Listen to the High-Impact Growth podcast : Candid conversations about technology for humanity


Episode 38: Building Resilience: The Key to Combating Burnout in Frontline Workers with Lilianna Bagnoli - Dimagi


Building Resilience: The Key to Combating Burnout in Frontline Workers with Lilianna Bagnoli

Episode 38 | 43 Minutes

In a world where stress is inevitable, burnout is rife, and the global mental health burden is growing, it’s crucial to develop the skill of resilience to recover, adapt, and grow from stress. This episode highlights how building resilience can guard against burnout, a workplace phenomenon that affects many Frontline Workers, resulting in feelings of fatigue, detachment, and a reduction in professional efficacy. Jonathan Jackson sits down with Lilianna Bagnoli to dig into Dimagi’s work on resilience-building through the launch of the WellMe application – a user-friendly tool focussed on equipping Frontline Workers with resilience-building behaviors, that can be used across geographies, languages, and Frontline Worker cadres. You’ll also hear about the ways in which we can scale access to mental health support for individuals and Frontline Workers, how technology can support this, and what this means for technologists, implementers, and funders working in global health.

Other topics discussed:

  • Why resilience-building is important amongst Frontline Workers
  • The growing mental health crisis & four interventions that can help deliver mental health support at scale
  • Leaning into collaborative approaches to deal with stress on all levels amongst essential and non-essential staff
  • An introduction to Dimagi’s WellMe application & the feedback received from the user testing phase
  • The importance of adapting messages and language from user testing to appeal to specific contexts and demographics
  • The need for organizations to incorporate resilience-building into professional development efforts
  • The effects of bolstering mental health on the results of treatments for other health issues

    Show Notes


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

    Amie: 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 Amy Vaccaro, senior director of marketing at Dimagi and your cohost. Along with Jonathan Jackson, Dimagi CEO. And co-founder. Today, we’re talking with Dimagi is Liliana biannually about resilience, burnout, and mental health.

    We’ll be discussing what is the global burden of mental illness? And how does burnout effect frontline workers that are so essential to increasing access to healthcare services? What are the ways that we can scale access to mental health support for individuals and frontline workers alike. And how can technology support these approaches?

    And what does all of this mean for funders, implementers and technologists working in global health? We break down why you need to care about mental health and what you can do about it. Enjoy.

    Amie: I am super excited for today’s episode. I am here with Liliana Vanoli, who is our Associate Director of Delivery at Dimagi, and she is also informally our mental health lead at Dimagi. Today we’re gonna be talking about mental health and specifically resilience.

    And this is a topic that I’m very passionate about myself, and excited to kind of share some of the work that Liliana has been leading. I will say over the last year or two, Dimagi has been building out a team focused on mental health, which makes me really happy and Liliana is closely involved in, in leading some of those efforts.

    She is one of many people at Dimagi working on this, and so you’ll also get to hear in future episodes from additional folks, who are working on our mental health work. You’ve also heard from Lauren Magoon on a previous episode about some of her work. So really excited for today’s conversation.

    Liliana, do you wanna quickly introduce yourself and share a little bit about the work that you’re you’re doing at tamagi?

    Lilianna: Yeah. I’ve been working with Dimagi since 2016. And I am currently working out of our India division, so I live in New Delhi, India, and I currently am working as the associate director of delivery for our India division, which means I get to support all of our projects that we run out of the Asia region.

    And I’m also, as Amy mentioned, working as our informal mental health lead. So when the India division decided that we wanted to focus more. On mental health as a priority area. I was given the really exciting task of figuring out what a mental health strategy might look like for our India team, and resilience has become a really big part of that work, which I’m excited to talk more about today.

    Amie: That’s awesome. So I wanna hear from you, what is resilience and why does it matter so much?

    Lilianna: So resilience, is a skill, first of all, so it’s something that we can develop over time by practicing the right behaviors. And there are many different ways to define resilience, but we go with this definition that says resilience is the acquired ability. To recover, adapt, and grow from stress. So when presented with a stressful situation, how do you, respond to that situation?

    How long does it take for you to recover from that situation? And are you able to grow from that situation? Your level of resilience has a big, role to play in, in how you manage that stress. The reason that we think resilience is so important is that, Because it helps us manage stress. It can also guard against burnout, in a workplace setting.

    And at Dimagi we’re really focused on equipping frontline workers with skills they need, to take care of themselves, to be good at the work that they do. And so by being able to manage workplace stress, through resilience, we can help to guard against burnout in frontline workers.

    Amie: Yeah. That’s such a great definition. And so it’s not so much that you don’t actually feel the stress, it’s that you have the ability to kind of, recover from it quickly. Right. Like you’re still, you’re still feeling it.

    Lilianna: Yeah, that’s right. And I can say a little bit more about burnout and, the problem that we’re trying to. Counteract when we’re building resilience. So if you look at the way the World Health Organization defines burnout, there are three things. Somebody who’s burned out might experience. The first is just an overall feeling of fatigue or exhaustion.

    The second is that you’re either distanced from your work or you feel cynical about your work. Or another way to say that is you might experience some detachment from your work. And the third is that you actually see a reduction in professional efficacy. And so people often use the word burnout, kind of colloquially or informally if we actually take burnout.

    The way it’s defined in the international classification of diseases, it is specifically a workplace phenomenon. So it’s something that you develop when you are. Faced with chronic workplace stress and you’re not able to successfully manage that stress. And so, when we think about frontline workers and the stress that we know that they experience in their jobs, building the right set of skills to prevent that burnout is something that becomes really important for the frontline worker as an individual, as well as the frontline worker, as a service delivery agent.

    Jonathan: And we’ve been, focused on. Frontline workers for the past two decades at Dimagi trying to support, their work and help drive better outcomes. And I think it’s interesting that it took us so long to realize how critical this area was to focus on with, you know, the role that technology can play, which is certainly not, solving the entire problem.

    I know you personally worked on a ton of different CHW programs and, and with frontline workers. How do you think about. What it means if you’re a resilient worker versus a non resilient worker, and how that affects, you know, your, your day-to-day. Like, what does that look like in, in your mind, how do you bounce back?

    Like what, what would having higher resilient skills, help you to achieve?

    Lilianna: Yeah, so when I think about someone who has a high level of resilience or doesn’t, I almost. Can picture an individual standing, in the center of a frame. And then there’s this buffer zone around the person that gets thicker as their resilience increases. And to have more resilience means to practice behaviors that lead to resilience.

    And in particular, we’re looking at things like stress management, caring for yourself, practicing relaxation and mindfulness. Connecting to others and connecting to your purpose. And you can leverage these behaviors at different points in time depending on the scenario you’re faced with. So I can imagine a, a frontline health worker who has a really difficult week at work.

    There could be new reporting. Criteria that get introduced and their supervisor is, is really, nagging at them to submit their report. They might have difficult patients who are not listening, to what they’ve suggested or maybe are not responding to treatment the way that they’d hoped. They might have things going on at home that make it difficult for them to put in extra hours at work.

    And by leveraging these tools, that are part of resilience, they could do things like reaching out to their support system. To vocalize some of the stress that they’re going through. Or maybe they leverage a support system at work by talking to a trusted colleague or supervisor about the challenge they’re going through.

    Connecting to purpose would look like saying, Ugh, this has been a really tough week, but the work that I do is really important because I know I’m making X impact. Or maybe taking some breaks in between work to just collect your thoughts and breathe deeply would be ways to engage in relaxation as well as self-care.

    Throughout the day. So it’s kind of like a toolkit that you carry with you to be able to manage the stressful situations that are inevitably part of the job that you have.

    Jonathan: That’s great. And I love that idea of kind of thinking of the frontline worker in the frame and the resiliency skills, giving them a buffer. In India in particular, but globally, we’ve worked With some amazing frontline workers who are doing just heroic work, and it is so challenging both for them personally and for their client base.

    Can you give us kind of a broader context of, you know, what is the burden we’re facing with the global mental health crisis? And then at a high level, kind of what are the major thematic areas that you’re thinking through around ways that we can address this?

    Lilianna: Yeah, so a lot of what I know about global mental health is, based on readings that I’ve been doing as well as interactions with partners and frontline workers. I’m not a mental health expert. I think it’s important to say that. But in terms of the, the global burden of. Mental illness, about one in eight people in the world do have a mental disorder and most people out of that one in eight will be affected by anxiety or depression.

    And we often group these into a category called common mental disorders. And, um, if you look at all of the diseases in the world that contribute to disability adjusted life years or disease burden, You’ll see that mental disorders come within the top 10, causes of the global burden of disease.

    So there is a massive, need for mental healthcare. Many, many people experiencing mental illness of some kind, but there is pretty limited capacity globally to provide the right care and services for people. Struggling with mental illness. So we see a shortage of counselors, a shortage of psychologists and psychiatrists who are able to treat people if they have a mental illness.

    And so a lot of the work that’s been done on Global Mental Healthcare is looking at evidence-based models for delivering mental healthcare at scale. Given the constraints we have with a limited number of specialists, and there are four. Approaches are interventions that are, advocated by, and this was something that was published in the Lancet Commission in 2018 on global mental health and sustainable development goals.

    The four interventions, start with task sharing, which used to be called task shifting, and this is the idea that there’s too much work for specialists to be able to do. And so what we’ll, do in a task sharing model is train someone who is either a community health worker or a lay counselor in a community or a healthcare setting to provide a really specific mental health treatment.

    So you could think of, training a community health worker to deliver a depression treatment program to someone who has mild or moderate depression. And what we do is we equip people who are not specialists or non-specialist providers. To offer evidence-based effective care, and then only if we need a referral and more specialized care, do we tap into that, that specialized care framework.

    The second intervention is using digital technologies, and I think that’s something that comes really naturally to us at Dimagi, but digital technologies are a great way to. Share information about mental health that builds literacy at the community level and can counteract stigma. It can be used to implement screening and diagnosis protocols, and also as a, a, an agent for delivering a mental health, , intervention.

    The third intervention area is called the balanced care model. And I think this is really interesting because it says that people are not only in need of mental healthcare services in a healthcare setting. If you go into a school or you go into the community, people still need access to mental healthcare.

    And so what you do is you train people in non-health settings to be able to screen and treat for mental illness. So, In the education system, you might train teachers to be able to screen for and provide services for mental health. And the final intervention that the Lancet Commission has advocated for is one of increasing demand.

    So we have both a demand and a supply side challenge when it comes to mental health and getting someone, to a place where they understand that they might need to seek care or where they feel comfortable enough. Seeking care is is a big problem. So with this increased demand intervention, what you do is facilitate contact, between two people who have something in common.

    It could be that maybe they’ve been diagnosed with the same disease or from, they’re from the same age group or from the same community. And one person has lived experience of a mental illness and the other doesn’t. And by sharing experiences between those two people, the person who hasn’t sought care yet for their mental illness is more likely to do so.

    And so it’s kind of the positive, peer influence to seek care if you interact with someone else who has already done so.

    Amie: These are such rich examples, Liliana. So just to kind of repeat it back to you, it sounds like there’s, there’s task sharing where there’s social support provided by maybe. Lay frontline workers or community health workers, a huge opportunity for digital technologies to be used, in the care of mental illness.

    This balanced care model where non-specialist providers are able to integrate care into other settings. And then these sort of methodologies to increase demand for mental health support because, oftentimes people don’t seek help, likely because of stigma. I’m curious, can you talk us through a little bit about.

    How is DGI working within these, and what are some of the projects that you’re working on? And I know there’s one particular project we want to hone in on, um, which I’m excited to learn about, but maybe start at a high level.

    Lilianna: Yeah, so far a lot of our work has. Focused on the first two interventions, which are a combination of task sharing and digital technologies. So a lot of our work in India has, been in partnership with implementation and research organizations that train, a group of non-specialist providers or community health workers to deliver a specific intervention, in this case, a depression treatment program.

    And then they equip all of those frontline workers with a digital solution, to screen individuals, give a preliminary diagnosis for depression, and then also administer treatment over a period of six to eight weeks. The program that we are working on is specifically targeted at individuals who screen for mild or moderate depression.

    And the treatment that community health workers give is completely tracked using. A digital solution. The digital solution is important for a couple of reasons. One is that if you are trying to replicate a model that you’ve used successfully in one place, having all of your workflows codified in an application allows you to more easily take that and scale it in a new context.

    And so there are building blocks here where if we’re able to successfully. Provide depression treatment in this context, we could potentially move it somewhere else more easily. And the second is there’s a lot of concern for good reason about task sharing and making sure that the quality of treatment provided by non-specialists is consistent and of high quality across the board.

    And our solution in this case is, partially, designed to facilitate. Feedback on the counseling that’s being provided by non-specialist providers so that we can ensure that quality of care, that’s being delivered by non-specialist providers.

    Jonathan: And I think that notion of how to make sure we scale with quality has been a huge theme and continues to be a big theme in a lot of our. Initiatives at Dimagi, and this idea of leveraging, peer feedback, I think is really innovative because, you know, frontline workers are, are overburdened.

    Often undertrained need a lot of support, but the capacity at the supervision level is often equally overburdened, undertrained, and need a lot of support. And so this, this ability to use peers I think is, so fascinating. We’ll drop some links to that program and the, the research that’s been done, on that in India.

    And, and we’ll have one of the members in the future episode, as well join us who, Dr. Brooklyn Patel, who’s a mental health expert. But Amy, you mentioned the Wemy product in Liliana. You’ve been visionary at Damia on building this out, and we’re really excited to hear about it. And so share a bit about what Wemy is and how it came to be at the Magie.

    Lilianna: Yes. So Wellie is our newly launched application, which is built on Deb’s open source platform. Comcare and Wemy is a tool that builds resilience and wellbeing in frontline workers. Wemy is a new product, but it is built on now three years of formative work that Dimagi has done on resilience. So Dimagi in 2020 became part of a resilience collaborative community of practice, which was convened by the Johnson and Johnson Foundation’s Center for Health Worker Innovation.

    And as part of that working group, we helped to test messages about resilience with healthcare workers in India and partners as part of the collaborative, tested those messages in many other countries. After those messages were developed and then publicly released by the Johnson Johnson Foundation, we then developed an early version of Wemi, that was piloted in Nigeria and Mexico with frontline health workers and soon will be piloted in Brazil.

    And through all of these experiences, we really gained confidence in this idea that we could teach resilience skills using a digital solution, and that also we were seeing a positive impact on. Resilience and wellbeing of health workers by using a digital tool? So well, me is the product of many years of work on resilience and the application uses a combination of short courses and, text-based learning material.

    It has things like journal prompts, so you can reflect on a lesson that you’ve just completed, quizzes to reinforce your learning. Inbuilt videos for you to understand or see a concept that’s been described to you. And then practice activities that help someone put to put into practice what they’ve read about in their courses.

    The ultimate goal of wemy is to provide a scalable tool to frontline workers that helps them build their resilience and wellbeing. Our, our theory of change for Wellie is that it is a cost effective application. So if you compare this to an in-person residential training on resilience, being able to deliver this through an application is, it requires less resources that will improve the resilience and wellbeing of frontline workers.

    And we are measuring this within the application using validated measures for both resilience and wellbeing. And that because we are able to increase resilience and wellbeing, we should see better retention levels among frontline workers as well as better outcomes for the communities that they serve.

    this year our focus for Wellie is testing our theory of change by doing pilots. And so our, our plan is to pilot, well, me with 1200 frontline workers this year across different geographies and sectors of frontline workers.

    Jonathan: That’s awesome. And if you’re listening, there’s an open RFP that we’ll drop a link to if you’d like to test wemi with your, workforce. And we’ve seen a lot of excitement, to do this because I think so many organizations are struggling with burnout and resiliency, in their workforces. And, and one of the.

    Things that I think is so exciting, potentially about the approach we’re taking is if Liliana, everything we’re hoping you, we validate this year in these studies, shows that this resilience can get built. This really moves into our better jobs for better outcomes, goal because we can now have this content available to every Comcare user, right?

    Anybody in any role, anywhere in the world, they already have a smartphone. They already have a data plan. They’re already used to using digital applications in their job. And this now becomes a, a tool that can be available to them to build that resiliency and drive, you know, both better job satisfaction, hopefully, and better outcomes.

    So it’s really exciting. What you’ve built, and I’m curious, what’s one thing that’s kind of surprised you so far based on the, the feedback from users, to date and what are you excited about?

    Lilianna: I am. Immediately thinking about a user acceptance testing activity we did a couple of weeks ago in Deli. And one thing that’s new about Wellie for Dimagi is that in addition to health workers who have been, the frontline worker we work most closely with at Dimagi, we’ve also, been planning to roll out wemi to both drivers and delivery partners.

    So like drivers, you can think of Uber. And with delivery partners, you can think of food delivery or, grocery delivery. We don’t know a lot about these frontline workers. So we went out, in deli in the streets and asked if we could talk to drivers and delivery partners and get their feedback on the concept of well meet.

    And, the feedback was difficult. I mean, for a lot of the frontline workers we were talking to. It’s, I think, obvious, but their primary concern was being able to make enough money, that day with the work that they were doing to keep their household running. And what they were really looking for from us was an explanation of why they should use Wemi and what was in it for them.

    What was the worth of this application. And it’s, it’s really challenged me to think about what is the value proposition for a frontline worker when. There are so many, basic needs that someone needs to fulfill with their job. That’s been one surprising piece of feedback. I think the other thing which has been a really pleasant, outcome of the pilots that we’ve done in Mexico, in Nigeria is just the overwhelmingly positive response that we saw from frontline workers.

    At least anecdotally we’ve heard that. The frontline workers who were part of these pilots together really came together to support one another. And so there was a lot of peer support that came out of that program organically.

    Amie: Luna, that’s really fascinating that that first anecdote, and I think in some ways that speaks to that fourth, method of like, we need to actually be building the demand because in many ways, People may not even know that mental health and resilience is a problem that they might be dealing with.

    I think for me, being based in the US having studied psychology, like mental health to me is always top of mind. But I’m curious your take on like how prevalent is like an understanding of mental health. And I also, I know when you were doing this research, you kind of.

    Even just the word resilience I think was problematic for you. So I’m curious to kind of hear how you’re thinking about this.

    Lilianna: Yeah, it’s true. In fact, we did some testing on. How do we even describe resilience and the word that we thought would be appropriate? People were asking us what it meant. So, we got some great feedback on just how to adapt the messages from that user testing we did. My sense from the testing we did with drivers and delivery partners was that maybe there is knowledge, but there was definitely resistance to talking about stress, so, The way this conversation would go is we’d say, we know that your job is difficult.

    You work long hours in the deli summer, the heat is really overwhelming. What do you do when you experience stress in your job? And sometimes even just, getting to a point where someone agreed that they were experiencing stress was something that didn’t come naturally and really kind of caught us. Off guard because we expected that to be a really smooth transition into a conversation about stress. But people would either say that there wasn’t stress or actually the stress happened when they weren’t getting work, and that as long as they had work, they weren’t stressed because their main concern was whether or not they got enough jobs, to be able to earn what they needed for the day.

    So I think. One thing is for us to use the right language when we’re talking about resilience and stress and, I think, Jonathan earlier mentioned that we would try to, take Wemi into different contexts and be able to use it with other frontline workers. And that’s true, but not without a lot of focus on correctly adapting the content to resonate with a particular frontline worker population.

    So language is one thing, and I think the second is that the, the theory of change that we might use to talk about wellie on this podcast or internally at Dimagi might not be the right way to talk about wellie externally. And so I think we’re, we’re kind of trying to understand what is it that is appealing about this solution and would encourage someone to invest their time in learning resilient skills that.

    That makes sense in a particular setting if that’s been harder than I expected.

    Jonathan: And we’re, doing some research on this and it fits into our broader area of, Comcare Connect and some other initiatives we’re having to help frontline workers opt in to taking on additional activities. But one of the things we’ve also been talking about, Liliana, is whether we should be advocating in the community for them to be paid.

    You know, while they’re building this resiliency, because it is a core part of their job function, they are gonna be, in theory, a higher performing worker as a result of this. So in some ways, it makes a lot of sense that this should be viewed as part of job training and part of professional development, not something an individual has to, care about their own mental health for personal reasons. Like this is a professional need as well.

    Lilianna: Yeah, I completely agree with that. And the testing we did really reinforced for me that it’s going to be important for organizations to see this as something that they need to provide. To their workforce? Both because it’s for the wellbeing of the worker and because we can see that if someone is less stressed, they don’t develop burnout, then they’ll also be more effective at their job.

    And we are doing some work in our pilots of, well need to try and understand what the role of incentivization is in using wemi. So, for example, in one of our pilots that we’ll be launching in India in this month, We’ll be providing two incentives to frontline workers. One for completing all of the courses in the Wemy application and the other for taking monthly surveys on resilience and wellbeing for a period of three months.

    So what we wanna see is if we, explain this to somebody as something that they’re doing for their job, and we also provide compensation or incentive for completing, Or for using the application, then are we able to, to get people more excited about using it and see that engagement?

    Jonathan: That’s great. So really exciting to hear about everything, you’re working on with the team and wellie, but obviously you mentioned this is a huge disease burden. It’s a top 10 issue for the world. So there’s a ton more that will need to happen outside of the work that just the Margie’s doing. One of our common phrases is we want to out collaborate rather than outcompete, and we are certainly doing that in the mental health space.

    So in all the work you’ve been doing and the collaborations in the division is done both in the region but also globally, kind of what recommendations would you make to our listeners, whether they’re technologists or funders or subject matter experts, but you know, what have you come across and, and what can you share with the audience?

    Lilianna: Yeah. One really important thing for us as DGI to think about and also our listeners, is that if we look at any system that people operate in, We can call this the socio ecological model. There are factors that contribute to stress and burnout at the individual interpersonal community, organization, and policy level.

    And addressing just the individual level, which is what we are doing with resilience, is important, but shouldn’t be confused for being sufficient as a response to the stressors that frontline workers face. And so I think anyone working in this space of resilience, tamagi included, should be collaborating with organizations who do advocacy at these other levels to create workplace environments for frontline workers that are healthier, and have lower levels of stress.

    For technologists like Dimagi, I think it’s important that we adopt an, an evidence-based approach to the work that we are doing. There’s been really great work done by the global mental health community. To share what are the interventions that we know work, and we, I think we should be using technology to support those existing interventions.

    To reference the language part about resilience, we should be appropriately adapting mental health interventions. So I, I think not an effective model would be to take an app that works in the US and then try to roll it out as is in India without a lot of testing. And then we should also have, technology which is scalable.

    So I think we’re really focused on looking at what are problems that technology can solve and solve for many people. For funders, one thing that I would love to see is that more funding would become available for mental health within existing programs. And I think a great example of this is that there’s a lot being done for tuberculosis and for HIV treatment globally.

    And there’s also a lot of evidence showing that people who have, poorer mental health also have lower success at being able to complete their medication regimen for TB and hiv. And so by addressing mental health within those programs, we can lead to better treatment outcomes and then also hopefully build a system, for mental health care that has spillover positive effects for the community.

    So, I think a plug for funders to maybe ask their implementing partners or even when they’re putting out, requests for proposals to include mental health as something they want people to, to talk about. And then for implementers, I would say that you should use technology to your advantage. You don’t have to work with Tamagi or use Comcare, but just generally, I think technology is a really good tool for being able to codify the work that you do and then scale it to other places.

    And I think if you have a successful model for mental healthcare, but you’ve seen work in one setting, I would really encourage you to share that with the community and potentially even approach a research or a technology organization and see if they can help you bring that to new places. Because I think we are in this phase of, of global mental health technology where we need to learn from implementers who’ve actually done this before.

    Jonathan: Yeah. And on that sharing, I think it is, Very well known in a lot of areas of research. The, the publication bias that you published, the positive findings. And then, you don’t see a lot of publications of it not working. And it’s particularly challenging in mental health because you see a lot of positive studies at a smaller scale, and then you’re challenged to see that same effect when they scale up.

    And that’s true of many different interventions. But one of the areas that we’re really excited about, in addition to the areas LA mentioned, is also, interpersonal therapy in groups. And so we’re launching several pilots, in Uganda and elsewhere, but this has been a field where there’s been amazing results in pockets.

    And then as you scale up these programs, whether it’s school based or community based or these other areas, and I think to your point, this, you know, technology can play a role, but there’s so many systemic other factors that are gonna come into this. That influence the scalability and the reproducibility of these positive findings.

    And as a community, understanding what are those elements to scale so we can scale what’s working and learn from what’s not, is gonna be critical as, as we move into this. And it’s exciting that there’s, you know, it feels like there’s more activity and more awareness going into this, but there’s also just such a huge burden and so much to do, that we really need to share as a community, as best we can.

    Amie: Jonathan, I’m curious. Just reflecting on all of this and hearing this, and thinking about Liliana’s example of, frontline workers who don’t necessarily know that they need this kind of support, from your point of view, as a CEO of a company with 250, 270 employees, how do you think about resilience, like at your organizational level, right?

    Because obviously this isn’t just about frontline workers, this is about everyone. And I’m curious to hear your take on should we be getting paid to be building resilience and some of these thoughts that you’ve shared.

    Jonathan: Yeah, it is a great question, Amy. And I think, building resiliency skills and building stress management skills are certainly areas that, GIE thinks is important to invest in as an employer. It’s important for employees both for retention, but also as Liliana mentioned, like productivity on the job when you’re burned out.

    Not only do you not do your best work, but you get into this spiral cause you feel bad about being burned out in the first place, right? You feel guilty, you’re not able to, deliver at work. You feel bad that you’re not productive and you get into this really negative spiral, that then like leads to you having to quit current job even if you didn’t want that to be the case. And so for us it’s a really critical issue to make sure we’re taking care of our staff. We have, done a lot around trying to support our managers to be. Showing up in the right way to support their team members. We’ve invested a lot in manager training and other areas like that. We pay for coaching, for some of our team members to have that ability to talk with a professional coach, which has been awesome and I highly recommend it to those who are looking.

    And then also we do things like DGI rust days. So we have one coming up that we just give the entire company the day off so that we’re able to really take that mental health break. I think. For me personally, and I really try not to project, my experience, towards others. And, and I think everybody needs to be very cautious about their own personal biases and, and lived experiences and how those apply to other, but, I can work, you know, extremely long and intense hours, but I need that outlet, you know, I need to feel like I can turn off work and that the world’s not gonna end.

    And that, you know, the stress of the job can be left behind and then I can come back to it and that works for me. That doesn’t work for everyone. But we try multiple different ways to, offer opportunities to our team members, our staff, all the way up to me. You know, it’s important for me not to get burned out.

    And that it’s not gonna be one size fits all. Some people like the rest days. Some people like the coaching, some people don’t like any of this stuff, and we need to find, you know, yet another tool. So I think it’s, you gotta keep trying and you gotta try a lot of different stuff. But I think it starts from our deep, you know, belief that our team is our biggest. Asset at the organization and, and investing in and taking care of that team is something, you know, again, all the way up to myself included, is really important to Tamagi and something we want to want to keep doing.

    Amie: Yeah, I think that’s really good to hear, Jonathan. And, I’m just reflecting on even just a situation we had yesterday between you and me, where, I was working on something. I shared it with you, you did not like it one bit and you wrote me kind of a, a terse email and that’s the type of thing that like, could have sent me into kind of a spiral.

    And it did for a little bit. I went out for a walk. I tried to kind of practice some of these resilience skills, and then I was able to actually just bring it to you and say like, Hey, look, I thought that was a shitty email that you wrote me. You’re like, yeah, I know. It was, But I was mad and here’s why. And I think we were able to kind of talk through it, but I think that, you know, 20 years ago in my career, I don’t think I would’ve been able to have that conversation with you. And so, I would not say that I am the most resilient human being. I think I’m a very sensitive human, but I think it’s a constant learning.

    Right. And I think as an organization, as Tamagi, like knowing that Dimagi is. Supportive of us being on that journey to figuring out how do we take care of ourselves and make sure that we’re able to bring our best to work. Because something, you know, an incident like that could have cut me up all night, but instead we were able to talk about it and I was able to sleep and it was fine.

    But, I do think that it’s just, it’s so important that we all be kind of on our own, on our own journeys of taking care of ourselves, and looking at the ways that we can be taken care of, the frontline workers that are, are most important to the progress we need to make.

    Jonathan: I totally agree, and I appreciated that conversation that you and I were able to have, yesterday. And, one of the things that contributes to, I think, Resiliency at Dimagi is just our openness and our honesty as an organization. And that is, we take that for granted here. Because it comes naturally to us as a culture, I think, when you can’t have that discussion when you’re a frontline worker with no power whatsoever to voice, you know, the fact that you feel disrespected because your phone is terrible and they gave you a broken phone, or didn’t give you supply, like little stuff.

    Not the big stuff. Like you should be paid and you deserve, you know, a livable wage and all the really, like the minor stuff. The power imbalance is just so strong in a lot of the workforces we support. And that’s why, again, I was stressing taking our lived experience, being like, oh yeah, of course people wanna build resilience on this digital app that we created.

    And then Leanna, you know, like really validating that and saying, do they need to be paid? How do we make this work? Because we know this workforce is just making these huge gains and outcomes on behalf of a. Healthcare system that is often underinvested in and has provider shortages all over this workforce is absolutely critical.

    All the way up to the nurses, physicians, administrators, and the burnout we saw from Covid is just making all of this worse. And so that’s why we’re so passionate about, you know, this area for frontline workers, but also for our own staff. I mean, Liliano was part of one of the most intense projects we’ve ever done in India and we.

    Had, you know, I think everybody was burned out for years on that project just due to the stress of, of trying to scale so fast and working with the government and these workforces. We had that shared connection to work there, which I think kept a lot of us going through that period of knowing that at the end of the day, this was leading to better digital support for this amazing workforce in India.

    But all of these things coming together is why I’m so excited by the work Liliana’s doing because I think if we can crack this, even a little bit, You know, the burden is so huge. Will a digital app work for everybody? Absolutely not. But if it works for 10, 20, 40% of the workforce, we’re making huge gains at almost zero marginal cost on top of existing programs. So that’s what’s so exciting to me about this work.

    Amie: And Liliana in closing, I’m curious to hear a little bit from you if you’re comfortable sharing, you worked on that huge project in India that I’m sure was a burnout machine. As it sounds like. How has kind of your experience and, stance towards your own resilience evolved as you’ve been doing this research? Cause I imagine there’s a lot of self-reflection that happens as you’re digging in so deep on this.

    Lilianna: Yeah, I didn’t expect to be asked this question and so what’s coming to mind is that I think my willingness to talk about my own mental state at work has. Evolved a lot over the past few years, and I attribute a lot of that to working with the Johnson Johnson Foundation because they, as a funder, really normalized asking on calls, what’s something you did for self-care in the past 24 hours?

    And would start a lot of conversations reflecting on how you came into a meeting in terms of your mental. Status. And that encouraged me to start asking that question to my team in meetings and us being able to talk about our self-care practices and connecting, to one another when we’re thinking about resilience personally.

    And I think growing with my vocabulary and my ability to talk about these behaviors that I think are really important is something that has been huge and for the people that I manage as a people manager to be able to. Talk to me in the vocabulary if I’m feeling burned out, and for me to be able to go back to them and say, okay, well that’s obviously a systems problem.

    What do we think is causing this stress? It’s just given me this whole language for talking about stress and being able to kind of dig into that with the team that I don’t think I had before. And so I feel. Really grateful to have been able to work on this, area. And I’ve heard this from other people at Dimagi working on mental health, that like building this app has helped me because I’m reading all these resilience messages as I’m, you know, putting the app together.

    And, I think we’re so excited about Wemi because even for us as people just putting the product together, it’s had a positive impact.

    Jonathan: I was really excited by the results that we’ve gotten so far on the self-assessments because you wouldn’t think this would work that well. Right? It’s an app, it’s a set of messages. I mean, they’ve been validated, but, it just goes to show how bad we are in general at thinking about this stuff and addressing it because relatively low dose interventions work extremely well because it does.

    Shift your brain in thinking about the problem in a different way and taking that burden from just trying to put up with everything to saying what needs to change here so that I can be more productive and, I can be better off and my work can be better off. And so I think there are definitely lots of things to be skeptical about with technology at large and lots of apps that may or may not, have a significant impact, but, When designed correctly and when done with the user in mind, I think the potential’s really exciting because we do lack this language and so many people, you know, can be late in their career and literally never have had a conversation about this or addressed it in a substantial way. And so the opportunity is really significant, I think, for that reason too.

    Thank you so much to Liliana for joining us today. I’m sure we’ll be having her back at some point to share the progress on. Well, me and the other projects she’s working on. I’ll share my six takeaways from today’s conversation. First it’s vital that we reflect on the diverse sources of stress affecting individuals at every level, personal interpersonal community, organizational and policy.

    Our efforts are really beginning at that personal level, but we need to be thinking about all levels of stress and coming up with collaborative approaches. Second. As we work to push this field forward, we have to rely on evidence-based methodologies. Let’s embrace Dimagi value of continuously evolving.

    By learning and sharing openly and share our successes, our challenges, our failures.

    Like most things in global health and development, we really need to out collaborate here rather than out-compete. There’s just too much at stake.

    Third. The importance of language, can’t be understated. It’s really crucial to use language that resonates with the local communities when you’re implementing resilience programs

    dimagi has done a lot of work on this with the J and J foundation. And we’ll share links in the show notes.

    Fourth, when it comes to mental health, we really need to be looking at scalable models. And technology is a great way to codify and scale our work.

    Fifth. To all the funders out there, we really urge you to increase the financial support allocated to mental health within existing programs. And remember that bolstering mental health can dramatically increase the results of treatments for other health issues.

    And lastly, let’s not forget to take into account the resilience of everyone involved in your work. So this isn’t just about frontline workers. It’s about everyone. Including your staff and yourself

    We all need to make sure that we can sustain ourselves for the important work we do every day.

    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 With any ideas, comments, feedback, questions. This show is executive produced by myself. . Danielle van wick is our producer. Brianna. Doris is our editor and cover art is by sit on Chicago.

    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.



    About Us

    Learn how Dimagi got its start, and the incredible team building digital solutions that help deliver critical services to underserved communities.

    Impact Delivery

    Unlock the full potential of digital with Impact Delivery. Amplify your impact today while building a foundation for tomorrow's success.


    Build secure, customizable apps, enabling your frontline teams to collect actionable data and amplify your organization’s impact.

    Learn how CommCare can amplify your program