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Episode 15: Bringing Global Health Best Practices to US Public Health Response: Entering the US Market to Meet the Needs of COVID-19 with Carter Powers, Sarah Sagan and Lily Olson - Dimagi


Bringing Global Health Best Practices to US Public Health Response: Entering the US Market to Meet the Needs of COVID-19 with Carter Powers, Sarah Sagan and Lily Olson

Episode 15 | 52 Minutes

“We went from no solution to a fully deployed at scale solution in less than six weeks. And all of that is really a testament to the power of a technology platform.” – Sarah Sagan, Senior Director of Delivery

“I felt really patriotic. I felt really proud of my government. I felt really lucky to have the curtain lifted on my healthcare system and the way that state and local government contribute to healthcare in the United States…we had a front row seat to what was a really devastating and also a really important moment in US history and that was inspirational and will remain something that I’m proud of for the rest of my life.” – Lily Olson, Senior Director of Partnerships

At the start of the COVID-19 pandemic, Dimagi decided to support pandemic response efforts by building and releasing a free global COVID-19 case investigation and contact tracing solution. We had been working for nearly two decades focused on Low and Middle Income Countries, but when the CDC approached us to support US public health response to COVID 19, we rose to the occasion. This episode tells the story of our entry to the US market and how we leveraged learnings from our global health experience to meet the needs in the US.  Hosts Jonathan Jackson and Amie Vaccaro are joined by Carter Powers, Managing Director of Dimagi’s US Health division, Sarah Sagan, Dimagi’s Senior Director of Delivery, and Lily Olson Dimagi’s Director of Partnerships to share the full story of an intense period of hard work, growth, and learnings. We reflect on the work we have done on the CommCare platform that allowed us to respond to an urgent need incredibly fast, how we approached entering the US market so that we could continue our global work, and the passion and courage of our team stepping up to support the critical work of US public health departments. We also share how this work led to the creation of Dimagi’s US Health division and where we’re headed.

This is part 5 of our 5 part series highlighting pivotal moments in Dimagi’s history in honor of Dimagi’s 20th anniversary.

Show Notes


This transcript was generated by AI and may contain typos and inaccuracies.

Welcome to high impact growth, a podcast from Dimagi about the role of technology in creating a world where everyone has access to the services they need to thrive. I’m Amie Vaccaro, your cohost.

In 2020. Dimagi entered the U S market to serve public health departments on COVID response. At the height of COVID. Dimagi is CommCare platform was used to track more than 7% of COVID cases nationally in the U S and over 25,000 contact tracers were using CommCare. To contain the spread of COVID 19. Today for the first time we are peeling back the curtain to share with you why we entered the U S market, how we made it happen. And most importantly, what we learned.

We’ll also share with you seven of the key, best practices that we were able to leverage from 20 years of working in global health.

As we transitioned to working with us public health departments. I’m joined by four of the people most closely involved in making this happen at Dimagi Jonathan Jackson, our CEO and co-host of this podcast. Carter powers managing director of our us health division. Which we spun up in response to COVID. Sarah sagan director of project delivery for this us health team and lily olson senior director of partnerships for the U S health team i hope

Amie Vaccaro: All right, welcome. Thank you so much for joining. Today’s episode is the fifth in a series where we’re looking back at Dimagi’s 20 year history. This is our 20th anniversary looking at kind of milestone turning point moments. And so today we’re gonna tell the story of how Dimagi entered the US market and Dimagi, as you’ve heard from other episodes, you know, we’ve worked for 20 years all around the world, largely parts of Africa, Asia, some parts of Latin America. We’ve really hadn’t worked explicitly in the US until Covid hit.

So today we’re gonna tell the story of entering the US market, what happened, how it went down, what we learned from that, right? As an international organization transferring our, our knowledge and our learnings into the us. And where we’re going from here. So with that, I wanna do quick intros with folks on the call.

My name is Sarah Sagan. I’m the Director of for the US Health Division. I’ve been at demo for eight years and there are many reasons I choose to work at Demo and why demo keeps me around. But the top things that come to mind are the new challenges that I get the opportunity to work on, as well as the sense of community.

Sarah Sagan: I fostered with my colleagues.

Lily Olson: I’m Lily. I’m the of partnerships with our US Health Division. I’ve also been here for eight years. And I stay here because I really do believe in the power of technology to improve public health

Carter Powers: hi, I’m Carter Powers, happy to be here. I am the managing director of the US Health Division I’ve been with Dimagi for more than 12 years, and was formerly more on the business side, working as the coo. The reason that I have stayed with Dimagi is that, I believe is the best place for individuals who in their personal life are trying to make impact, team and profit, which is mantras that, I like to live by as an individual.

So I have found Dimagi the best place that I could focus on projects that, are making impact on the world, uh, hang out with the team, and not take ourselves too seriously. And then, wanna live sustainably. And, DMA has, uh, found different ways for me to, live that uh, personal mantra as well Over.

Amie Vaccaro: Wow. So we’ve got almost. years of Dimagi experience just across the three of you. That’s really cool.

Jonathan Jackson: Yeah, it’s great to be here with Carter, Lilly, and Sarah. I’ve known all of you for, for quite some time. And I think it’s fascinating. These three leaders have all been in different positions and were pulled together to form the US Health Division. Lilly was previously in India, previously in West Africa, and Carter was previously our coo.

And so one of the things that has really been exciting about the form in shape that we’ve taken in the US market is pulling so much of our global expertise the US market and seeing how relevant it has been.

Amie Vaccaro: That’s really cool. Yeah, and I think this, one of the themes for me from this story is the level of agility that Dimagi had shown and being able to kind of create this new team in response to new need and a new challenge. Set the scene for me. What was, what was happening at Dimagi when Covid hit?

Jonathan Jackson: Yeah, so this was, a crazy time period for Dimagi, for Lily and Sarah. They were on teams that had just reorged heading into 2020. We had been doing huge scale projects and we were trying to figure out how to both sustain those and grow the business. And we were, in a pretty stressful time period for the organization heading into 20. When Covid hit. And so it was really a kind of crazy moment where we knew there was gonna be huge, huge need for technology. We’d seen this with Ebola, we had seen this with Zika. But we also, you know, we’re in a pretty high stress, low energy, point in the organization’s history. And so it took a lot to, be in a position to seize the opportunity.

But I’d say we were, excited for the challenges ahead. We had had a pretty successful reorganization, but we were all pretty tired at this point in early 2020. When Covid was heading

Amie Vaccaro: So what happened? Like how did we decide to support Covid response efforts in the us?

Jonathan Jackson: And we knew the power of CommCare as a platform to support use cases like contact um, lab uh, just basic data systems that we had deployed basically overnight for Ebola very quickly for Zika as well.

And so when Covid hit, and it was pretty clear it was gonna be a public health emergency in February, we had pulled a team together to create template applications for Covid. So these were simple apps that could be deployed for contact tracing case investigation. P P b protective gear tracking targeted the global health market.

And so we released these freely available. We started working with lots of countries very quickly in. And then in early March, March 7th, actually around Saturday at 1:00 AM we get an email from the cdc, saying We’re being deployed to Santa Clara and we’re interested in using CommCare for contact tracing.

And so at 6:00 AM I was on the phone with the CDC trying to learn more about what they might be interested in using CommCare for here in the us. And we had not been working primarily in the US market until this point. We’d been really focused on global health overseas.

We had done a lot of research in the US but it wasn’t, with, a lot of direct experience in the public health sector here. And so talking with them, had assumed there would be better data systems that we could use here in the United States. And the CDC said, No, we’re really worried, about how adaptive our current systems are.

We need something flexible and powerful that can do case investigation and contact tracing. So this is Saturday, March 7th. I call 10 different people on March 8th and start texting And we have, um, Rissa one of our team members who’s a leader in our US Health Division, deployed with the CDC in Santa Clara on Monday morning. And then we start building an application for contact tracing for Covid. And this was when, Covid in the United States was primarily in Boston, Seattle and Santa Clara. we deploy the application, build it within 24 hours, start working with them on Tuesday, and by Tuesday the public health officials are overwhelmed with the number of. Contacts they have to trace, so they have to stop contact We rebuild the application to do case investigation. And then by we couldn’t do case investigation anymore cuz again, we were overwhelmed. we’re sitting here in Boston we’re supporting multiple countries in lower and middle income settings with their national contact and case investigation. And then we can see what’s about to happen in the us Every public health department is not gonna have the staffing to do contact or the staffing to do case investigation. And we realize there’s a huge, huge need for a platform like what we can offer with CommCare. So we continued to work with Santa Claire trying to deploy that application and things kind of exploded from there. But it was a, a very difficult process and difficult journey And around this time we realized we had to really stand up a dedicated team to be deploying these solutions in the US if we were gonna be able to be a good partner to the public health And that’s when Lil and Sarah got pulled in to kind of lead the team to see if we could do this.

Amie Vaccaro: So we, we get pinged by the cdc. We are there on site two days later building an app for Santa Clara. What does that app do?

Lily Olson: So the solution that we developed the US was similar to the solution that we developed for our international partners. one used w h o protocols for case investigation and contact for Covid And our US specific solution used CDC protocols. was the major differentiator at the beginning. So the solution was used by two user types, a case investigator, and that’s usually a, staff member at a public health department that’s responsible for letting someone know that they’re covid positive, letting them know that they need to stay home for a certain period of time. And then gathering from them anyone that they might have exposed. The second user type is a contact tracer. That person is responsible for following up with those contacts getting their contact information, phone number, email telling them that they’ve been exposed. Giving them instructions to test and quarantine. And then finally the actually send an automatic text message to those contacts for the entire duration of their quarantine with additional instructions or asking them if they’ve started to be symptomatic. and then, you know, encouraging them again to go get tested. That at a high level is what the we delivered is responsible.

Amie Vaccaro: I remember that was a time when a lot of agencies were just like scrambling to hire contact tracers. So this is basically the software that they’re able to use to follow every case that’s reported and try to contain the spread of those cases.

Jonathan Jackson: Yeah. When we deployed it originally, as Lilly mentioned, this was prior to when most jurisdictions realized they were getting to hire an army of contact tracers. So this was when we were still working the public health officials were doing the contact tracing, and it became very clear that that was going to be impossible.

And One of the early partnerships we had was with San Francisco that Lilly led where they were an early mover on hiring a bunch of external contact tracers using the librarian workforce in the city of San Francisco to support contact Um, but Lilly, Sarah and I regrouped and we’re like, Everybody’s gonna have to do this.

There’s gonna be millions of contact racers in the US during this time period.

Carter Powers: I just wanna add a, a bit more of what it felt like during that time and how much uncertainty there was just with Covid in general. Now that Covid has been here for more than two and a half years, it’s hard to remember how much uncertainty there was in the early phase. At times there was not yet mass.

Guidance and there was uncertainty about whether it would spread over air. It was uncertain if you should be spraying all of your mail down if it could be passed through transmission. So a lot of this was really figuring things out in a very uncertain situation where a lot of the facts that we know today didn’t exist

Sarah Sagan: yeah, that’s right. And one of the things that marked this period at the start, is how this work was just really all consuming. And of course, like I would not claim that I was a frontline worker by any means in the way that, you know, people in, in hospitals, grocery stores, were truly the frontline workers supporting pandemic. But we have this seat of having our lives totally absorbed in our lives, the uncertainty of Covid response, our lives being turned upside down. Trying to figure out how we navigate this world with elderly or loved ones who might have disabilities. What does that look like for them?

How do we deal with vulnerable populations that we care about in our personal lives? And then also trying to figure out how to navigate that professionally when there’s so much uncertainty that we’re seeing from, frankly, government stakeholders themselves about what pandemic looks like. And so the duality of that at times, still can remain the significantly less so, totally overwhelming and all consuming.

And yet what I saw from the team was just this to push the work forward and recognition of this greater cause we needed to serve of developing an application and a robust piece of software to support response. And that’s something that I think really marked a lot of those first, really six months of, of our work

Carter Powers: I know during this period myself we were just having my second daughter in the first week of April. So when I left and I was sort of aware that John and Lily and Sarah were jumping in on this work, I then took paternity leave for three weeks right as the pandemic was getting started.

And I came back and it felt like a totally different company and a totally different level of energy seeing everyone deployed. And it was sort of a addicting where you were like, Well, there’s so much energy we need to like, keep finding out the ways that we, we can drive our support forward. At the same time was also very, it, it was a privilege to be able to feel like you were able to contribute back to the pandemic

Amie Vaccaro: yeah, I remember that time vividly. I wasn’t at Dimagi at the time, but it was such a, such a scary time and really knowing that like you could pour your heart and soul into your work and that would actually help in some way to curb the impact of this, this new so I think I, get the basics of the, the app that we rolled out in Santa Clara. The, the feeling at Dema of kind of rallying around this, what, what happened next in terms of the growth within the US market.

Jonathan Jackson: Yeah, so we, had deployed the application Santa Clara, and actually we couldn’t get the lab data into our system quickly enough. So for contact tracing to work, you need to, to know your positive quickly, and then you need to reach out to all your contacts to tell them they might have been exposed so they can break the chain, right?

So the idea of contact. that I expose Sarah. Sarah now knows that and she doesn’t go hang out with Lilian Carter and therefore Lilian Carter don’t get it. But if I don’t tell Sarah, you know, within 48 hours that I’m positive, it’s, it’s a problem. And so in Santa Clara, unfortunately we could not figure out a way to get the lab data into our system fast enough. And so we had kind of agreed with Santa Clara, we need to put this on pause until we can come up with a solution to this problem. Cause it doesn’t make sense from an epidemiological standpoint. that’s when Lily started talking with San Francisco who did have a real time lab feed. So as positive cases, positive lab results came into the system, we could immediately start reaching out and doing contact tracing. And so we worked with the city of San Francisco and their Department of Public Health to deploy CommCare for several hundred contact trace. and that did two things. One is it kind of exposed us to what be would become the predominant public health response model, which was hiring hundreds of contact tracers and deploying them at scale centrally within a state or a city. And two, gave us more confidence that our really a good fit for the market. You know, we’d built it with Santa Clara, but we had been customizing. Overnight and totally switching the application every night. when we moved to San Francisco, we’re like, Okay, this looks pretty stable. And then I like overnight Lily, I don’t remember, you know how early on it was to send to Clara and San Francisco.

We just started getting inbound requests left and right. You know, it just seemed like everybody in the United States had realized they needed a case investigation and contact tracing And that’s when we. together and we’re like, Okay, if we’re, if we’re doing this Lily, you need to like stop your day job and Sarah, you need to stop your day job.

And like, this is all we’re focused on. And not just YouTube, but like 10 other people. And so we kind of had an internal meeting where we just said, Look, this is the moment. We gotta step up and see if we can support the US not by giving up on global health by any means. We had a whole dedicated team for that as well, but by really trying to pull resources together in team and then we staffed up extremely quickly as well. But that was like a huge go. And I think Lily and I probably had 50 phone calls you know, over the course of April trying to figure out which states we could support. And, fortunately were able to support many um, in the response.

Lily Olson: Yeah. What I see as a turning point us our, in our engagement with San Francisco, they released a press release and the mayor did a news conference about their uh, decision to develop a for case investigation and contact and their to hire all these contact tracers. And it was a statement about the seriousness of Covid 19 made by one of the most prominent local governments in the country. The effect of in CommCare really followed that news day that became news, selection of CommCare and that investment in covid 19. Months. And then as Jon mentioned, we just not keep up with the, the demand to learn more about what we built with San Francisco County.

The first state that we heard from was Alaska. Alaska uh, was another, you know, really early investor in Covid 19 response. After Alaska. as, as Jon said, we were on the phone with different state governments and different local counties for it felt like. I recently looked back at our timeline.

Lily Olson: It was about four days Um, but we had, you know, maybe 30 conversations hopping around the country, speaking to different state governments. New York State was the next major, partner to decide to work with DGI and CommCare. And that was a, again, a, a real testament to the appropriateness of our for the moment New York State is an enormous state. Know, they were being really hard hit by Covid early in the pandemic. And so their sort of stamp of, of for the Covid solution that we developed amplified that in in our solution. After New York State, New Jersey State decided to use CommCare, followed by Philadelphia. Um, The Navajo Nation and then finally state of Colorado. All in all, we had four states and initially four local governments actively using CommCare for Covid response.

Carter Powers: And Sarah, can you talk a little bit about the timeline of what a project looked like? I think we’re, we’re almost underselling how quickly these complicated systems went live on what timelines.

Sarah Sagan: absolutely. So I can speak to this regarding in the New York context. So I, on April 30th, received a Skype message at the time, Dima Skype. Thank goodness we’ve since moved to Slack. From my boss, Courtney, said, Hey, someone’s gonna talk to you tomorrow. a couple things we need to go over with you. Uh, Nothing to worry about. So I thought, Right, it’s not ominous, hopefully. and then was basically told, drop everything that you’re doing. you are going to be leading this project with New York. Um, And that, so May 1st I got on my first call with New York and then we hit the ground running and we deployed to 57 New York State. By I early June. We were at full scale. And full scale. There not only includes the application, so that case investigation, that contact workforce management component also a data pipeline, right?

Like one of the key gaps we saw was this need to ingest lab data. So get lab data quickly into the system. Time was of essence. We need to notify contacts quickly and we need to inform cases to isolate. so cases, isolate, contacts, quarantine and we need to get that information out as soon as possible. So we went from no solution to a fully deployed at scale solution in less than six weeks. And all of that is really a testament to the power of a technology platform One of the things that we found, throughout our engagement in the US is that is often a desire for a truly custom built solution.

So a really personalized, detailed to fit a, a bespoke need or very use case that those are great and have, and do have benefits, but it is highly unlikely, if not nearly impossible to imagine something like that. Being able to be stood up in such a short timeframe to support such a robust need. And so really what DMA was able to do is build on all of the work that our international teams had been doing for years. The power of decades of technology being developed to take CommCare and make that a reality, to serve an enormous thousands plus workforce in a state that was also really nationally being regarded as the center or the focal point of response in the us. So it was, it was a journey.

Amie Vaccaro: So Sarah and Lily, I wanna hear from you. What was this time like? Like obviously you were doing incredible work, moving so fast.

Um, I wanna hear kind of your reflections on what that, that time was like.

Lily Olson: It was crazy was really crazy. have never worked so hard in my entire life. I have a, strong memory of taking a break. By sweeping, I swept the floor of my house and I was like, Man, this is great this is really fun. But in the background, I still had a county government conference call going on. It was a Saturday, and one of our county partners was, you know, just, just connecting and talking about their There were no breaks really in those days. There were no hours that were off hours. You know, we followed the lead of our state and local partners and our state and local partners were always working. So it was a really crazy time. It was a very time. I felt really patriotic I felt really proud of my government. I felt really lucky to have the curtain lifted on my healthcare system and the way that state and local government contribute to healthcare in the United States. As Sarah mentioned, we had a front row seat to. What was a really devastating and also a really important moment in US history and that was inspirational and will remain something that I’m proud of for the rest of my life.

Sarah Sagan: It really was. A singular time, and have such pride in being able serve public health in the us in the way, in the, in the small that I was able to make and in the team that we worked with. It was really tough. I mean, we mentioned, of course, like the, the personal challenge of balancing the person, the professional. Um, Remember, I think it was in July, so this is maybe a month and a half after this work, really the work was scaling up throughout the us. I was the first time I had gone a, a week without crying and that, and I, and just to like put more of a finer point on. I’m, don’t cry super easily. I had not, I think I cried once in my previous seven years or six years at Dema. Um, So, and I was crying almost daily from exhaustion, stress. I mean, was at their breaking point, the, the people we were working with in state governments. And it was not, it was really taxing if I felt a leader, right?

Like asking so much of my team, I was, I was feeling like I was getting rung dry. I felt like I was ringing people dry in what I was asking of them. And that, that makes you feel horrible. And we had no idea what the end was, what the end looks like. We hired folks, some of whom were going through such strife.

We hired someone who’s had a grandparent who passed away in a New York nursing home. You know, I mean, there was a lot, it was a lot of heaviness. So it was both like you felt so called to the moment, but also equal measure. Really just didn’t know if you were making the right choices in the way you were conducting yourself as a leader in the decisions you were making.

And that really weighed on me then, I think in many ways when I reflect on it still does just because of the amenity of what that led to and of, of what that moment felt like.

Amie Vaccaro: I can only imagine just how, how hard that was, Sarah and, and Lily. So I, I appreciate you, you sharing

Jonathan Jackson: and, and I think certainly I remember we would be scheduling calls with each other at eight, 9:10 PM without thinking tw I mean, there’s just not even checking if people are available. Like we just knew we were gonna have to go that late. Um, And we’re on the phone with our partners all day. and to stress what Lily and Sarah both mentioned, like we were working extremely hard, but it was unfathomable how hard our partners of the public health had to work. I mean, it was just you were double booked all day. You know, We knew they would have another conference call going on whenever we needed to reach out to them. And part of what Sarah mentioned is that level of stress completely burned out the American public health workforce as well. I mean, if you look at what’s happening with attrition right now and recovering from this is gonna take us some time. It’s gonna take the public health workforce some time.

But you know, we talk about impacting profit here at Dema and this was a chance to have a huge impact and it definit. had to be put above team because we were working crazy hours. But that’s, you know, our stated priorities and it’s something we’re really proud of, but it was certainly unsustainable.

Like we knew full well we couldn’t keep this pace up indefinitely. We’re trying to really figure out how are we gonna stabilize the team um, and, and our partnerships to be successful while not making it the case that everybody had to quit.

Sarah Sagan: And I do think we did get to that point, right? Like, you know, when. When we talk about the early craziness, so to speak, of what response of what Dimagi’s response to the, to covid 19 pandemic was like. It was everything that, that I spoke to it, it was that, that turmoil, the, the feeling of being rung dry, the uncertainty, the dealing with people who were the brink of collapse or just from the sheer stress and exhaustion they were feeling at the public health level. But we made a very concerted effort by starting in September, and I would say would really with an earnest by October to change that mentality. We knew very quickly that once the summer months were winding down, we cannot continue this pace of the organization. It was out, it was out of line with our values. We could not continue to deliver and be successful in the way in which we were pushing our team and pushing ourselves. So we brought in more staffing, we brought in more we set better boundaries, frankly, with some of our partners, with times that we were able to be online or offline, we encouraged folks to take more time off.

We. Had like blackout dates for when we wouldn’t be available for, you know, for support except for emergencies. We set better escalation pathways. Like we started to bring in all of the things that demo AGI has always done with many of our other partners in workforces that we set aside in the um, the call to action required for the pandemic.

And I, I don’t think that was the wrong choice to make, but the trade off and the, the, yeah, the trade off that it was, it was still.

Amie Vaccaro: Know, Carter, I wanna ask you like, how did, how did you think about, as a leader, right? How did you go about transitioning the team from this really intense heads down that’s, you know, quite frankly unsustainable to a more sustainable.

Carter Powers: Yeah. We talked earlier about how rapidly. Uh, Started delivering these projects. And part of the pain that we, we felt during this period was we rapidly needed to build a team and build a team structure that could sustain and support these projects with the level of work that they needed. Uh, So during this period, we started with a group of internal team members of about 10 working with Lily and Sarah to deliver these projects.

And quickly by the end of the year, we were already up to 30 people and, and very quickly had had more than doubled. Uh, Today were more than 50 people uh, as a division. So we fortunately had put a lot of the right structures in place with our technology team, our delivery team, our partnerships team, and our operations team, sort of providing the support structures.

This period also internally became uh, referred to as wartime. And we made a really intense effort to sort of acknowledge that this was unsustainable. And to put a the team on a path where we felt like we had more steady state structures. And I’m happy that today we, we have the sort of fully fledged division and, and we’re going after additional areas that we could make a big impact in the US public health market.

Amie Vaccaro: I feel like we’ve, we’ve done a really good job of, of walking through kind of what happened how we entered the market, what are some of the learnings that we had from this period? Why does, why does this matter?

Jonathan Jackson: I think organizationally one of the big learnings or takeaways, obviously the, the counterfactuals impossible to know. But as Carter mentioned earlier on in this episode, had just done a lot of work to restructure the organization and our new structure that we were entering 2020 with really allowed us to be able to pull this team together rapidly deploy them without kind of breaking everything else we were doing and supporting all of our partners globally. And I think that while it felt like we’d just done all this work planning and then immediately threw it out the window and, and kind of went all hands on deck, which in some ways we did do, we were only able to pull all those hands together because of the we had done. so I think in some ways, one of.

Things that I think you look at a big corporation, you spent a lot of time in strategic planning and, and doing all these things. Um, What’s the value of it? And we were certainly of that mindset as a smaller organization and as we’ve grown, planning didn’t enable us to necessarily execute the plan that we had set out, but it did prepare our structures in our team to be agile and in a place where we could really seize on the opportunity ahead of us.

And it’s something we’ve seen already, again, in the US health market, Lilly was able to pull together the team. Sarah was able to go deliver a solution, again, seize on the opportunity in front of us. And it wasn’t necessarily what we thought it was going to be, but that planning and diligence and transparency that we had across the organization put us in a position so that we could go after this urgent response that obviously nobody had planned for.

One of the things that’s so interesting about this story is that Dimagi had been around for almost 20 years. Working internationally. And when we entered the U S market, you were able to put all of those learnings from those decades of work. Into the work in the U S. back in January, you shared on a webinar with the Linux foundation.

Seven learnings. That you brought from all of that global work that you were able to bring to bear for this us public health response. And I’d love to walk through those for the audience here. So the first learning. Is that paper is inescapable.

Lily Olson: One of our surprises, one of the things that surprised us as we began working with local and state government is that some of them were using paper to their public health we work with couple county governments that were using sticky notes in the early days of the pandemic to track cases and contacts. Paper based to public health are really common in the low and middle income countries where Demond has worked for the past 20 years. We were pretty surprised to see paper based here in the US even in those early days pandemic. We’ve learned of other use cases the US that are still reliant on paper based I found it very meaningful, especially because the US has such a saturated tech market because there’s a lot of discussion of really advanced technologies for public health, like machine learning and artificial intelligence. It was a, a confirmation for me that there is still work to be done to shore up the very foundation of our health it the United States.

The second learning you shared is that better tools? Lead to usage, which lead to better data. Can you say more about

Lily Olson: Another theme from our work in the US which echoes essentially our thesis is that building better tools actually leads to use of those tools, which results in much better data. Reflecting on our experience, it occurred to me that what a donor is to an international government or an I NGO, state government be to local government donors, state governments have different mandates than their recipients or local governments. an emphasis on data and reporting. Donors can’t force international governments to use the tooling they pay for, and states can’t always mandate that local governments use the tooling they pay for. As such, the tooling actually needs to be good to keep users on board. This requires user-centered design, and again, is the premise of our work.

We built a platform that enables rapid iteration in response to user feedback. User-centered design results in better tools and which ends up producing these really strong data sets, which are what some of these state governments and donors really need to guide their making.

That brings us to the third learning, which is that platforms help you move fast. Can you say more about that?

Sarah Sagan: Yeah. So one of the, the third learning we had was really about the power of the platform as a, as a technology stack or technology Here in the us what we found is that it was much more common in many instances for there to be a desire for custom builds or more specialized features. So a, a solution or a technology solution, very des for very specific context or, or state or, or partner, whatever the, the end user may be. But the consequence is that uh, customized solution is hard to develop in a very quick urgent response context. And that’s where the really came in. A, a conducive tool or mechanism to stand up and develop a solution very quickly. Again, that six week for one of our state partners is not imaginable.

When you’re designing something from the beginning, we had a platform to build on and yes, there was a lot of design and iteration on the application from its initial stance to where it is today. But the fact that we’re able to stand up a working and prototype is really a testament to the power of a platform. Um, In the way that our designed, it gives a feel of aspects of custom software because we have this ability to use, whether it’s icons or word choices, that really do feel specialized to the uh, state or local partner that we’re working with. But still, again, the power to get it deployed and in the hands of users at a much faster pace.

The fourth learning is that design must subsidize training.

Lily Olson: Internationally, we build tools that cater to users with mixed levels of training and expertise. A typical CommCare user, like a community health worker, can receive minimal training or a regular despite their public health mandate. Short term contact tracers in the United States faced the same predicament. They were hired out of their communities. They were volunteers. maybe had never done work in public health before, but they had this incredible mandate at the front lines of pandemic response. Designing for this type of workforce goes beyond an easy to use interface. Our design needed to guide users through complex workflows with scripting, with advice and decision support validated by leading experts or the cdc. And this was especially important during covid, we saw public health guidelines change

So the fifth learning was to look abroad for expertise. Carter. Do you wanna elaborate on that one?

Carter Powers: So this was really crucial and, and built on our experience. Uh, So internationally, Many countries have struggled with public health challenges uh, that the US has. Uh, And often their new challenges in the US where we don’t have modern experience with them.

So for example, as we talked about earlier, as a result of our work with Ebola, many years ago, Dimagi had a lot of domain knowledge about how tech for contact tracing should actually work as the U. As public health system continues to rebuild, we can be looking more abroad for additional expertise and bringing in other tools from outside the us when they’re better fits for some of the areas that come up.

And that brings us to the six learning that you had shifting from global health to us, public health response, which was that flexible API APIs are a must.

Carter Powers: So APIs stands for application programming interfaces and is the way to send data between two systems. CommCare and DGI have very flexible a APIs. When we started working in the US market, we thought it would be much easier to do integrations in the us.

We anticipated that there were higher quality systems, increased standardization with things like HL seven or fire and that these standards existed that we could hook into, but that was not the reality that bore out uh, on the ground. Most of the places we work with in the US are still using bespoke systems.

So us having flexible APIs is really crucial uh, to be able to meet our partners where they are. So luckily we, we’ve had very flexible APIs as an area we continue to build out. But we continue to be pushing for uh, flexible. Uh, APIs and, and more standardized uh, approaches, even in the US public health system.

Thanks Carter. And that brings us to the seventh and final learning that you shared, which was that. Open source rules. Can you tell me more about

Carter Powers: So this is a, a very common thing you will hear about tamagi. We uh, have embraced the concept of being open and transparent uh, both in our technology as well as many aspects of the company. Uh, So CommCare is open source.

Code base is the product of hundreds of different projects that we’ve done globally across, across the world and responding to everything from Ebola to Zika and other endemic diseases even things like malaria. So the power of open source and the reuse that comes with that really is a powerful learning.

Overall our code base is robust and well maintained and our open source repositories. Uh, And it’s really powerful and important for our platform app builders to be able to respond to new problems as quickly and rapidly as they’re able to.

Uh, Because we have so much transparency and collaboration in our open source.

Amie Vaccaro: Awesome. Thank you so much. Those are really fascinating kind of seven insights from transitioning our work from, from globally to, to the us. So I wanna talk a little bit about where, next for this team? Right? So Dimagi really rallied. We pulled together this incredible team. You’ve heard from three of the folks on the ground, or really four of the folks on the ground. Where is this US Health Division headed next?

Lily Olson: Yeah. At this point are about a 50 person We to support the state and local governments that adopted our for Covid response to this day. At the same time in the past year, we have had moment to step back from Covid and ask ourselves where else might be able to make a difference in the United States. One of the places that we found we could make a difference was behavioral health response. In the same way that our platform was quickly configured respond to Covid uh, a state government has decided uh, and has progressed in CommCare um, behavioral health response. Um, Including assessments to assess someone’s behavioral health support requirements including tracking availability of beds behavioral health facilities um, and down the line, potentially supporting referrals within a state to make sure that people access the behavioral health, mental health, substance use services that they require. We are to once again see this sort of confirmation that CommCare can be helpful here in the US where there are so many other solutions available. And as we did with covid, we hope to take a that we develop with one partner and make it available to others. Um, With some localization, we hope that a similar solution could serve other state governments, could serve other local governments that are working in behavioral health. Another place that we have begun to work in the past couple months is on Monkey Ps so Monkeypox over this summer of 2022, emerged as a public health emergency and an infectious disease for which some of that same case investigation and contact tracing capabilities that we utilized for COVID response are really valuable. So my team, we did with COVID has decided to build and release a free case investigation and contact solution any public health department across the US that wants to use it. That is out now, if your public health department is involved in Monkeypox response, please reach out to us and we will set you up with that solution at no cost. We really just wanna be part of curbing this spread as quickly as we can.

Carter Powers: Yeah, when I think about what’s next or what’s ahead for us, it’s building on a, a lot of the things that have, have brought us success to date. So we do not sort of see Covid as the main focus of the division. As Lily said, we have sort of shifted to other ways that we can support public health. Uh, So I, I’m very excited.

Of the behavioral health areas that we’re building out. And we’re really excited to con continue to find ways to work with our public health partners. One thing that is pretty unique about Demo Maggie’s culture is that we’ve been working in global health, public health for the last 20 years, and we plan to be working primarily focused in public health uh, for the next 20 years.

So even though there’s been a lot of changes in the market, we’re really seeing synergies where we think we fit really well and can grow with public health in the us. So we are not going anywhere and, and looking for additional ways that we can support additional uh, technology , enabled areas with public health partners.

Sarah Sagan: And I’ll just add, all the things that we’re so proud to do to support public health in the US and to maybe give a brief glimpse of what we’re thinking about internally. We’re really looking to invest in our team even more. You know, I mentioned that perhaps we took a bit of a team hit at the start of, of pandemic response and thinking about how just given that we had to really rally behind the call to action of the moment, it’s been wonderful Promote team members, create new rules, tackle new aspects of technology, like bringing on a data and analytics team and workforce behind it. So we’re just so proud to continue to stretch and grow our team to both be, measure it with the needs public health in the United States, but also the desires for our own to make sure we’re continuing to cultivate their own and ultimately retain the best individuals that make Dema this the type of community that we hope to.

Amie Vaccaro: I’m curious like what makes Dimagi different from other health technology companies that are in the us?

Jonathan Jackson: Yeah, I think this was really interesting learning for Sarah Lilly, Carter and I early on. We are truly mission driven with our focus on impact team profit, but also very sophisticated in our belief of how technology can make a massive investment and improvement in public health And I think the combination of the fact that we are a social enterprise and of scaled and worked with many governments across the world and have sophisticated financial systems and procurement, coupled with the ability for us to get on a plane, be there on the ground the next day and have 10 years of public health expertise at your doorstep was really unique.

I don’t think there are a lot of companies in any market the US market specifically that have such a big horizontal platform like we did with CommCare such a strong professional services team that has done so much work in public health and has a lot of expertise and literally done contact tracing. the of partnership and joint problem solving we’re able to do with our clients I think is really unique. And one of our core tenants that we talk about is being a partner, not a vendor. You know, we really look for organizations and public health that are looking for partner, not just a vendor who can deliver technology.

Cuz there’s lots of those types of forms out there. We like to think of ourselves as the ones you can go to to really create a true partnership over a multiyear period. And we’ve been really successful I think, so far in supporting our partners and, you know, expecting hope to continue to be going forward. I think the other thing obviously is our cost benefit. Um, You know, we are a social enterprise and we’re trying to maximize our impact, not our profit margin. So we also um, saw that we were extremely cost effective in Covid and as Lil and Sarah and Carter determine what use cases we’re gonna really double down on over time, we hope to be the most cost effective those markets as well.

And I think we have a great chance of doing that.

One of the things Lily and I reflected a lot on early on, cuz we worked together for years in health and selling to governments of all different types and working with donors of all different types was just how similar a lot of. Problems felt from a bureaucratic standpoint and from a money standpoint in terms of how items made it impossible to do certain things or the way were structured. And it’s easy to, to sit back and say, Oh, the government doesn’t work. Or Why can’t the government be more cost effective when you’re not in this space and not working governments?

But when you’re working with people who are working, you know, 18 hours a day for six months on end, and you see how hard it is to, to just, you know, do everything you need to do to to buy software and to hire training and to pay people, you really gain a lot of empathy for understanding why some of these things just that seem like they should be a lot easier, are so difficult.

And I’m really proud. Our approach and our team and our partners for figuring out ways through that. But it is you know, frustrating for me at times to hear people’s negative attitudes towards public health and towards certain agencies from people who just don’t understand all the complexity that people need to follow to make sure you’re handling text dollars appropriately.

And that’s something that was really interesting cuz it was, it felt so similar to what we had faced in our international markets as well.

Amie Vaccaro: Awesome. Lily, Sarah Carter, any other things you wanna add to One thing I was wanted to add is related to what we’re bringing back to global Devon to Global Health. We’ve talked a lot about how it was great to see sort of things that we had worked that applied in the us. One area that I’m really excited about is how much I think we’re contributing to where CommCare the technology.

Carter Powers: Globally and how complimentary the work in the US has been to sort of build out the future vision and the power of CommCare globally. Uh, So one of the, some of the key areas that we built on, on the platform are like web applications of web app use cases, and it was really powerful to be able to bring that now to Global Dema.

So as we go from here, I think we’re equally interested in, in sort of the shared learnings between what we’re doing in US public health and bringing them uh, sort of bidirectionally uh, in both directions. So that’s something that makes me really excited about the work that we’re doing and how it can be synergistic

Lily Olson: one thing that I’ll mention that we’ve heard from our partners is that they can tell that our team really cares about the work that we are supporting. this is a real testament to the team that Sarah oversees, the team that delivers these projects. come and work at DGI because they care about public health. And when that’s your partner as a public health that’s really powerful and that can be unusual. Public health officials in the United States rely on a vendor ecosystem. That’s the way that a lot of public health work gets done. And there’s a lot of vendors that don’t necessarily have that makeup in their staff.

There’s a lot of vendors that that do, there’s a lot that don’t. And we’ve heard that it’s really refreshing to get to work with members of Sarah’s. Um, Who ultimately care about the project success a lot more than they care about any sort of individual thing that they’re responsible for. that type of partnership, that partner not vendor, which Jon alluded to, we’ve heard again and again from our state and local government partners, is really meaningful and, and really.

Sarah Sagan: Thanks so much, Lily, for sharing that. It’s certainly something that I, I hope the team is cultivating. And I think also really speaks to the ethos of demo as an organization. You know, in, in the US health and in the us healthcare technology space partner, not a vendor is something that, you know, folks have really rallied behind and has. I’ve been a really wonderful message to spouse, but I think really speaks to the years of tradition, culture, and community that demo has cultivated in many other parts of the world. So it’s a real joy to be able to bring that to our work in the US and I look forward to continuing to espouse that type of mentality with our partners for years to come a variety of sectors. so very excited to continue that work.

Amie Vaccaro: Thank you so much to Lily Olson, Carter powers, Sarah Sagan. And of course, Jonathan Jackson for joining us to tell this story. Having joined Dimagi after this team had already This episode gave me such an incredible perspective. On the heroic efforts, this team led to rise to the moment of COVID 19. And support us public health response.

There’s a lot. I took away from this conversation, but I’ll emphasize a couple of key takeaways. So first. Leading through COVID was hard. We gained a lot of respect for public health agencies across the U S and of course, globally. And the incredible effort they put into taking us through COVID.

It was an honor to work alongside them to meet this and we’re looking forward to continuing to support public health in the U S for the decades to come. Second. The story is one of responding to the need and working around the clock to do so.

I took away that after a time of huge effort, like this one, it’s really important to regroup and take thoughtful steps to bring the team back into a more sustainable equilibrium state. You can’t be all out sprinting all the time.

Third. Good planning helps you be prepared to tackle unseen new challenges. Like COVID, Dimagi his level of agility and flexibility allowed us to really step into this

Fourth. Even though every market is unique. There are many similarities between challenges faced in global health, serving low and middle income countries. And the U S and Dimagi is experienced globally. Positioned us well to serve the us as a partner, not a vendor.

Thank you so much. That’s our show. Please rate, follow, subscribe. And if you really enjoyed this episode, we’d be so grateful if you’d share it with someone you think might find value. And learning from our experience. And you can also email us with any questions or feedback. Thanks.

Meet The Hosts

Amie Vaccaro

Senior Director, Global Marketing, Dimagi

Amie leads the team responsible for defining Dimagi’s brand strategy and driving awareness and demand for its offerings. She is passionate about bringing together creativity, empathy and technology to help people thrive. Amie joins Dimagi with over 15 years of experience including 10 years in B2B technology product marketing bringing innovative, impactful products to market.

Jonathan Jackson

Co-Founder & CEO, Dimagi

Jonathan Jackson is the Co-Founder and Chief Executive Officer of Dimagi. As the CEO of Dimagi, Jonathan oversees a team of global employees who are supporting digital solutions in the vast majority of countries with globally-recognized partners. He has led Dimagi to become a leading, scaling social enterprise and creator of the world’s most widely used and powerful data collection platform, CommCare.



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