Foundational digital literacy training for frontline immunization officers: lessons from implementing the electronic stock management tool across selected comprehensive health centers in Sierra Leone.

Background: Sierra Leone has advanced its digital health agenda. However, digital literacy among frontline health workers remains low, with over 82% reporting limited confidence in using digital tools. The health workforce also recorded the lowest digital health maturity score among all enablers in the WHO Global Digital Health Monitor, underscoring the need for workforce upskilling as a foundation for digital transformation. Objective: This paper describes the design, implementation, and outcomes of a foundational digital literacy training program for frontline health workers under the Digital Innovation in Pandemic Control (DIPC) project, aimed at improving readiness for digital tool adoption. Methods: A training needs analysis (TNA) aligned skill gaps with the competencies required for using the electronic Stock Management Tool (eSMT). Training modules were adapted from the European Commission's DigComp framework, contextualized for Sierra Leone, and delivered through a blended learning model. Post-training competency gains were assessed to determine effectiveness. Results Implementation: Among 150 trained health workers, "high understanding" in basic computer literacy increased from 7.1% to 72.2%, while "low understanding" dropped from 65.9% to 9.2%. For computer troubleshooting skills, "high understanding" rose from 4.4% to 73.8%. Both courses showed large effect sizes (Cohen's d = 1.3-2.1), indicating substantial learning gains. Conclusions: Systematic digital literacy training, grounded in competency frameworks and contextual design, can substantially improve digital readiness among frontline health workers. Such interventions are essential foundations for sustainable digital transformation in health systems.