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Episode 45: Too Valuable to Fail - Dimagi


Too Valuable to Fail | Your Questions Answered

Episode 45 | 16 Minutes

Testing out a new format for this podcast – short form responses to questions from you, our audience. Plus video!

In this Your Questions Answered episode, we break down a recent learning that Jonathan Jackson shared on LinkedIn regarding working with governments on digital health programs:

“I used to think the goal with digital health programs as a technology partner was to get too big to fail.  I’ve learned a lot however in the last 20 years. Now I know: the only path to success is to be too valuable to fail.”

We discuss taking an Impact Delivery approach for digital, and answer the following questions:


  • Can you kindly provide specific instances where you have consistently provided benefits to your users, clients, and communities? Understanding how you have avoided becoming stagnant and maintained the growth of your program would be highly beneficial.
  • How do you suggest measuring and assessing the value-added for users, clients, and communities?

Show Notes


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

Amie: All right, hello, Jonathan. Good to see you.

Jonathan: Excited to be here with you.

Amie: Yeah, me too. So today for our audience, we’re going to try something a little bit different. We’re going to do a pretty short and sweet episode, based on a LinkedIn message that John shared, uh, last week, um, that got some interesting questions and wanted to give some time to answer some of the questions that came up. Um, so this will be just a little bit different than our normal format. Just kind of Q and A based between myself and you, Jonathan. So you slacked me one day and you were like on a call and you had shared something that was a powerful sentiment.

Amie: And the idea was that as a digital health provider, you originally thought, okay, the goal here is to become too big to fail. So we want to have so many users that we’re so embedded, um, we’re too big to fail. And you had learned over, you know, really the course of the last two decades, that actually the goal is to be too valuable to fail.

Amie: And so your LinkedIn post was really about that sentiment. Um, and it got some interesting traction and questions. Um, anything you want to share about that particular learning before I kind of get into some of the questions?

Jonathan: Yeah, thanks, Amy. I had been talking, I forgot with whom. Um, but if you’re listening, you’ll recall this conversation last week or the week before. Um, and it was, it was exactly what you said, Amy. Like, we often thought, okay, if we get to national scale, if we have enough users, um, kind of the system will just have to sustain itself and, and will kind of be irreplaceable.

Jonathan: And over the years, we’ve recognized, like, nothing’s too big to fail. Um, you know, governments are incredibly busy, have lots of competing priorities, lots of options. And you have to win the argument that you’re too valuable to fail. That, that doing the work to maintain your solution or improve your solution is worth it.

Jonathan: Because it’s creating so much value. And that’s something that I think a lot of the digital health community, including Dimagi doesn’t really behave like that’s the goal. You know, we launch these products, we try to count the… Number of users. We try to, um, you know, look at scale stats, but we don’t really have the language of value embedded in how we, as a community, talk to governments, how governments measure success of their digital health projects.

Jonathan: And so I, um, you know, really was struck when we were talking about this, um, because I think it is something that’s an important change for the industry. It’s something that DeMoggy has really shifted our mindset towards. And as you mentioned, got some cool questions on it. So happy to, to refiner with you.

Amie: Awesome. And Jen, what do you, when you say like, shifting to this language of value from number of users, like, what do you say, say a little bit more about what that looks like?

Jonathan: Yeah, so in our direct experience as a moggy, but this would be true of other vendors and partners to governments as well. The measure of success is often like, did we launch Comcare or did we build an app that did X, Y and Z? Whereas the measure of success should be, did that lead to improved health outcomes or did that lead to improved agricultural output?

Jonathan: And the digital community writ large, um, you know, often, um, Tasked with standing up these systems and the measure of success is like, did you turn it on or did you train these users or did it get deployed? Um, and we need to be really owning and partnering on the whole problem, which is, did it achieve the outcome you were going for?

Jonathan: Um, and a lot of approaches that one can take in deploying technology don’t correctly set up that, um, discussion with the government. And part of the reason why it’s important to have that lens of being too valuable to fail is like, it is a trade off. There’s limited amounts of money. There’s limited amounts of.

Jonathan: Digital expertise and capacity, and so if your system is a good idea, that still doesn’t mean it’s worth deploying, right? You can have lots of good ideas that in a world of infinite funding and infinite resources you might do, but in the reality of having to make hard trade offs, um, it’s gotta be worth it, and it’s gotta be worth it, um, relative to other opportunities.

Amie: That’s interesting. And I love that concept of like, partnering on the whole problem, right? It’s not just like, let me do my little task and check it off and say it’s done, but like, let’s really own this problem with you.

Jonathan: You and I have talked about this a lot, like one of the big areas we’re focused on right now is resilience building for frontline workers, we have a previous episode on that, um, and digital training. Because as we talk about this whole problem, you know, even, even winning the argument that we often have around doing both service delivery and data collection.

Jonathan: Um, it’s not just service delivery isn’t enough, we need to support training, we need to support resilience. So it’s, it’s that whole problem of is that phone with a suite of tools. really enabling that worker to have a better job so that she can provide better outcomes and that’s ultimately really partnering on the whole problem.

Amie: Yeah, I think that’s a good, good segue into the first question that you got on your LinkedIn post, which was, can you kindly provide specific instances where you’ve consistently provided benefits to your users, clients and communities, understanding how you’ve avoided becoming stagnant and maintain the growth of your program would be highly beneficial.

Jonathan: Yeah, so two, um, great examples of this, one in Burkina Faso and one in Ethiopia. Um, both have case studies and lots of public material that we can link to. Um, but both those programs were deep partnerships involving the government leading the strategy and the vision. Um, a partner in Burkina, it’s been Teraday Homes and Living Goods, in Ethiopia, it’s been JSI, um, and Living Goods, and these deep, you know, multi stakeholder partnerships to drive digital solutions for community healthcare workers that are then able to, um, and nurses in the case of Burkina Faso, are then able to drive improved outcomes through decision support, cost savings on medicine, there’s a really cool cost effectiveness study on in Burkina Faso that we can link to, um, but it wasn’t Ever designed to be stagnant from day one.

Jonathan: We had set up the structure, the discussion with the government around governance, product management and how they were going to leverage the ComCare platform to keep improving what they were doing digitally over time. And now Burkina is going not just at the clinic level, where that evidence base I mentioned is from, but all the way down to the CHW level.

Jonathan: So we’ll have a comprehensive, nationally integrated digital solution across both. And Ethiopia, which we can link to the episode we just recorded, has done amazing work scaling their community health information system across multiple use cases and domain verticals and is now doing an incredibly cool, uh, pilot, uh, to demonstrate a fully paperless Bereda, um, and really measure the outcomes there.

Jonathan: So just two really phenomenal national scale projects. And of course, we see this across huge numbers of programs, um, that are running ComCare at scale.

Amie: Yeah, those are such such good examples. And I’ll link to those those case studies. And I believe our conversation about Ethiopia is going to be coming out after this. So we’ll have to reference back to this conversation as well. Um, one thing john I’ve heard you talk about is sort of as you’re scaling a program and trying to continuously add more value is sort of shifting between sort of vertical going deeper, creating more and more.

Amie: Value and impact for that, the end user, the community health worker in the communities and then also like expanding horizontally. So could you maybe speak a little bit about that and how you’ve seen that play out in Ethiopia and Burkina?

Jonathan: Yeah, I mean, we as Damagi have been spending a lot of time with you and I specifically on trying to figure out how to communicate about this because so much funding is vertical, whether it’s HIV, TB, ag related, and we have to recognize that’s where the majority of the funding comes in to supporting these digital platforms, but we have to have a lens to deploy to more use cases over time and to do that at low or zero marginal cost for those additional use cases.

Jonathan: And we have a prior episode on, um, build, um, platforms, not projects, uh, that we can link to. And that’s been a lot of our theory of how do you achieve higher value over time. And we’ve now wrapped this together in our last 20 years of thinking around a new approach to methodology that we’ve been talking with some of our partners about to get feedback on called impact delivery.

Jonathan: And this is really about how you kind of work within the extremely complicated constraints of the funding ecosystem and government procurement. and government planning and still create horizontal value. And it’s blending the vertical approach with the horizontal approach and recognizing neither one is going away, both are completely necessary and they have a very complex interaction.

Jonathan: And I think a big failure mode of a lot of digital health advocates often is why can’t we just have this big strategic horizontal lens? You know, and get all the funding and it’ll be easy and why can’t people do the right thing? And impact delivery is about accepting the have real world constraints.

Jonathan: They have vertical, um, business units, they have vertical hierarchy, and you can still create horizontal value, but you have to do it recognizing how to, how to cut across those verticals and create so much value that within any given vertical, you’re too valuable to fail. And then horizontally, you get mass scale and mass value, but it’s really about that blend of the horizontal and vertical approaches.

Amie: Yeah, that’s so well described. And I think we’ll definitely have more conversations on this podcast around this impact delivery concept. I think another piece of that concept is really. accepting that we know that governments need to be funding things in kind of a time-bound way. And I think Rajkumar talked about this a bit on a, a previous episode.

Amie: Um, that’s, that is, that is how it is, right. The, the US government likes to fund in five-year increments. Right. But as a digital partner, we need to be thinking long-term beyond those five years. Right? And so having kind of a platform that can be used and evolved and improved over time is, is so essential, um, to long-term impact.

Jonathan: And one of the great points Raj made on the episode you’re referencing, Amy, is the ability for other actors to have different durations of time. You know, so just because the U. S. government funds in these big five year cycles doesn’t mean you can’t work with the private sector or philanthropy or foundations to also have different blends of funding.

Jonathan: And Raj talked about the importance of that when we were talking with him. Um, but if USAID is often the driver of some of these major projects, it does mean you have to accept that. The way USAID funds today and figure out how to bring in those other partners. And so for a lot of what Impact Delivery is about, it’s a both and.

Jonathan: Right, it’s saying kind of accept the amazing work everybody’s doing today under very difficult constraints and advocate for changing tomorrow, but find that path through the ecosystem as it exists today because there’s just not enough time to wait for everything to fix itself. We have to be able to mobilize today and we think we have that answer with taking an Impact Delivery approach.

Amie: Awesome. So this is to the second question we got, which was really around measurement. And the question is, how do you suggest measuring and assessing the value added for users, clients and communities?

Jonathan: Yeah, so this is a great question. And one area that we spend a lot of time or had spent a lot of time working on is measuring the direct impact digital has. So doing randomized control trials or pre post surveys, and we have a huge evidence base on Comcare specifically, but many other digital providers do as well.

Jonathan: So I think it’s very clear that well designed digital applications with well run programs have a lot of value, just like, you know, well, well deployed software in your organization. with well functioning teams adds a lot of value. And the question is, how often are we able to deploy well designed software into well run programs?

Jonathan: Probably less often than we would like, so we’re frequently making trade offs and not able to add quite as much complexity into our products, or we don’t have the funding to do certain things. And there it’s really important to ask ourselves, like, not with the idealized version of what I could do, but like with the actual version of what I built.

Jonathan: Is this having sufficient value? Is it creating a better job for the user? Is it getting the data insets back to the government so they can react to them? Does the government have the capacity to react to them? And those are all critical questions to ask ourselves. And one thing that I love about that earlier use case I mentioned in Ethiopia, we’ve been working with the government and partners for five plus years on this system, and we’ve finally gotten it to a point where everybody’s extremely excited by the content that’s there, by the complexity of, of use cases that we’re able to support, and they’re really doing what I think more government should be doing, which is saying, okay, if we think this is a complete package at this point, let’s really deploy it to a new set of users in the idealized conditions and really measure what happens.

Jonathan: And that’s a great way to make sure that you are, you know, demonstrating that you’re too valuable to fail, rather than continuing with just assuming that because you’re deploying to more users, it’s creating that impact.

Amie: Yeah, so really kind of trying to step away from just this idea that like the number of users correlates to impact, right? Like that is sure that’s one metric, but really thinking about the value created for those users. Um, John, the other example that’s coming to mind for me is what we’re doing with WellMe right now.

Amie: I wonder if you want to share a little bit about that, where, you know, this is a new product we’re designing. You heard about it from Liliana Bagnoli on a previous episode, um, really around resilience building for frontline workers. And as we’re launching that, we’re also running RCT, like, trials, right, to get data on that, um, solution and sort of see how it works.

Amie: Um, do you want to speak to that one at all?

Jonathan: Yeah, I think this is a, you know, classic product management approach where we are launching this new product that will be on and team’s been working on. And we were running free trials over right now if you want to sign up, but it’s targeted at frontline workers, and it’s supposed to build resilience such that they are better able to cope with the incredibly stressful, complex job that they have.

Jonathan: And we’ve had really encouraging results on pilots that we’ve run so far. And now we’re doing more rigorous research to really convince ourselves, um, that it is having the impact that we hope on frontline workers resilience. And so we’re partnering with research organizations to do that. And we’re also not just stopping at the research though, we’re also doing lots of just normal UAT, getting product feedback.

Jonathan: So we’re doing both. And that’s really important because the faster we can prove both in a rigorous, Um, research controlled setting and from just kind of product adoption. Do users want to use this? Are we seen regular use? Are we seen them come back to the application? And so we’re trying to collect all of that as rapidly as we can because we know the messaging is validated.

Jonathan: We worked with Johnson and Johnson, they spent years, um, doing this with all sorts of experts. So we’re pretty confident that if we can get people to consume the content, it will lead to stronger resilience. And the question is, you know, have we built a compelling enough user experience? Appropriate to the target user group and to the target setting.

Jonathan: And that’s what we’re doing right now. And so, you know, normally we launch these products and we probably wouldn’t start doing the rigorous research until a year or two in. We do a lot more UAT, a lot more traditional product development. And we’ve spent so much over the last 12 months building this and J& J had already spent so much time validating the content that we wanted to move more quickly into really ensuring that we’re proving value quickly.

Amie: Awesome. That’s a cool example. All right. Well, it’s been 15 minutes. Uh, we said this would be short. Um, John, any final thoughts you want to add in before I close this out?

Jonathan: That was great and fun. Um, yeah, leave us feedback. We’re trying this format out. And if it works, we’re gonna, you know, pick up whenever we get good questions that prompt something like this. We’ll try to record a video and post it back out.

Amie: Yeah. And definitely feel free to add, add more questions and we can continue to follow up on them. Thanks everyone.

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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