Facilitators of Blood Pressure Control Among Treated Patients in Public Clinics in Botswana.

Health systems are complex, adaptive social systems that respond to evolving health, social, and political contexts [, ]. Managing these complex and evolving health needs poses challenges for all health systems []. These are particularly evident in low‐ and middle‐income countries (LMICs) due to high disease burdens, rapid population growth, and limited resources [, , ]. The Learning Health System (LHS) concept offers a framework for continuous improvement of health systems through iterative learning cycles [], as illustrated by the Friedman model where practice generates data, data generates knowledge, and knowledge is applied back into practice []. While digitalisation of health systems initially drove the LHS concept by enabling the sharing of large datasets for data‐driven innovation, social and cultural dimensions are now recognized as equally critical []. A recent review of various LHS frameworks suggests broad consensus around Friedman's cycle as the core of the LHS, supported by six interdependent domains adapted from the Institute of Medicine: science and informatics, continuous learning culture, incentives, patient–clinician partnerships, structures and governance, and equity and ethics [, , ]. While the LHS framework has gained traction in high‐income countries, its application in LMICs remains limited [, ]. A systematic review of 219 LHS articles found that only 3% were from middle‐income countries and none from low‐income countries []. Several factors contribute to this gap. The global LHS discourse has been shaped predominantly by high‐income countries, overlooking the specific needs of LMICs [, ]. Rigid bureaucracies, short‐term funding, fragmented data practices, or a lack of mature health information systems, operational pressures, and a lack of institutional structures for iterative learning limit the implementation of LHSs in LMIC [, , ]. There is also limited shared understanding of what constitutes an LHS or how it should function in LMIC, often relating to a disconnect between policies and realities []. When health systems fail to engage in systematic learning from past initiatives, they risk repeating mistakes, leading to the failure of policies and programs []. Therefore, embedding learning to strengthen health systems is especially critical in LMIC contexts.