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- [00:01]
A
Welcome to High Impact Growth, a podcast from Dimagi. For people committed to creating a world where everyone has access to the services they need to thrive. We bring you candid conversations with leaders across global health and development about raising the bar on what's possible with technology and human creativity. I'm Amy Vaccaro, your co host, along with Jonathan Jackson, Dimangi's CEO and co founder. Today, Jonathan and I are joined by two of our amazing leaders at Dimangi. Gillian Javetsky, managing director of our Software as a service team. Kelly Collins, VP of Digital Adherence. Today's conversation is a bit messy and, dare I say, controversial. We discussed the health and maturity of the digital health market and the role of aid and funders in shaping the market for better or worse. We think the market is broken and we talk about ways to make it better. We get candid on what it takes to build software that matters in a broken market and how hard it is, and yet how important it is to have a relentless focus on users. I'll be honest. After we finished recording this conversation, we had a moment of should we share this with the outside world? Ultimately, we decided that yes, we should. Because often it's the messiest, diciest, most controversial topics, the topics that people might hesitate to talk about out of fear that we care most about unearthing and sharing with you, our listeners. We all know that in the world of tech and global health and development, things are not working as anyone would like them to. We're still facing incredible challenges around equitable access to care, despite technology advancing rapidly. So it's worth considering how we might do things differently. Enjoy.
- [01:40]
B
All right, welcome to the podcast. Hey, John, Good to see you.
- [01:44]
C
Hey, Amy. Nice to be here.
- [01:46]
B
We've got Jillian Javetsky and Kelly Collins here, two of our incredible leaders from the DiMaggi team. Welcome.
- [01:54]
D
Thanks for having.
- [01:55]
B
Thanks for having us. There has been an ongoing, very important conversation, I think, happening across. Dimagi and Kelly, you recently were at the World Health assembly and you came back particularly fired up about this conversation, and it's the type of topic that I've always imagined. Yes, that could be an interesting one to talk about on the podcast, but I think hearing your passion coming home from WHA brought it to mind. Again, I have no idea where this conversation is going to go. I think there's definitely some very different opinions across this call. So excited to kind of see where this conversation takes us, but maybe we could start with you, Kelly, and just share a little bit about your experience at World Health Assembly. And hopefully that can be sort of a segue to tee up this fairly massive topic.
- [02:48]
E
Yeah, it's a big question. So I think. Amy, I'm really excited to be here. Thanks for teeing up this conversation internally at Tamagi. I think it's a big one. Being at wha for me this year was, I think, heavy in the sense that the landscape of global health seems to be changing, especially as it relates to, like, purchasing digital products. And one of the things that felt really interesting to me was that I get the sense that there's still, there's still some misunderstanding within the global health community about how to purchase software as, as a product. You know, we, when. When a community like a, you know, when a clinic or when a country buys a drug or a diagnostic machine, it's a commodity, right? They can go to a marketplace, they can purchase it. They can. They have their choice of six options and they choose the one that, that fits them best and they get all the specs, et cetera. That's still not the case for software being in so many rooms where we're talking about like, bulk buying and how to get prices down of these commodities. That makes sense. And those conversations can get frustrating and they can have friction. But ultimately the person purchasing the equipment understands that they have to buy it and that they're not going to go build it themselves. And one of the things that continuously happens to us in software is that because I think software is sort of reproducible to some level or, you know, people can build their own systems with, you know, internal IT resources, there's a sense that, oh, we're just going to go build that ourselves. But what I think we continually see happen, as, you know, DiMaggi and me previously, it should. Here is building it yourself. I mean, it's like, are you going to go build your own diagnostic machine? Are you going to go. You know, some countries have the capacity to do that and others don't, or to go, you know, develop their own drugs. And so I think there's a reality here where we do need to spend some time with our partners in teaching them to buy software as a commodity in some way that helps them understand that, you know, software isn't something to just be, you know, rebuilt, that it has to be maintained, it has to be, you know, supported. Well, it needs to be secure and, and that messaging tends to get lost in the fact that, like, it can always be repurchased. And I, I just kind of walked away from wha this year with that real reality that now feels like the time to be able to, for us to have that conversation. How do we teach the global health community to buy software as a commodity? And to me that means building something that's really indispensable. So I don't know if that was kind of my high level walkway, but maybe I'll stop there.
- [05:26]
B
I love that. Thank you, Kelly. And I think like the sort of pithy line that you just said at the end, it's like we need to teach the market to buy software so that we can build tech products that matter. And like that just really stuck with me. I'm curious to hear from you, Gillian, and then from you, John, on your reactions to what Kelly shared.
- [05:49]
D
Kelly, it's great to hear that this is a big conversation topic at WHA this year. I know it's something that we're seeing a bit of a change in the market this year at least. I work on the team at Tamagi that creates and sells commcare for our self service partners. So ones that are building CommCare on their own. And I think we're seeing two things happen which are sort of like in conflict as well. One is that we know very much that by next year uscid is directing 25% of their funding to local partners. And so that's bringing into question for us not just teaching larger organizations, right. And NGOs and donors about how to sell tech products, but also what that means for local partners and working with different organizations and seeing our portfolio and clients change. That's one thing that's happening. At the same time we're also seeing, which is great and we're so excited about this, but a greater focus on security for the first time in those same products, which inherently means that like the cost of products should be going up. Right. So we're. There's something as well that isn't quite. We have to both sort of like meet different, like market demands for organizations that may have less funding, but also knowing that like the demands are being put on organizations for more expensive tech products are increasing. So how do we also figure that out? So it's something our team is always talking about. We're trying to figure out the right balance here.
- [07:08]
B
Don, what about you? I'd love to hear your thoughts.
- [07:11]
C
Yeah, I mean, I've talked at length about this on various previous episodes, but there's a huge challenge we have in the market that Kelly alluded to, which is the combination of people feeling like digital should be getting more mature, which there's, you know, lots of Advancements, as Jillian mentioned, around security, around scalability, around performance. There's new products coming out all the time. We've been talking a lot about AI and doing a ton about AI internally. So there's clearly, you know, more good software out there. But procurement has not procured, not matured at that same rate. So, you know, the ability to buy what in the US market is called cots, commercially off the shelf available technology is extremely rare. In fact, I don't even think that term is in an RFP I've seen in global health. And so everything is kind of being compared to custom software or internally built software. And so there's a lot of challenges in the market of, you know, for product like Kelly's offering through Shared Here, or Jillian's offering through SaaS or our competitors offer. Governments don't want to be locked into one vendor. We don't think that it's, it would be a healthy marketplace if there was only one vendor you could buy from. But although the market's matured for a lot of use cases, there really is only one or two available vendors in a, you know, productized, proven, evidence based, scalable, secure model. And so we're kind of faced with these two challenges. On the one hand, obviously, much of global development and global health are trying to get the lowest price possible because there's limited resources to go around. Everybody understands that. But we also want great technology, great drugs, great clinics, great med tech. And you need vehicles that create those things. And in our opinion, you know, for profit, social enterprises are a great vehicle to get that accomplished. And that requires charging enough that you can invest that back into R and D, you can invest that back into sales, marketing, you can support your product indefinitely. So there's really just two opposing forces that I think we all see. And Kelly came back and kind of lit up our internal slack with some feelings about the need to get to products that are must have. In our 2024 Annual Strategy for Tamagi and for many of our divisions, one of our focuses was chart a path to being indispensable from a product standpoint. 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. And I think the hope and the advocacy I spend a lot of my time doing as the CEO of Tamagi, but also just as a fellow entrepreneur in the space of digital health with a lot of the other people in the Space is complain about how hard it is, you know, to talk in this way to donors who, you know, shape the market a lot of the time, to governments who should want good software, not just the lowest price possible. And it's, it's a, it's a shifting landscape and a shifting market. And as Jillian said, there's a need for tons of changes due to the really important and really, you know, aligned efforts to go to a more localized agenda. But it makes it just very, very difficult when you look at the landscape, where the digital health market is and where the transactions are actually happening, procurement's actually happening, which is a very difficult time right now.
- [10:46]
E
I wonder though, John, like something you just said was really interesting that like governments should be coming to us and donors should be coming to us to want to pay for our software. And I think that that to me is like the biggest crux of this concern. I don't think that we should be pandering to donors or governments anymore. Like my big takeaway from WHA is let's stop doing that. We, we should, if we're building for local organizations, we should be talking to them. They should be willing to purchase our software without that funding. I know that's a big leap. Like I think that that is a huge leap and I'm not, I don't have an answer to how that should be working. But like if we're making something that valuable to the organization that's supporting those community health workers or to the organizations that supporting TV patients, if they're willing to pay even a small amount of money for the software that we have, and It's a pure SaaS play both of those things. As we grow our space, like as we grow our user base, our impact is going to grow by default and our value in the marketplace is going to grow because we'll continue to see outcomes. And I feel like this top down approach of building what the donors want or having to go to the donors or the government even particularly is really difficult. And I don't think we're going to win that way. And I guess that's just like how do we shift that paradigm to, to sell, to build, to you know, create for that very end user and keep them like in our focus. And I don't, again, I, we haven't seen this work yet. So I don't, I don't have an answer that like this is the golden, you know, ticket, but I think that ultimately that's what we have to shift our thinking around.
- [12:21]
C
Yeah, I definitely agree with that. And I think the challenge we have with how dimagi has built its business, how many organizations have built their businesses, is you have such a diverse pool of funding that you need to piece together in order to get enough capital to build your software in the first place. So you have some grant funding, you have some maybe investor funding, you have a little bit of product revenue, you got some services revenue mixed in. You lose sight of the. 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? So you get good at a lot of different things and it's very easy to lose sight of. Is my product adding enough value that you think it's worth continuing to pay me next month for the value I provided or the value you think I'm going to provide? And the more that relationship could exist in our market, I think the more it's going to create better software, but not just stronger companies. It's ultimately going to lower the price of technology in the long run because it's going to find the businesses that are providing the software that's providing enough value that it's actually worth what they need to charge to make that software available to the global health community.
- [13:34]
D
I do wonder if there are ways that donors could keep us more honest in that conversation. Like I would love if we lived in a world where the proposal you're working on or like the project that you win. Right. Isn't just looking at like the indicators that you owe it to a donor at the end of the month around it, but actually like there's integrated actual user feedback is one of like the indicators. Right. So like do the users like it? And like, is that like, if not right. What's, what's the case of it? I know we, there's a lot of like talk around that in our industry. But yeah, I think, Kelly, just going back to your point around how do we bring the user's voice more into. This is such an important one. And especially I think just for like most organizations on the tech side, like do have to start by like cobbling together like all donor funding in that way.
- [14:18]
E
But.
- [14:19]
D
Right. How is there a way to at least bring those two voices together that's a little bit easier?
- [14:25]
E
Yeah, I guess I think that like DiMaggi is particularly well positioned to actually force that conversation. I love the fact that we have a really strong services based business that works directly with, you know, governments, directly with NGOs to build very Custom solutions. And I think that that very strong partnership approach actually potentially helps facilitate the fact that we could go back to that very square one model and start taking a productized approach with, you know, the smaller areas that we're, we're trying to focus on. I think in fact we're already doing that shared here and with CommCare SaaS and then also potentially with CommCare Connect. I think these are really beautiful examples where we can say how do we scale back our approach to that very productized feedback loop with our partners and then show that that type of value is being driven on the ground? Right. We're improving efficiencies. These organizations want to continue working with us with or without that donor funding. If we can prove that model out sort of at a smaller scale, I think that will help us feel more comfortable investing in it internally. So rather than needing to go out and find donor funding, we're bootstrapping an approach that we really believe in to say this is valuable, people are asking for it, they're willing to pay a very small amount for it. We recognize it's going to take time to grow, but, but not being afraid of that. And I think that's kind of. Damagu is probably one of the only software companies well positioned enough in the space to be able to do that and to be able to take that approach because we have this great, you know, services based business that does continue to work on its own. It works in partnership, finding that donor funding, working as a sub to a prime, et cetera, that it enables us to kind of like step back and take this other approach and prove it out. So I really like that we have this opportunity to do it. I'm excited to take this forward and I think we are particularly well placed to do that.
- [16:13]
C
Yeah, I think that you had it really well, Kelly. And that was one of the very appealing aspects of why DiMaggi and shared here came together to scale up the shortier product is it was, you know, product based. And the division that Jillian runs is also purely product based. Which isn't to say there isn't a role for these big complex multimillion dollar services projects that we do a lot of. But then extrapolating back what is productizable, what is able to be offered at 1/10 the cost the next time, and building a team that is isolated from the kind of custom Cadillac version of software and really figuring out what's scalable and repeatable. And I think that's, that's something that I think you're right. We are really well set up to do and I think is a huge part of our, our five year strategy is saying both there's a really important role for those professional services, big engagements, but also how do you create repeatable products and what's the market we're selling repeatable products into? And Jillian's been doing a lot of work with both large enterprises that we sell CommCare to, the small to mid sized businesses that we sell CommCare to and then what's that productized offering for governments, whether that's hosted in the cloud or on premise? You know, how do we find that repeatable offering that governments can really get, you know, 80, 90% of the value at 10, 20% of the cost, you know, as this market matures. And that's the other thing that frustrates me a bit about how we talk about this as a global community. It's not just annoying for Dimagi that we have a business model problem. You know, when, when we can't figure out how to crack this. It's like software is not getting cheaper out there on the market and it should be, it should be getting cheaper and better as markets mature and we're getting more software. But I, they were getting better, faster, cheaper software, which is how this is supposed to work as markets mature.
- [18:05]
D
And John, I think on that point, like I have a question about that too. Like when you say we're getting more software in our market, like I am trying to think about just like when we think of like other global goods or competitors of ours. Like I've actually, I felt like in the last year this has been like a really tough year for a lot of them. Like there's been something about after Covid that like a lot are like, we don't know if we want to do this anymore. We're closing up shop. Like, are we actually seeing more types of technology that we compete with?
- [18:34]
C
That's a great framing, Jillian. And you would know this better than I in terms of like who commcare is coming up against. But that's a great point. No, I don't think we're seeing more mature software. I think we're seeing more early stage software, which is good and we want that competition. But yeah, I mean the same products have been available for doing community health based systems for the last five years, you know, and I'm not sure anybody's, you know, on the horizon. So that that market has matured in that sense of, you know, there's a finance set of global goods that are really viewed as like the tools you could select for if you're building a national scale community health information system. But has the price gotten notably cheaper over the last five years? Has the, you know, sophistication of the experience for CHWs notably matured? And so those are the things we want to be looking at from is this market functioning right? Is the competitive pressure causing those things to get cheaper and better over time? So you're absolutely right. I think there's a huge, and I think everybody's recognized this. There's a huge problem and we DiMaggio is extremely fortunate with the help of many funders and customers and partners to cross that early stage. Scrappy, get any money you can to build your product into multiple successful growing business lines. But I think it's really hard to come in behind right now because quote unquote, the market's matured and it's like, well, has it? And you still need $5 million to get off the ground building these software systems. Not all at once, but if you just look at the R and D, the support, the marketing that it takes, there's no shortcut. And so where's that 5 million going to come from for the next set of products? And then after they get that, to Kelly's point, how are they going to get off of that model and onto a more value based model fast enough that they're not tied to kind of this weird donor driven model?
- [20:34]
E
It feels to me though that like it's sort of our job as a tech company working in this space to start advocating for this more loudly. I don't know what that looks like, but I think that there's been some, I think really maybe harmful market shaping that's happened in the software space and harmful conversation that's happened that has sort of made it almost the default to like go build it yourself. And not to say that many of our partners can go do that, many governments can go do that and they should go do that. And so I'm not advocating. I mean ultimately we don't have healthy markets in software, in global health. Like they're really unhealthy markets. They're completely donor driven. Somebody tells you to go buy some system or you build some system that does, you know, two different things and it gets deployed and then, then it dies on the vine because nobody maintains it. And this is just like this loop keeps happening over and over. And what I'm worried about is that we as a market leader in this space don't get louder about that because we're concerned about sort of our, you know, our ability to be a partner or our ability to engage with, with these organizations that it's actually going to cause harm to the users that like those on the ground that are using our software. I think we should be outwardly vocal about the fact that choosing to build it yourself could have worse outcomes. Right. Maybe DiMaggi is not the right partner. Maybe there's a local partner who's already built something similar that could be used and we should be pushing those types of market dynamics to be successful as we engage in this space, sort of in using our platform to really advocate for like healthy market dynamics as opposed for the like really unhealthy market dynamics where we're all jockeying around for funding.
- [22:11]
C
Yeah, I think the point you're raising on the build versus buy there decision, in the parlance of kind of other markets that we've seen, it's not just can you build it, it's what is the opportunity cost of skilled engineers working on a problem that you could have bought something to solve indefinitely that's not just going to solve it, but get better over time because there's a company or a community or something like invested in getting that thing better. And your team could have been doing something that isn't solved yet. You know, that's, that's one of the biggest things we think about. And if you just think about how we run dmaggi internally, you've all been part of extremely fun conversations with me on whether your team should do it or whether you should, you know, have a shared 1dmage approach to it. And one of the biggest factors in that is opportunity cost. Whereas like, of course each division could do everything on their own, but then your highly skilled team of limited people is not doing the thing that only your division can do or only your sub team can do. And that's a huge challenge I think, for how do we talk about that, how do we communicate that? Because it's not working the way the global health community is currently thinking about it. And it doesn't feel like anybody is talking about the opportunity cost of like yes, you, of course you can build a CHW system from scratch with custom software. It's just software. Everything's just software. But you could have used one of the available tools and then had your team do something that isn't solved or isn't, you know, serviced by a company whose mission is to go make that use case better over time. I've talked a lot about this, written a lot about it and have not, have not found the language that resonates with people around this opportunity cost issue. I think part of it is, you know, the reality is a lot of people may not be in that role in that organization, whether it's a government position or a donor position, long enough to experience the downside of the opportunity cost. You know, if you know you're not going to be there in five years making it decisions, you don't actually face that opportunity cost. It's your successor or your successor's successor. So, yeah, I don't have the language to use. I know we experience a lot of, you know, we're constantly drawing parallels to how dimagi works internally and how that mirrors a lot of the challenges our partners and government funder everybody faces. And so we see this internally, how painful some of these discussions can be, but we do face the opportunity cost in a lot of those decisions. So I think that's a great point, Kelly. And I don't know what the answers are, but I do think it's like if you had infinite engineers, infinite budget, maybe you should do everything custom, but that's not the set of constraints anybody actually has in the real world.
- [24:49]
B
I think what's interesting about this is that DiMaggi is where we're at because we've been so good at playing the funder game, I think.
- [24:58]
C
Right.
- [24:58]
B
And being able to get these pockets of funding and then use it to take this product approach. Right. I think that's sort of been some of the secret sauce. But I think, Kelly, what I hear you saying is that that same approach that got us here, could that be harmful going forward? Right. If we're still playing the funder game, we're still allowing funders to have this outsized impact and skew the market. Right. You sent us a piece that I can link to in the show notes around creating a false market. Is there any world where dimaghi shifts away from looking at donor funded projects?
- [25:34]
E
I'll let Don answer that question about shifting away from donor funded projects. I think that's a, that's a hard one because you're absolutely right. We, we unfortunately startups like as a startup in this space, as a long lost, previously assured here and then moving over to Somagi as a very long acting established company in this space. This has been the world that we've all been living in for so long. I mean this is, this is how global health works. It's how it's worked till date. I think there's this really great book called Dead Aid by Dembisa Moboyo. She's an economist that talks about sort of the harmful impacts of aid in Africa and sort of the legacy of that and how do we, how do we shift that? This is a book that was written probably 15 years ago and I think just now people are starting to take some of the things that she brought up and more start to like institutionalize this thought of like how this conversation around sustainability has gotten so deep into like, you know, the global good conversation, open source and you know, making sure everything is like widely available. And it's really particularly, I think hit hard in the software conversation. Whereas like in a commodity discussion you could talk, you can negotiate on price but like ultimately there's something tangible that you're purchasing, whereas in software it's not as tangible. And so I think this has been particularly harmful. And I, I'm feeling like people are starting to come out of the fog, especially as like there are these incredible companies, software and otherwise, coming out in the digital space, coming out of Africa and they're starting to, to sort of demand more of the cycle that has happened and started to demand more of the governments locally to say, you know, don't create these false markets, you know, we want to be growing our economies and we should have the capacity to do that. And so to me, I think I'm excited to see people demanding more of this structure and I think now is kind of the time we can start having that discussion both internally and externally on what does it look like to operate in this space. What does this look like to operate as, you know, a team solely focused on our end users goals and the things that create value for them and improving outcomes for them.
- [27:39]
C
For our funders in the audience, it's not a game, it's just, you know, it's, it's a relationship. But yeah, I, I think, Amy, to your point, there is, this is true of startups getting to massive companies and massive companies like what worked two years ago may not work for you today. There's absolutely nothing wrong with having donor support and definitely we want to work with donors and definitely part of our core strategy. But it's the question of knowing the pros and cons of that relationship, of that market, of that channel and others. And the problem with the donor space, which, you know, we're all incredibly pro, trying anything you can to improve the lives of others and doing all this amazing work and our customers and our clients and our funders are doing all these great things, but not always in a sustainable way and not, not all funding and donor spend should be sustainable. Like it's the right thing to do just to get food to people who need it. It's the right thing to do to just provide massive relief or longer term relief as appropriate. But with technology you don't get any benefit from just trying to do these things. Like the, the impact's gonna come in software and technology through well built, sustained, durable, at scale, deployed products that get better over time. And this is something I harp on all the time. You know, at best, a lot of our projects, even at dmaggi, definitely in the industry, you spend all this time deploying the software multiple years, you finally get it up and running, you finally get in the hands of users, then the funding's gone, then everybody moves on to the next project. And it's like that that startup phase was, was just work that wasn't impact and now everybody shifted into the next project. I mean, when we deploy products at dmaggi A, we failed plenty of times internally to deploy. But like it pains me and you three have all heard the outcome of that pain, how long it takes us to get value out of products we deploy internally, right? And it's like the whole time we're getting that stood up, that's just like, to enable, getting impact in the future. So it's like, it's not that it's a bad instinct to want to help as much as possible as fast as possible and get the technology out there and just see what happens, but it just doesn't work. It doesn't work that way with software and with technology. So that's a challenge. And on top of that you have donors within the same organization sometimes funding things that obviously are going to have a great impact but aren't that sustainable. And then the other part of their organization's asking you why you're not sustainable and you're like, well, this is odd that the same organization's asking me both these questions. And so I think that's also a big challenge is, you know, do you want your organization to die before it can get to that sustainable software model? Absolutely not. So you're going to take the money, but do you know there's no chance the government is going to pay you the same rate the donor's paying you? Like, absolutely, you know that. And so you're faced with these really difficult decisions as an entrepreneur of, of what to do in those cases.
- [30:44]
D
John, do you think you would start damagi now? Like just pretend like if you were like starting out of like MIT again, like giving it a go. Like would, like knowing like where the market is. Would you have added to Mogi?
- [30:57]
C
I would definitely be doing something in the social impact for technology space, but I think I would try to get to this understanding faster. So I don't know the answers, but I now understand the problem a lot better than I did 20 years ago when we first started Tamagi. So I would definitely make different decisions and remove the wishful thinking. And I've talked about this in a previous episode, but I think a lot of people, you know, get that half a million or million dollar grant. Like, oh, if I deliver on this really well, then there's a $2 million grant and if I deliver on that one really well, there's a $5 million grant. And that may be true all the way up until 5 million for us. It's fortunately been true way longer than anybody probably thought. And the checks keep getting bigger. But like it, it stops. It stops at any one individual product project at a country level, and it stops at your products overall. And knowing that you need to know you're building more and more weight, more and more machinery. And if you're not coming in behind that with a business model that has a flywheel, that is not requiring bigger and bigger checks from more and more people, then I think you can build a great business. But I think so many people get the wrong idea that, oh, if I deliver on what somebody gave me 500k for, they're going to give me a million or somebody will give me a million and somebody will give me two. And that does work for a while. And that's why there's so many early stage good companies with good leadership, with good software they're turning out. But that hit this wall that we almost hit. And we were just very fortunate that we wanted that SaaS model, not because we thought there was a huge flaw with their donor model. The original reason we went SaaS model is we thought we wanted to reach more users. So it wasn't viewed as a fundamental flaw in our donor funding, which was dominant in our business model at the time. It was just like, we don't want to only be able to do these huge projects. We want to be able to serve thousands of organizations, which we now do. And we knew the only way to do that was through a SaaS product. You know, so I didn't have the knowledge I do now or my perspective on the problems on the market. And if I was restarting the mind geeks of age, I didn't your question, I would, I would at least be factoring that in much more because it took us many years to learn that lesson.
- [33:15]
B
That's actually a really interesting segue. I think as we've been talking through all this, you know, kind of honing in on some of the negative aspects of this market. I'm looking around on this video call and I think each of you right now are spearheading a product approach in this market. Right. Despite all of this. So I wonder if I might ask each of you to share a little bit around what is working right now. Right. I think between shared here, CommCare and CommCare Connect, each of those efforts to me represent changes in this approach. Right. And evolution. Starting with you, Kelly, if you want to share a little bit about how Sherrod here right now is trying to take a different path, maybe just to.
- [33:59]
E
Kind of reiterate back to John's point, Amy, and I think this is a really good question about getting that initial funding from a donor. Right. As a startup, when you receive money from somebody to do something, whether it's an investment or whether it's a grant, you have a perception that what you're doing is impactful. Like just the fact that you got that grant or just the fact that somebody invested in your idea is that there's this perception internally of like, okay, we were building something that's going to be of use of value. And I think for me, turning that paradigm on its head a little bit is actually really empowering to say just because we have the funding to do to build this thing and deploy it on the ground 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. Right? We need to show that. I think what I'm really excited to do on the stewardier side is to stop like assuming that because somebody, you know, is willing to give us money to build something, start with the assumption that that's just the investment to catalyze this productized approach to then go back and say, okay, what is the most important, you know, outcome and how. What is the problem that we're trying to solve for these users and to start with that problem. And so I think from, from my side, we've started to build a team out that is really going to start with the problem solving what is the main problem that our users have? How can we solve that and then come back to the team and allow the team to iterate on Solving that problem for the user, rather than letting sort of the user define how we solve the problem, it's actually having them really well define the problem to us and having us come back with, you know, a really great solution that makes them excited to then go deploy it on the ground. So I think for us, it's really about flipping that paradigm of assuming value, because we're building it and actually proving that value by solving a problem on the ground with what we're doing and starting with one really simple problem, or maybe it's a really hard problem, but starting with one problem, solving it really well, and then learning about the next problem and solving that next problem really well, and so on and so forth. So. So then we're building up that really strong product over time, and we know that each incremental piece that we build is actually providing additional value as opposed to kind of deploying this big system all at once, which is what we've done in the past. So I'm really excited to take that approach. I think we started building out a team that, that can do that. And I. I feel really strongly that, like, this feels like a very obvious path forward because it will build that incremental value over time.
- [36:24]
B
Thank you so much for sharing that, Kelly. I think that's super compelling and clear, and I love that sort of flipping of, 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. Right. Which sounds so simple, but where there are so many layers of complexity and different incentives like, it actually, it takes a lot of work to. To kind of come back to that and to keep coming back to that. Gillian, would you be willing to share a little bit from the Commcare? We mentioned the word SaaS before, but that's kind of how we refer to the team that runs CommCare within Dimaghi. In terms of how you're. You're thinking about this, I think for.
- [37:02]
D
For us, one of the things that I am personally really excited by, and I know our entire team is as well, is like probably the least sexy part of tech, which is security. Right. Which is like the platform. And the thing that we have lots of teams at Tamahi that support governments that are really focused on local hosting, which makes sense in a lot of contexts. I think for us, like, going back to what John was saying, which is like, why we started with a SaaS product for CommCare was both to increase our impact in terms of number of users. And for us, it's incredibly important that those users data is protected. I think in our industry this is like a wildly misunderstood like area. And I think going back to what you were saying, Kelly, around like a need for maybe groups like DiMaggi to advocate more. I think there's also a lot of like communicating and educating. We can do as well around security and what it takes to have a secure platform. I think from what we know, CommCare is the only SOC 2 certified global good. And there's a lot, it's like a pretty loaded statement. There's a lot that like goes into understanding what society SOC 2 certification is. Kelly and I were just having a conversation yesterday about it because I'm sure here also is now SOC 2 certified. But I think that's like an incredibly important piece and something that we intentionally separate out from our roadmap. So I learned a lot from Kelly around focusing more on the problems that users are having instead of the solution. And so we have that for our roadmap as well on compare. But we always hold special place for security in terms of just like seeing that as like a completely indispensable thing and how to teach people more about it. So we're excited we'll be doing. We're putting out a data security playbook in the coming weeks and also talking to Digital Square about doing a webinar as well on security just to like make this known to other organizations. But I think that's something that we're looking forward to.
- [38:44]
B
That's awesome. Thank you, Jillian, for sharing that and definitely want to add a link in the show notes to the Data security Playbook and webinar if that's out when we published this. And I think it's also been, I think, heartening to see Dimagi leading on the security side and also that so many of our clients are really, as you said at the top, like really valuing security more and more and really taking data security seriously as. As they should be. So it feels like we're, we're pushing the market forward where it needs to go in that place, and there's. We're, we are getting some reward for that. John, I wonder if you could share in the last couple minutes a little bit on the CommCare Connect side. And I know that we haven't talked a ton on this podcast about CommCare Connect, and we actually do have a dedicated episode coming up in the coming weeks and months around more information about CommCare Connect, but maybe you could share a little bit about your, your take there.
- [39:39]
C
Yeah, I think CommCare Connect, for our listeners who aren't familiar with it, we, we can drop a link to our latest update on the blog on it, but it's a, it's a vision to help frontline workers opt into doing additional paid, purposeful work. And the really exciting part about how we're designing and developing Commcare Connect is we're extremely fortunate with the Steel foundation for Hope that we have a significant amount of capital up front to really build this in a product first mentality, you know, so testing it with users, pushing out a push notification of the blue to users saying, do you want to opt in to learn how to do vaccine promotion? And just seeing what happens, you know, and so we have no donor pressure on making sure the answer to that is yes. You know, we can run these tests and say 80% of our users are opting in, 80% are passing the digital learning, 80% are moving through certification, and 80% start delivering those home visits. And it's incredibly exciting and fulfilling to be able to meet our number one five year strategic objective of creating better jobs to achieve better outcomes in a way that's taking this product first mentality. But it's incredibly hard to stay in that mindset all the time. Like, it is so easy to fall back into. Oh, but if we added this feature, maybe we could sell it to this donor for this reason in this country as opposed to, you know, is this creating a better job for the CHW workforce that we're trying to target or in the future, all frontline workers? So, yeah, it's been really exciting and we'll talk a lot more about that in a future episode. But I do want to highlight one thing Kelly touched on and Jillian as well. It's taken us 20 plus years to build this business and it's really hard to have the financial flexibility and stability of our business that allows us to focus on things like Kelly said of kind of rethinking how she's doing product and for Jillian to really invest and double down on security and a lot of the other areas that our SaaS team is doing. And so I get asked a lot by younger entrepreneurs, you know, how to, how to get into that state where you can make these choices and kind of control your own destiny. And it's hard, you know, like, it took us many, many years of having hybrid business models all mixed together, all very complicated internally, before we were finally able to say, okay, Kelly, you take your team and just go create an amazing product. Jillian, you take your team and go create amazing product services team, go make as much impact as you can, you know, in all these different ways. And so it is really challenging and I'm sympathetic to how hard it is to take that product mentality into the global health market. And so I think that, you know, the sooner donors, government, the ecosystem can support faster value based feedback loops, the better products we're going to get and the easier, hopefully the easier it's going to be to build companies in the space because those feedback loops are there.
- [42:31]
E
Yeah, John, I might just like add that I think the gravitational pull to, to go work with, you know, to get money, to build something is always going to be there for startups. And I think that, you know, if there was any advice that I was giving to sort of like young entrepreneurs trying to be out there, I would, I would sort of say don't get into that cycle to begin with. I mean, it's a really hard, it's definitely like a siren call, right, because it's money, it's free capital. And so I think especially in a space where it's really also hard to raise venture capital when you're trying to work in the impact space, that pull is almost too much to sort of walk away from. And I would suggest that we should all be doing our best to really keep users at the forefront of what we're doing and to try to walk away from that as much as possible. Because ultimately if we're not having impact on the ground, I do think we are helping sort of create the cycle of false markets. And so the more that we can be doing to like push away from that and make sure that the value that we're creating is not just sustainable from a funding perspective, but that we're creating true, you know, value on the ground from an efficiency perspective, from a health outcome perspective, from a, you know, workforce perspective, that's going to, you know, ultimately drive global health outcomes in a much more positive light.
- [43:55]
B
Love it. Well put. Jillian or John, any final words you want to add in before we close out?
- [44:01]
C
That was great. Clover by Kelly.
- [44:02]
D
Yeah, that was great, Kelly. It was, yeah. Handling job. Thank you.
- [44:07]
A
Thank you to Kelly and Jillian for joining us for this lively conversation. I waited a couple weeks after recording the conversation conversation to record this closing because I wanted to let the conversation marinate a bit. I heard something yesterday that really helped me put the whole conversation in context and that was awareness creates choice. Practice creates capacity. This is a quote from Amanda Blake, author of youf Body Is yous brain and the context is around somatics and somatic intelligence, but I think it actually applies here. Let me unpack each of those statements. Awareness creates choice Donors and aid obviously currently play an important role in global health and development, but we need to be careful that we don't over rotate towards pleasing a funder at the expense of building a product or an implementation that users will love and need. Ideally, as we're building tech products, we do so without any donor funding and a pure focus on solving problems for our users that they're willing to pay for. But if that's not possible and donor funding is at play, then keen awareness is important. Let's be outspoken about the ways that donors might be influencing product development and from there look for ways to choose a different way. The second element I want to unpack there is practice creates capacity. So I agree with what Kelly shared around needing to move towards a world where tech is purchased like a commodity and not seen as something that should be free. Free software, great. All kinds of risks, particularly around privacy and security, which we heard from Jillian as a key focus on Comcare. Let's each look at the ways that we can begin to practice a more market driven approach to products in global health. If you're building products, this means getting really focused on solving problems for your users. It's not enough to just get funding, you need to show value. And if you're using tech products, look for ways to move towards purchasing some software as a commodity as opposed to finding ways to get it for free. Have candid conversations with your tech partners about creating value in your work. The availability of free software for limited times doesn't help anyone create long sustained value, which is what we need to.
- [46:11]
B
Be creating in this space.
- [46:13]
A
The third piece I want to add here is that collaboration creates progress. So when you're considering building something custom or buying something off the shelf, consider focusing you and your team's time on what's most differentiated and high value that you can do. And it might not be building a custom tool that you could pay for. The cost of building a digital tool in house may seem more palatable in the short term, but over time maintaining a secure modern system takes a lot of bandwidth and resources that may not be the best use of your time. Let's build on each other's work and focus where each of us can create differentiated value, not recreate the wheel. That's our show. Please like Rate, Review, subscribe and share this episode if you found it useful. It really helps us grow our impact and write to us@podcastemangi.com with any ideas, comments, questions, feedback. This show is executive produced by myself. Michael Kelleher is our producer and cover art is by Sudan Shukan.