Electronic Health Record systems offer the transformative potential to strengthen Tanzania's healthcare system, yet this promise remains largely unfulfilled due to a persistent cycle of failure. However many EHR initiatives, often driven by external partners, struggle to move beyond the pilot phase or are eventually abandoned, leading to wasted investment, duplicated effort, and a continued reliance on inefficient paper-based processes. This real-world challenge stems from a critical gap in strategy: current approaches focus on the internal process of a system while neglecting the overwhelming external pressures of the Tanzanian context, such as inconsistent funding, infrastructural deficits, and a lack of local ownership. Therefore, this study will address this deficiency by developing an integrated sustainability framework that synthesizes these internal and external factors, providing a context-specific framework to ensure that EHR investments become truly effective and sustainable in Tanzania.