Formal and informal digital health in Tanzania: healthcare workforce, regulatory and trust implications of e-patients and virtual care and the development of the TRUST framework.

Digital health and virtual care are increasingly reshaping how healthcare is organized, delivered, and experienced. In Tanzania, digital transformation is evident in national commitments to digital health governance, health information exchange, hospital information systems, digital referral and emergency transportation, telemedicine, and emerging diagnostic applications supported by artificial intelligence. At the same time, patients are increasingly using social media, mobile platforms, and other digital channels to seek health information, consultations, diagnoses, and medicines, creating new forms of digitally mediated care that often operate alongside formal healthcare systems. Using a narrative synthesis design informed by a practice-based perspective, this study reviewed policy documents, national strategies, implementation reports, peer-reviewed empirical studies, global guidance documents, and conceptual literature relevant to Tanzania's digital health ecosystem. Evidence was identified through a structured search, source-selection, and thematic synthesis process. The review examined three interrelated questions: (i) how Tanzania's digital health and virtual care landscape is evolving; (ii) how e-patient behaviours, informal digital consultations, and emerging e-provider practices are interacting with formal health systems; and (iii) what these developments imply for workforce preparedness, clinical governance, patient safety, antimicrobial stewardship, confidentiality, accountability, and trust. The findings suggest that Tanzania's digital health transition is not primarily a technology-adoption challenge but a practice challenge involving how healthcare workers, patients, digital technologies, and governance systems interact in everyday care. While substantial progress has been made in establishing digital health policies and governance frameworks, important gaps remain in workforce preparedness, digital professionalism, virtual care governance, stewardship, privacy protection, and management of informal digital health practices. The review highlights the growing influence of e-patients and digitally mediated health-seeking behaviours in reshaping traditional patient-provider relationships and expectations of care. To support policy and implementation action, this paper proposes the TRUST framework: