Sustainability of a Nationally Scaled Digital Clinical Decision-Support System in Burkina Faso

<title>Abstract</title> <p>A digital clinical decision-support system (CDSS) for maternal and child health has been rolled-out to cover 90% of primary healthcare facilities in Burkina Faso. As the technological, financial and policy environment evolves, its future is unclear. This study explores factors influencing the sustainability of the intervention and their implications. The qualitative study combined a document review and interviews. The analysis used Greenhalgh’s ‘Non-adoption, Abandonment, Scale-up, Spread and Sustainability’ (NASSS) framework. High relevance, acceptability and engagement of authorities at local level promoted sustainability. Funding gaps, governance and infrastructure were challenges. Opportunities included integration into the national health system and optimised data flows to leverage routine CDSS data for management and epidemiological surveillance. Despite challenging complexity in the wider system, the program itself has high potential for sustainability, and its scale and resilience for over a decade demonstrate the feasibility of nationally scaling and sustaining CDSS in low-resource settings.</p>