ABSTRACT
Although low-income countries have recently seen an exponential flourishing of digital health initiatives, the landscape is characterised by a myriad of small pilots that rarely reach scaling, sustainability and wide adoption. The case of Burkina Faso represents an exception where a digital health initiative initially conceived to improve the diagnosis of sick children under 5 has supported millions of consultations. Technical aspects such as interoperability, standardisation, and adaptation to the existing infrastructure were considered as they are prerequisites for scaling; so was the demonstration of the health impact and affordability of the initiative. Beyond those factors which are largely documented in the literature, the experience in Burkina Faso showed that the positive outcome was also determined by the support of numerous stakeholders. A vast network of stakeholders from the Ministry of Health to child caregivers is involved and each of them could have either blocked or promoted the digital health initiative. Thanks to an extensive, time-consuming and tailored stakeholder strategy, it was possible to avoid potential blockages from multiple actors and gain their engagement.