-centred design (UCD) embedded within an Engineering V-model (V-model) supports continuous adaptation, usability, and stakeholder ownership. CONCLUSIONS The study proposes an FI-anchored framework in which context-aware solutions, institutionalized PPPs, and iterative UCD jointly underpin sustainable Health IT implementation in resource-limited African public health systems. The framework offers actionable guidance for policymakers, implementers, and donors seeking to design, scale, and sustain equitable digital health interventions. CLINICALTRIAL n/a