With societal challenges, including but not limited to human development, equity, social justice, and climate change, societal-level digital transformation (SDT) is of imminent relevance and theoretical interest. While building on local-level efforts, societal-level transformation is a non-linear extension of the local level. Unfortunately, academic discourse on digital transformation has largely left SDT unaccounted for. Drawing on more than 25 years of intensive, interventionist research engagement with the digital transformation of public healthcare information management and delivery in more than 80 countries in the Global South, we contribute to theorizing SDT in the form of a design theory consisting of six interconnected design principles. These design principles articulate the interplay and tensions of accommodating over time increased diversity and flexibility in digital solutions, while connecting local, national, and regional/ global efforts at the same time.