High-Impact Growth — Episode Summary

Episode Title: Building SaaS Products for Global Health: Lessons from CommCare & SureAdhere
Date: December 19, 2024
Host: Amie Vaccaro & Jonathan Jackson (Dimagi)
Guests: Dani Roberts, Kai Cowger, Matthew Hato

Overview

This episode dives deep into the unique challenges and lessons of building scalable Software as a Service (SaaS) products for global health, focusing on Dimagi's flagship offerings: CommCare and SureAdhere. Host Amie Vaccaro and CEO Jonathan Jackson are joined by core product leads Dani Roberts, Kai Cowger, and Matthew Hato. The discussion ranges from the why of SaaS in global health, to financial trade-offs, product vs. project mindsets, product marketing's importance, and advice for product teams seeking high-impact, sustainable growth.

Key Discussion Points & Insights

1. Why Global Health Needs SaaS Products

• Scale is Essential: Digital health's increasing pressures and tight budgets make scalable, reusable software models crucial for maximum impact.
• Efficiency Over Projects: Products built once and used many times provide better ROI than bespoke project work.
• The Funding Paradox: Global health donors rarely fund "maintenance," making sustainability a core challenge.

Quote:
"It's imperative that money goes further. And I think one of the ways money can go further is by creating products that you build once and sell many times... We're only going to be able to make massive impact with CommCare and SureAdhere if both they're impactful today and we have teams behind them to keep making them better." — Jonathan Jackson (05:36)

2. Unique Challenges in Global Health SaaS

• Market Dysfunction: Fluctuating funding cycles, unpredictability, and short project lifespans create a “broken” market for SaaS.
• Sustainability Is Hard: Thin margins and relatively small user bases mean global health SaaS must do more with less.
• Product Maintenance: Software “rots” — ongoing resources are needed for security, compatibility, and user expectations.

Quote:
"Software kind of rots the same way fruit does... people discover vulnerabilities and components you're using and constantly have to play cat and mouse." — Dani Roberts (09:50)

3. Product vs. Project Revenue (and Why It Matters)

• True Growth Comes from Product Revenue: Project-based funding masquerading as product revenue can be a mirage; only “real” product revenue supports scalable teams and sustainable growth.
• Disciplined Tracking: Separating project from product revenue is critical to understand financial viability.

Quote:
"It's really critical that you know what is the true product model you hope to get to and you measure your revenue... and not trick yourself into thinking your project revenue represents product demand." — Jonathan Jackson (42:22)

4. The Importance of Product Marketing

• Complex Products Need Clear Stories: Marketing is about driving the right customers to the right value—helping potential users see themselves in the product.
• "Easy things are easy; hard things are possible." Too often energy goes on advanced features, while first-time user experience suffers.
• Champion Barriers: Adoption is often driven by organizational champions, but a difficult onboarding or opaque value proposition hinders spreading.

Quote:
"People don't want a product that can do anything. They want a product that can do their thing." — Dani Roberts (30:51)

Quote:
"For us to find ways through our product development to make that pathway easier essentially does so much of that product marketing job for us." — Kai Cowger (29:06)

5. Product Stewardship & Strategic Trade-offs

• Engineering Focus: Most costs are fixed, not variable per user—growing revenue and users allows stable, appropriately sized teams.
• Prioritization: The need to choose between immediate maintenance, new features for existing users, or bets on new markets.
• Customer Success as North Star: Metrics like “adherence” in SureAdhere or active users in CommCare help guide these trade-offs.

Quote:
"It's possible to build really, really high scale products with really, really small teams... Rigorously prioritize the work and use an impact framework." — Matthew Hato (19:44)

6. The True Cost of Competition and Redundancy

• Spoiled Market: Multiple overlapping products, many funded below cost, inflate system-wide costs and sap efficiency.
• Incomplete Product Cycles: Chasing the next donor-driven feature or tech trend prevents successful maturation and scaling of platforms.

Quote:
"If this one sector could be using one or two pieces of these software, instead it's funding the development and maintenance of 10... they're all paying 5 times more than they need to." — Dani Roberts (38:43)

Notable Quotes & Moments With Timestamps

• [05:36] Jonathan Jackson: On why SaaS is essential for impact: "We're only going to be able to make massive impact with CommCare and SureAdhere…if both they're impactful today and we have teams behind them that continue to make them impactful tomorrow."

• [09:50] Dani Roberts: On software maintenance: "Software kind of rots the same way fruit does... you also can't just not build new features on it and expect it to continue to be useful as the world changes."

• [14:38] Danny Roberts: On team sizing: "Our current revenue kind of decides for us our team size and then we do the most we can within that team size... It’s not how a Silicon Valley company grows."

• [15:44] Kai Cowger: On platform focus: "So much of our focus has been on stability, reliability, more than chasing the next killer feature..."

• [27:18] Kai Cowger: Importance of onboarding: "We lost our way slightly... even the easiest things on CommCare... started to be not as easy. People were very happy once they crested the hill of using it... but it was that hill that was so difficult."

• [30:51] Danny Roberts: On product marketing: "People don't want a product that can do anything. They want a product that can do their thing."

• [42:22] Jonathan Jackson: On project vs. product revenue: "It's really critical that you know what is the true product model... and not trick yourself into thinking your project revenue represents product demand..."

• [47:09] Matthew Hato: Team vision: "Good work, sustained over a long period of time is what results in success... setting a vision that the whole team can align to and drive impact."

Lightning Round — Building Great Products in Challenging Spaces

• Don’t Count on Project Revenue: Track “true” product performance.
• Product Mentality over Project Mentality: Invest in what brings impact over time—even if investors push for project outputs.
• Small Teams, Big Impact: Motivation, clarity of purpose, and longevity trump team size.
• Resourcefulness: Focus on product improvements that lower the barrier to entry; sometimes big impact comes from fixing “easy things.”
• Clear North Star Metrics: Pick one clear, measurable customer outcome to guide prioritization—then live by it.

Memorable Moments

• [12:00-22:00] Honest talk about making hard resource bets, what it feels like to “run a business on thin margins,” and why traditional funding models fail to incentivize making the product better for tomorrow.
• [27:18] Realization that for all the technical wizardry, if new users are turned off, all impact is stunted; onboarding and product marketing become existential.
• [38:43] The surprising downside of competition: instead of lower prices and more impact, the sector’s fragmented donor funding leads to duplicated effort and higher costs.

Final Takeaways

• SaaS is the future (when done right): Impact and sustainability in global digital health demand scalable, well-maintained products, not endless projects.
• Product marketing is as vital as engineering: A great product must be matched by stories and pathways that show value clearly and simply to the right users.
• Measure what matters: Separate sustainable, repeat revenue from one-off projects. Impact and financial health must be tracked with discipline.
• Small, value-driven teams can build world-changing tools: The secret is sustained effort, a clear mission, and relentless prioritization.

Recommended Reading:

• "Loved: How to Rethink Marketing for Tech Products" — Silicon Valley Product Group (mentioned at 49:46)

For more insights, episodes, and resources, visit Dimagi’s Podcast Page.