This research examines the application of Lean Portfolio Management (LPM) principles to public health infrastructure modernization efforts. Through a mixed-methods study of 14 public health agencies across three countries that implemented LPM approaches between 2019-2023, we identified key enablers and barriers to successful adoption. Findings reveal that organizations implementing comprehensive LPM frameworks achieved 37% faster delivery of digital health initiatives, 42% improvement in resource utilization, and significantly higher stakeholder satisfaction compared to traditional project management approaches. Success factors included executive leadership alignment, cross-functional governance structures, incremental funding models, and capacity-based planning. This study provides a framework for health system leaders to effectively govern technology portfolios, prioritize investments based on population health impact, and foster innovation while maintaining operational stability. The research demonstrates that LPM offers a viable approach for public health organizations to navigate complex modernization efforts while maximizing value delivery in resourceconstrained environments