Abstract
This study explores digital health policy implementation as a governance practice in public hospitals in Gombe State, Nigeria. Despite national policy commitments, implementation remains fragmented in resource-constrained settings. Using an explanatory sequential mixed-methods design, we investigate how Technology, Organization, and Environment (TOE) factors influence digital health adoption. We distributed 285 questionnaires and retained 247 valid responses for Partial Least Squares Structural Equation Modeling. Quantitative results indicate that organizational readiness and policy clarity strongly predict implementation success. Qualitative findings from 32 interviews and four focus groups explain these statistical pathways. The data reveal that weak interdepartmental coordination and misaligned incentives undermine technological readiness. Furthermore, environmental instability acts as a governance multiplier that exacerbates coordination failures. This study extends the TOE framework by empirically testing governance as a mediating mechanism. We conclude that digital health success depends on formalized governance structures rather than technology alone. We recommend appointing a senior clinician as a digital health focal point and mandating clinical shadowing for IT vendors. These targeted interventions offer a pragmatic roadmap for fragile settings.