High-Impact Growth Podcast: “Building Tech Products that Matter in a Broken Market”

Date: August 15, 2024
Host: Dimagi (Jonathan Jackson, Amie Vaccaro)
Guests: Gillian Javetsky (Managing Director, SaaS), Kelly Collins (VP of Digital Adherence)

Overview

This episode dives deeply—and candidly—into the realities of building and scaling impactful tech products for global health and development in an environment where the digital health market is widely recognized as “broken.” The Dimagi team, joined by leaders Gillian Javetsky and Kelly Collins, reflects on the challenges of market immaturity, the problematic role of donor-driven funding, and the tension between custom solutions versus scalable software products. The team also explores how to keep users at the center, shares ideas for future directions, and underscores the need for sector-wide paradigm shifts to build more sustainable, user-driven, and impactful technology.

Key Discussion Points & Insights

1. State of the Digital Health Market

• Market Maturity Gap:

  • Although technology itself is advancing quickly (e.g., AI, security, scalability), procurement and organizational buy-in for software lags behind.
  • Comparison between buying drugs or equipment (commodities with clear specs and purchasing protocols) and software, which is still often treated as something organizations should or can “just build themselves.”

    “Are you going to go build your own diagnostic machine?...Some countries have the capacity to do that and others don’t, or to go, you know, develop their own drugs.” – Kelly, [02:48]

• Broken Procurement Models:

  • Most governments and donors default to comparing commercial off-the-shelf (COTS) tech with fully custom solutions, usually failing to adequately value proven, scalable products.
  • Fear of vendor lock-in and a drive for the lowest possible price, even at the expense of quality and sustainability.
  • “Procurement has not matured at the same rate [as tech].” – Jonathan, [07:11]

2. Harmful Impact of Donor-Driven Funding

• False Markets & Skewed Incentives:

  • Donors’ needs often overshadow user needs; innovation is often driven by what funders want, not what end-users need.
  • The sector’s funding structure incentivizes organizations to focus on grant-writing skills and relationship management over true product value.
  • “You lose sight of: Is this buyer really valuing my product for the value it’s creating?” – Jonathan, [12:21]
  • Reference to “Dead Aid” by Dambisa Moyo and the creation of harmful, unsustainable markets. – Kelly, [25:34]

• Pressure to Build Rather than Buy:

  • The default to build custom solutions drives up costs, fragments the ecosystem, and leads to orphaned projects with little sustained value.
  • “Choosing to build it yourself could have worse outcomes... We should be outwardly vocal about the fact that choosing to build it yourself could have worse outcomes.” – Kelly, [20:33]

3. Shifting to a User- and Product-Centric Mindset

• Advocacy for Treating Software as a Commodity:

  • Calls to teach the market to value and buy software as they do other indispensable products—moving away from the idea that software should be free or always custom.
  • Focus on building products so valuable that governments and organizations want to pay for them—even if only a small amount.
  • “[We] should be talking to [local organizations]... If they’re willing to pay even a small amount... our value… in the marketplace is going to grow...” – Kelly, [10:46]

• Maintaining Indispensability through Quality:

  • The best path toward sustainability is creating must-have software—so good users and buyers actively want to keep using and paying for it.
  • Continual reinvestment in R&D, security, and user experience is essential.
  • “How can you be so good that... governments are happy to pay you because your product is valuable and worth what you think you need to charge?” – Jonathan, [07:11]

• Feedback Loops & Real Impact:

  • Emphasize tighter, value-based feedback loops: building incrementally, validating through actual user outcomes, iterating based on real-world insights.
  • “Just because someone gave you money to do something doesn’t mean it’s going to be impactful. It actually needs to solve the problem on the ground.” – Amy, [36:24]

4. Opportunities & Innovations at Dimagi

• Hybrid Business Models as Strength:

  • Dimagi’s combination of services and product (SaaS) work is highlighted as a unique capability, allowing cross-pollination and incremental implementation of productized, scalable solutions.
  • Using success and revenue from service work to bootstrap and test new product approaches (e.g., Shared Here, CommCare SaaS, CommCare Connect).
  • “[Dimagi] is one of the only software companies well-positioned enough to take this approach because we have this great… services-based business.” – Kelly, [16:13]

• Security and Market Leadership:

  • Pioneering with SOC 2 certification, setting new standards around data security, and offering educational resources (security playbook, webinars) to push the sector forward.
  • “For us...probably the least sexy part of tech… is security... But it’s a completely indispensable thing.” – Gillian, [37:01]

• Designing for Frontline Workers (CommCare Connect):

  • Using philanthropic funding with minimal donor constraints to run product-first experiments—directly testing what users choose, value, and benefit from.
  • “We have no donor pressure on making sure the answer… is yes. We can run these tests and see what happens.” – Jonathan, [39:38]

Notable Quotes & Memorable Moments

• On buying vs. building custom systems:

  “Are you going to go build your own diagnostic machine?... Some countries have the capacity to do that and others don’t, or to go, you know, develop their own drugs.”
  – Kelly, [02:48]

• On the sector’s inability to distinguish true value:

  “You lose sight of: Is this buyer really valuing my product for the value it’s creating? Are they valuing their personal relationship with me? Are they valuing how good of a grant writer I am?”
  – Jonathan, [12:21]

• On flipping the product development paradigm:

  “Just because we have the funding... doesn’t mean that it’s going to be impactful. It means that we have a chance to try to get impact on the ground and we need to prove it.”
  – Kelly, [33:59]

• On building for indispensability:

  “How can you be so good that it's not that governments are begrudgingly paying you, it's that they're happy to pay you because your product is valuable and worth what you think you need to charge.”
  – Jonathan, [07:11]

• Advice to new entrepreneurs:

  “…don’t get into that cycle [of chasing donor funding] to begin with… we should all be doing our best to really keep users at the forefront.”
  – Kelly, [42:30]

• On product excellence over grant chasing:

  “I would try to get to this understanding faster. I now understand the problem a lot better than I did 20 years ago when we first started [Dimagi].”
  – Jonathan, [30:57]

Timestamps for Key Segments

| Timestamp | Segment / Topic | |-----------|-----------------| | 02:48 | The unique challenge of buying vs. building digital health software (Kelly) | | 07:11 | Pressures of donor-driven procurement and the race to the bottom (Jonathan) | | 10:46 | Paradigm shift from top-down, donor-first to bottom-up, end-user focus (Kelly) | | 12:21 | Dangers of mixed incentives and fragmented funding structures (Jonathan) | | 16:13 | Dimagi’s unique hybrid business model and opportunities (Kelly/John) | | 18:05 | Market stagnation: Are there really more, better tools? (Jillian/John) | | 20:33 | Need for industry advocacy and warning about “build vs. buy” (Kelly) | | 33:59 | Building incremental, provable impact with new products (Kelly) | | 37:01 | Security as a differentiator and sector educational focus (Jillian) | | 39:38 | CommCare Connect: Real product-led innovation with philanthropic capital (Jonathan) | | 42:30 | Advice to future entrepreneurs on resisting the donor churn (Kelly) |

Final Reflections

• Awareness Fosters Choice:
  Understand how donor relationships, incentives, and funding streams shape products and markets. Be deliberate in choosing when and how to play the “funder game.”

  “Awareness creates choice. Practice creates capacity.” — Amanda Blake (quoted by Amy, [46:06])

• Practice Breeds Sustainability:
  Building sustainable, impactful products takes intentional practice and reinforcement of market-driven behaviors (securing revenue, focusing on core differentiation, building tight feedback loops).

• Collaboration Yields Progress:
  Avoid reinventing the wheel; focus precious resources on unique, high-value work, and seek to build collectively as a sector.

Tone & Takeaways

This is a rare, honest, and sometimes tough conversation among sector insiders. The team does not shy away from critiquing established practices, airing their own dilemmas, and wrestling with uncomfortable questions—all in the hope of building better tech for better outcomes. It’s both critical and hopeful: the market has enormous problems, but with self-awareness, user focus, and willingness to experiment and advocate, real progress is possible.