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

Amie Vaccaro: Welcome to high impact growth. A podcast from Dimagi for people committed to creating a world where everyone has access to the services, they need to thrive. We bring you candid conversations with leaders across global health and development. About raising the bar on what’s possible. With technology and human creativity.

I’m Amy Vaccaro your co-host along with Jonathan Jackson.

Dimagi CEO. And co-founder. Today, Jonathan and I are joined by two of our amazing leaders at Dimagi Gillian Javetski managing director of our software as a service team and Dr. Kelly Collins, VP of digital adherence. Today’s conversation is a bit messy. And dare I say controversial. We discussed the health and maturity of the digital health market. And the role of aid and funders and shaping the market for better or worse.

Spoiler alert. We think the market is broken and we talk about ways to make it better.

We get candid on what it takes to build software that matters in a broken market and how hard it is, and yet how important it is to have a relentless focus on users.

I’ll be honest. After we finished recording this conversation, we had a moment of, should we share this with the outside world? Ultimately, we decided that yes, we should. Because often it’s the messiest diciest, most controversial topics. The topics that people might hesitate to talk about out of fear. That we care most about unearthing and sharing with you.

Our listeners. We all know that in the world of tech and global health and development, things are not working as anyone would like them to. We’re still facing incredible challenges around equitable access to care. Despite technology advancing rapidly. So it’s worth considering how we might do things differently. Enjoy.

All right. Welcome to the podcast. Hey, Jon. Good to see you.

Jonathan Jackson: Hey, Amy, nice to be here.

Amie Vaccaro: We’ve got Gillian Javetsky and Kelly Collins here. Two of our incredible leaders from the Dimagi team. Um, welcome.

Kelly Collins: Thanks for having us.

Amie Vaccaro: There has been an ongoing, very important conversation, I think, happening across Dimagi. Um, And Kelly, you recently were at the World Health Assembly and you came back particularly fired up about this conversation. And it’s the type of topic that I’ve always imagined.

Yes, that could be an interesting one to talk about on the podcast. But I think hearing your passion coming home from WHA, um, brought it to mind again. Um, I have no idea where this conversation is going to go. I think there’s. definitely some very different opinions across this call. So excited to kind of see where this conversation takes us, but maybe we could start with you, Kelly, and just share a little bit about your experience at World Health Assembly, and hopefully that can be sort of a segue to, to tee up this fairly massive topic.

Kelly Collins: Yeah, it’s a big question. Um, so I think, Amy, I’m really excited to be here. Thanks for teeing up this conversation internally at Dimagi. I think it’s a big one. Um, being at WHA for me this year was, um, I think heavy in the sense that the landscape of global health seems to be changing, especially as it relates to like purchasing digital products.

Um, and one of the things that felt really interesting to me. was that, I get the sense that there’s still There’s still some misunderstanding within the global health community about how to purchase software as, as a product. Um, you know, we, when, when a community, like a, you know, when a clinic or when a country, uh, buys, um, a drug or a diagnostic machine, it’s a commodity, right?

They can go to a marketplace, they can purchase it. Um, they can, they have their choice of six options and they choose the one that fits them best and they get all the specs, but that’s still not the case for software. Being in so many rooms where we’re talking about like bulk buying, um, and how to get prices down of these commodities.

That makes sense and those conversations can get frustrating and they can have friction, but ultimately, the person purchasing the equipment understands that they have to buy it and that they’re not going to go build it themselves. And one of the things that continuously happens to us in software is that because I think software is sort of reproducible to some level, um, or, you know, people can build their own systems with, you know, internal IT resources, there’s a sense that, oh, we’re just going to go build that ourselves. but what I think we continually see happen as, you know, Dimagi and me previously at Shirt here is building it yourself. I mean, it’s like, are you going to go build your own diagnostic machine? Are you going to go, you know, um, Some countries have the capacity to do that and others don’t, or to go, you know, develop their own drugs.

And so I think there’s a reality here where we do need to spend some time with, um, our partners and teaching them to buy software as a commodity, um, in some way that helps them understand that, you know, software isn’t something to just be, um, you know, rebuilt, that it has to be maintained. It has to be, um, Um, you know, supported well, it needs to be secure.

And, and that messaging tends to get lost in the fact that like it can always be repurchased. And I, I just kind of walked away from WHA this year with that real reality that now feels like the time to be able to, for us to have that conversation. Um, like how do we teach the global health community to buy software as a commodity?

Um, and, and to me that means building something that’s really indispensable. So I don’t know if that was kind of my, my high level walkaway. Um, but maybe I’ll stop there.

Amie Vaccaro: I love that. Thank you. Thank you, Kelly. And I think like the sort of pithy line that you just said at the end, it’s like, we need to teach the market to buy software so that we can build tech products that matter. And like that just really stuck with me. Um, I’m curious to hear from you, Gillian, and then from you, Jon, on your, your reactions to what Kelly shared.

Gillian Javetski: Kelly, it’s great to hear that this is a big conversation topic at WHA this year. I know it’s something that we’re seeing a bit of a change in the market this year, at least. I work on the team at Dimagi that, creates and sells CommCare for self service partners. So ones that are building CommCare on their own.

I And I think we’re seeing two things happen, um, which are sort of like in conflict as well. One is that, we know very much that by next year, USAID is directing 25 percent of their funding to local partners. And so that’s bringing into question for us, not just, uh, teaching larger organizations, right, and NGOs and donors about how to sell tech products, but also what that means for local partners and, and working with different organizations and seeing our portfolio and clients change. that’s one thing that’s happening. At the same time, we’re also seeing, which is great, and we’re so excited about this, but a greater focus on security for the first time in those same products, which inherently means that, like, the cost of products should be going up. Right? So we’re, there’s something as well that isn’t quite, we have to both, um, Uh, sort of like neat different like market demands for organizations that may have less funding, but also, knowing that like the demands are being put on organizations for more expensive tech products are, are increasing.

So how do we also figure that out? So it’s something our team is always talking about. We’re trying to figure out the right balance here.

Amie Vaccaro: Jon, what about you? I’d love to hear, hear your thoughts.

Jonathan Jackson: Yeah, I mean, I’ve, talked at length about this on, uh, various previous episodes, but there’s a, there’s a huge challenge we have in the market, that Kelly alluded to, which is the combination of, People feeling like digital should be getting more mature, which there’s, you know, lots of advancements as Gillian mentioned around security, around scalability, around performance.

There’s new products coming out all the time. We’ve talking a lot about AI and doing a ton about AI internally. So there’s clearly, you know, more good software out there, but procurement has not procured, uh, not matured at that same rate. So, you know, the ability to buy. What in the U. S. market is called COTS, commercially off the shelf available technology, is extremely rare.

In fact, I don’t even think that term is in an RFP I’ve seen in global health. Um, and so everything is kind of being compared to custom software or internally built software. And so there’s a lot of challenges in the market of, you know, for a product like, Kelly’s offering through Shared here, or Gillian’s offering through SaaS, or our competitors offer. Governments don’t want to be locked into one vendor. We don’t think that it’s, it would be a healthy marketplace if there was only one vendor you could buy from. But, although the market’s matured, for a lot of use cases, there really is only one or two. Available vendors in a, you know, productized, proven, evidence based, scalable, secure model.

Um, and so we’re kind of faced with these two challenges. On the one hand, obviously, much of global development and global health are trying to get the lowest price possible because there’s limited resources to go Everybody understands that. But we also want great technology, great drugs, great clinics, great med tech.

And you need vehicles that create those things. And in our opinion, you know, for profit social enterprises are a great vehicle to get that accomplished. And that requires charging enough that you can invest that back into R& D. You can invest that back into sales marketing. And, You can support your product indefinitely.

Um, so there’s really just two opposing forces that I think we all see. And Kelly came back and kind of lit up our internal slack with some feelings about, you know, the need to, to get to products that are must have, um, you know, in our 2024 annual strategy for Dimagi and for many of our divisions. One of our focuses was, you know, chart a path to being indispensable.

From a product standpoint, you know, how can you be so good that it’s not that governments are begrudgingly paying you, it’s that they’re happy to pay you because your product is good. is valuable and worth what you think you need to charge. And I think the hope and the advocacy I spend a lot of my time doing as the CEO of Dimagi, but also just as a fellow, entrepreneur in the space of digital health with a lot of other people in the space is complain about how hard it is, uh, you know, to talk in this way.

Um, to donors who, you know, shape the market a lot of the time to governments who should want good software, not just the lowest price possible. Um, and it’s, it’s a, it’s a shifting landscape and a shifting market. And as Gillian said, there’s a need for tons of, changes due to the really important and really aligned efforts to go to a more localized agenda.

Um, but it makes it just very, very difficult when you look at the landscape where the digital health market is and where the transactions are actually happening, procurements actually happening, um, which is a very difficult time right now.

Kelly Collins: I wonder though, Jon, like something you just said was really interesting, that like government should be coming to us. And donors should be coming to us to want to pay for our software. And I think that that to me is like the biggest crux of this concern. Um, I don’t think that we should be pandering to donors or governments anymore. Like my big takeaway from WHA is let’s stop doing that. We, we should, if we’re building for local organizations, we should be talking to them. They should be willing to purchase our software. I know that’s a big leap.

Like, I think that that is a huge leap, and I’m not, I don’t have an answer to how that should be working, but like, if we’re making something that valuable to the organization that’s supporting those community health workers, or to the organization that’s supporting TB patients, if they’re willing to pay even a small amount of money for the software that we have, and it’s a pure SAS play, that’s Both of those things, as we grow our space, like as we grow our, our user base, our impact is going to grow by default and value in the marketplace is going to grow because we’ll continue to see outcomes.

And I feel like this top down approach of, of building what the donors want or having to go to the donors or the, the government even particularly is really difficult. And I don’t think we’re going to win that way. And I guess that’s just like, how do we shift that paradigm to. To sell, to build, to, um, you know, create for that very end user and keep them like in our focus.

And I don’t, again, we haven’t seen this work yet, so I don’t, I don’t have an answer that like this is the golden, you know, ticket. But I think that ultimately that’s what we have to shift our thinking around.

Jonathan Jackson: Yeah, I definitely agree with that. And I think the, The challenge we have with how Dimagi has built its business, how many organizations have built their businesses, um, is you have such a diverse pool of funding. That you need to piece together in order to get enough capital to build your software in the first place.

So you have some grant funding, you have some maybe investor funding, you have a little bit of product revenue, you got some services revenue mixed in. You lose sight of the, is this buyer really valuing my product for the value it’s creating? Are they valuing their personal relationship with me? Are they valuing how good of a grant writer I am? So you get a lot of different things and it’s very easy to lose sight of is my product adding enough value that you think it’s worth continuing to pay me next month for the value I provided or the value you think I’m going to provide. And the more that relationship could exist in our market, I think the more it’s going to create better software, but not just stronger companies.

It’s ultimately going to lower the price of technology in the long run because it’s going to find the businesses that are providing the software that’s providing enough value. that it’s actually worth what they need to charge to make that software available to the global health community.

Gillian Javetski: I do wonder if there are ways that. Donors could keep us more honest in that conversation. Like, I would love if we lived in a world where the proposal you’re working on, or like the project that you win, right? Um, isn’t just looking at like the indicators that you owe to a donor at the end of the month around it, but actually like there’s integrated, actually user feedback is one of like the indicators, right?

So like, do the users like it and like, is that like, if not right, what’s, what’s the case of it? I know we. There’s a lot of like talk around that in our industry, but yeah, I think Kelly, just going back to your point around, how do we bring the user’s voice more into this, um, is such an important one.

And especially, I think , just for like most organizations on the tech side, they do have to start by like cobbling together, like all donor funding in that way, but right, how, is there a way to at least bring those two voices together? That’s a little bit easier.

Kelly Collins: Yeah, I guess I think that like Dimagi is particularly well positioned to actually force that conversation. I love the fact that we have, A really strong services based business that works directly with, you know, governments, directly with NGOs to, to build very custom, , solutions. And I think that that very strong partnership approach actually potentially helps facilitate the fact that we could go back to that very square one model and Start taking a productized approach with, you know, the smaller areas that we’re, we’re trying to focus on.

I think, in fact, we’re already doing that with Shared here and with CommCare, SAS, and then also potentially with CommCare Connect. I think these are really beautiful examples where we can say, how do we scale back our approach to that very productized. Feedback loop with our partners and then show that that type of value is being driven on the ground, right?

We’re improving efficiencies. These organizations want to continue working with us with or without that donor funding. If we can prove that model out. Sort of at a smaller scale. I think that will help us feel more comfortable investing in it internally. So rather than needing to go out and find donor funding, we’re bootstrapping an approach that we really believe in, um, to say this is valuable.

People are asking for it. They’re willing to pay a very small amount for it. We recognize it’s going to take time to grow, but not being afraid of that. And I think that’s kind of, Dimagi is probably one of the only software companies well positioned enough in the space to be able to do that. And to be able to take that approach because we have this great, you know, services based business that does continue to work on its own.

It works when partnership, finding that donor funding, working as a, a sub to a prime, et cetera, that it enables us to kind of like step back and take this other approach and prove it out. So I really like that we have this opportunity to do it. I’m excited to take this forward, and I think we are particularly well placed to do that.

Jonathan Jackson: Yeah, I think that you had that really well, Kelly, and that was one of the, the very appealing aspects of, of why Dimagi and SureAdhere came together to, um, scale up the SureAdhere product is it was, you know, product based and the division that Gillian runs is also a product based. Purely product based, which isn’t to say there isn’t a role for these big, complex, you know, multi million dollar services projects that we do a lot of, but then extrapolating back what is productizable, what is able to be offered at one tenth the cost the next time and building a team that is isolated from, you know, The kind of custom Cadillac version of, of software and really figuring out what’s scalable and repeatable.

Um, and I think that’s, that’s, uh, something that I think you’re right. We are really well set up to do. And I think as a huge, um, part of our, our five year strategy is saying both there’s a really important role for those professional services, big engagements, but also how do you create repeatable products and what’s the market we’re selling repeatable products.

Um, and Gillian’s been doing a lot of work with both the large enterprises that we sell CommCare to, the small to mid sized businesses that we sell CommCare to, and then what’s that product has offering for governments, whether that’s hosted in the cloud or on premise, um, you know, how do we find that repeatable offering that governments can really get?

you know, 80, 90 percent of the value at 10, 20 percent of the cost, um, you know, as this market matures. And that’s the other thing that frustrates me a bit about, um, how we talk about this as a global community. It’s not just annoying for Dimagi that we have a business model problem. Um, you know, when, when we can’t figure out how to crack this, it’s like software is not getting cheaper out there in the market.

And it should be, it should be getting cheaper and better as markets mature and we’re getting more software. But I didn’t say we’re getting better, faster, cheaper software, which is how this is supposed to work as markets mature.

Gillian Javetski: And Jon, I think on that point, like I have a question about that too. Like, when you say we’re getting more software in our market, like I am trying to think about just like when we think of like other global goods or competitors of ours, like I’ve actually, I felt like in the last year, this has been like a really tough year for a lot of them.

Um, like there’s been something about after COVID that like a lot are like, we don’t know if we want to do this anymore. We’re closing up shop. Like, are we actually seeing more types of technology that we compete with?

Jonathan Jackson: Uh, that’s a great framing, Gillian, and you would know this better than I in terms of like who CommCare is coming up against. But that’s a great point. No, I don’t think we’re seeing more mature software. I think we’re seeing more early stage software. Um, which is good and we want that competition, but yeah, I mean, the same products have been available for doing community health based systems for the last five years, you know, um, and we’re not sure anybody is, you know, on the horizon so that that market has matured in that sense of, you know, there’s a finance set of global goods that are really viewed as like, The tools you can select for if you’re building a national scale community health information system, but has the price gotten notably cheaper over the last 5 years?

Has the, um, you know, sophistication of the experience for CHWs notably matured? And so those are the things we want to be looking at. from, uh, is this market functioning, right? Is the competitive pressure causing those things to get cheaper and better over time? Um, so you’re absolutely right. I think there’s a huge, and I think everybody’s recognized this, there’s a huge problem of, and we, Dimagi was extremely fortunate with the help of many funders, um, and customers and partners to cross that, you know, early stage, Scrappy, get any money you can to build your product into multiple successful growing business lines.

Um, but I think it’s really hard to come in behind right now, um, because, you know, quote unquote, the market’s matured and it’s like, well, how’s it, you know, and, and you still need 5 million to get off the ground, you know, building these, these software systems, um, not all at once, but, you know, if you just look at the R and D, the support, the marketing that it takes, um, there’s no shortcut.

And so where’s that 5 million going to come from for the next set of products? And then after they get that, to Kelly’s point, how are they going to get off of that model and onto a more value based model fast enough that they’re not tied to kind of this weird donor driven model?

Kelly Collins: It feels to me, though, that, like, it’s sort of our job as a tech company working in this space to start advocating for this more loudly. Um, I don’t know what that looks like, but I think that, there’s been some, I think, really, you know, Maybe harmful market shaping that’s happened in the software space and harmful conversation that’s happened.

Um, that has sort of made it, almost the default to like, go build it yourself and not to say that many of our partners can go do that many governments can go do that and they should go do that. And so I’m not advocating. I mean, ultimately. we don’t have healthy markets in, in software, in, in global health.

Like they’re really unhealthy markets. They’re completely donor driven. Somebody tells you to go buy some system or you build some system that does, you know, two different things and it gets deployed and then it dies on the vine because nobody maintains it. And this is just like, this loop keeps happening over and over.

And what I’m worried about is that if we as a market leader in this space, don’t get louder about that because we’re concerned about. Sort of our, you know, our ability to be a partner or our ability to engage with with these organizations, but it’s actually going to cause harm to the, the users that like those on the ground that are using our software.

Um, I think we should be outwardly vocal about the fact that choosing to build it yourself could, have worse outcomes, right? maybe Dimagi is not the right partner. Maybe there’s a local partner who’s already built something similar that could be used and we should be pushing those types of market dynamics, to be successful.

Um, as we engage in this space sort of in using our platform to really advocate for like healthy market dynamics, as opposed for the like, really unhealthy market dynamics, where we’re all jockeying around for funding.

Jonathan Jackson: Yeah, I think the point you’re raising on the build versus buy there, um, decision in the parlance of kind of other markets that we’ve seen, it’s not just, can you build it? It’s what is the opportunity cost of skilled engineers working on a problem that you could have. Bought something to solve indefinitely.

That’s not just going to solve it, but get better over time because there’s a company or a community or something like invested in getting that thing better. And your team could have been doing something that isn’t solved yet. You know, that’s, that’s one of the biggest things we think about. And if you just think about how we run Dimagi internally, you’ve all been parts of extremely fun conversations with me on whether your team should do it or whether you should, you know, have a shared one Dimagi approach to it.

And one of the biggest factors in that is opportunity cost. Where it’s like, of course, each division could do everything on their own, but then your highly skilled team of limited people is not doing the thing that only your division can do, or only your sub team can do. And that’s a huge challenge, I think, for how do we talk about that?

How do we communicate that? Because it’s not working, the way that global health community is currently thinking about it. And it doesn’t feel like anybody is talking about the opportunity cost of like, yes, you could, of course, you can build a CHW system. Um, from scratch with custom software.

It’s just software. Everything’s just software. But you could have used one of the available tools and then had your team do something that isn’t. Solved or isn’t, you know, serviced by a company whose mission is to go make that use case better over time. I’ve talked a lot about this, written a lot about it, um, and have not, have not found a language that resonates with people around this opportunity cost issue.

I think part of it is, you know, the reality is a lot of people may not be in that. That role in that organization, whether it’s a government position or donor position, long enough to experience the downside of the opportunity cost. Um, you know, if you know you’re not going to be there in five years making IT decisions, you, you don’t actually face that opportunity cost.

It’s your, Successor or your successor’s successor. so yeah, I don’t, I don’t know the language, um, to use. I know we experienced a lot of, you know, we’re, we’re constantly drawing parallels to how the Magi works internally and how that mirrors a lot of the challenges our partners and, and government funder, everybody faces.

And so we see this internally, how painful some of these discussions can be. Um, but we do face the opportunity cost, you know, and, and a lot of those. So I think that’s a great point, Kelly, and I don’t know what the answers are, but I do think it’s like, if you had infinite engineers, infinite budget, maybe you should do it in custom, but that’s not the set of constraints anybody actually has in the real world.

Amie Vaccaro: I think what’s interesting about this is that Dimagi is where we’re at because we’ve been so good at Playing the funder game, I think, right? And being able to get these pockets of funding and then use it to take this product approach.

Right? I think that’s sort of been some of the secret sauce. but I think Kelly, what I hear you saying is that that same approach that got us here, could that be harmful going forward? Right? If we’re still playing the funder game, we’re still allowing funders to have this outsized impact. And skew the market, right? you sent us a piece that I can link to in the show notes around creating a false market. Um, is there any world where Dimagi shifts away from looking at donor funded projects?

Kelly Collins: I’ll let Jon answer that question about shifting away from donor funded projects. Um, I think that’s a, that’s a hard one because you’re absolutely right. We, we, unfortunately, startups, like, as a startup in this space, as a long, well, previously assured here, and then moving over to Dimagi as a very long acting, uh, established company in this space.

This has been the world that we’ve all been living in for so long. I mean, this is, this is how global health works. It’s how it’s worked till date. I think, um, there’s this really great book called Dead Aid, um, called, uh, by Dembisa she’s an economist that talks about sort of the harmful impacts of aid, um, in Africa and sort of the legacy of that.

And how do we, how do we shift that? There’s a book that was written probably 15 years ago. Um, and I think just now people are starting to take some of the, the things that she brought up and more start to like institutionalize this thought of like how this conversation around sustainability has gotten so deep into like, you know, the global good conversation and open source and, um, you know, making sure everything is like widely available.

And it’s really particularly, I think, hit hard in the software conversation. Um, whereas like in a commodity discussion, you can talk, you can negotiate on price, but like, ultimately there’s something tangible that you’re purchasing, whereas in software, it’s not as tangible. And so I think this has been particularly harmful.

And I, I’m feeling like people are starting to come out of the fog, especially as like, there are these incredible, companies, uh, software and otherwise coming in the digital space, coming out of Africa. And they’re starting to sort of demand more of the aid cycle that has happened and started to demand more of, um, the governments locally to say, you know, don’t create these false markets.

You know, we want to be growing our economies and we should have the capacity to do that. Um, and so to me, I think, I’m excited to see people demanding more of this structure, and I think now is kind of the time we can start having that discussion, both internally and externally, on what does it look like to operate in this space?

What does this look like to operate as, um, you know, a team solely focused on, um, our end users goals and the things that create value for them and improving outcomes for them?

Jonathan Jackson: Funders in the audience, it’s not a game. It’s just, you know, it’s a, it’s a relationship. Um, but no, I, I think. I mean, to your point, there is, this is true of startups getting to massive companies and massive companies, like what worked two years ago may not work for you today, you know, there’s, there’s absolutely nothing wrong with having donor support and definitely we want to work with donors and definitely it’s part of our core strategy, but it’s the question of knowing, The pros and cons of that relationship of that market of that channel and others.

And the problem with the donor space, which, you know, we’re all incredibly pro, um, trying anything you can to improve the lives of others and doing all this amazing work and our customers and our clients and our funders are doing all these great things, but not always in a sustainable way and not, not all funding and donor.

Spend should be sustainable. Like it’s the right thing to do just to get food to people who need it. It’s the right thing to do to just provide massive relief or, um, longer term relief as appropriate. But with technology, you don’t get any benefit from just trying. to do these things like the, the impact’s going to come in software and technology through well built, sustained, durable, at scale deployed products that get better over time.

And this is something I harp on all the time. You know, at best, a lot of our projects, even at Dimagi, definitely in the industry, you spend all this time deploying the software, multiple years, you finally get it up and running, you finally get it in the hands of users, then the funding’s gone. Then everybody moved on to the next project.

And it’s like that, that startup phase was, was just work. That wasn’t impact. And now everybody’s shifted into the next project. I mean, when we deploy products at Dimagi, um, A, we failed plenty of times internally to deploy them, but like, it pains me. And you three have all heard the outcome of that pain, how long it takes us to get value out of products we deploy internally.

Right. And it’s like the whole time we’re getting it stood up, that’s just like to enable. Getting impact in the future. So it’s like, it’s not that it’s a bad instinct to want to help as much as possible as fast as possible and get the technology out there and just see what happens, but it just doesn’t work.

It doesn’t work that way with software and with technology. So that’s a challenge. And on top of that, you have donors within the same organization sometimes funding things that obviously Are going to have a great impact, but aren’t that sustainable? And then the other part of the organization’s asking you why you’re not sustainable.

And you’re like, well, this is, this is odd that the same organization’s asking me both these questions. Um, and so I think that’s also a big challenge is, is, you know, do you want your organization to. die before it can get to that sustainable software model? Absolutely not. So you’re going to take the money, but do you know, there’s no chance the government is going to pay you the same rate the donor’s paying you?

Like, absolutely, you know that. And so you’re faced with these really difficult decisions as an entrepreneur of, of what to do in those cases.

Gillian Javetski: Jon, do you think you would start Dimagi now? Like just pretend like if you were like starting out of like MIT again, like a minute ago, like knowing like where the market is, would you have added Dimagi?

Jonathan Jackson: Um, I would definitely be doing something in the social impact for technology space. Um, but I, I think I would try to get to this understanding faster. So I don’t have the answers, but I now understand the problem a lot better than I did 20 years ago when we first started to Magi. So I would definitely make different decisions and remove the wishful thinking.

And I’ve talked about this in a previous episode, but I think a lot of people, um, you know, get that half a million or million dollar grant. I’m like, Oh, if I deliver on this really well, then there’s a 2 million grant. And if I deliver on that one really well, there’s a 5 million grant. And that may be true all the way up until 5 million.

For us, it’s fortunately been true way longer than anybody probably thought. And the checks keep getting bigger, but like it, it stops. It stops at any one individual product, project at a country level, and it stops at your products overall. And, um, knowing that, you need to know you’re building more and more weight, more and more machinery.

And if you’re not coming in behind that with a, business model that has a flywheel that is not requiring bigger and bigger checks from more and more people, um, then I think you can build a great business, but I think so many people get the wrong idea that, Oh, if I deliver on what somebody gave me, you know, 500 K four, they’re going to give me a million or somebody will give me a million and somebody will give me two and it does work for a while.

And that’s why there’s so many early stage, good companies with good leadership, with, you know, good software, they’re turning out, but that hit this wall. That we almost hit, um, and we were just very fortunate that we wanted that SAS model, um, not because we thought there was a huge flaw with our donor model, the original reason we went with a SAS model is we thought, we wanted to reach more users. So it wasn’t viewed as a fundamental flaw in the, our donor funding, which was dominant, you know, in our business model at the time, it was just like, we don’t want to only be able to do these huge projects. We want to serve thousands of organizations, which we now do. And we knew the only way to do that was through the SAS product.

Um, you know, so I didn’t have the knowledge I do now or my perspective on the problems in the market. And if I was restarting Dimagi today, Joe, to answer your question, I would, I would at least be factoring that in much more because it took us many years to learn that lesson.

Amie Vaccaro: That’s actually a really interesting segue. I think as we’ve been talking through all this, you know, kind of honing in on some of the negative aspects of this market. I’m looking around on this video call and I think each of you right now are spearheading a product approach in this market, right?

Despite all of this. So I wonder if I might ask each of you to share a little bit around what is working right now, right? I think. Between shared here, CommCare and in CommCare Connect, each of those efforts, to me represent changes in this approach, right? and evolution. starting with, with you, Kelly, if you want to share a little bit about how Shared Here right now is, is trying to, , to take a different path.

Kelly Collins: about getting that initial funding from a donor, right? When, as a startup, when you receive money from somebody to do something, whether it’s an investment or whether it’s a grant, you have a perception that what you’re doing is impactful. Like just the fact that you got that grant or just the fact that somebody invested in your idea is that there’s this perception internally of like, okay, we’re building something that’s going to be of use, of value.

And I think for me, Turning that paradigm on its head a little bit is actually really empowering. Um, to say, just because we have the funding to do, to build this thing, um, and deploy it on the ground, doesn’t mean that it’s going to be impactful. It means that we have a chance to try to get impact on the ground and we need to prove it, right?

We need to show that. I think what I’m really excited to do on the SureAdhere side is to stop, like, assuming that because somebody, you know, is willing to give us money to build something Start with the assumption that that’s just the investment to catalyze this productized approach to then go back and say, okay, what is the most important, you know, outcome and what is the problem that we’re trying to solve for these users, um, and to start with that problem.

And so I think from from my side, we’ve started to build a team out that, is really going to start with the problem set. What is the main problem that our users have? How can we solve that and then come back to the team and allow the team to iterate on solving that problem for the user? Rather than letting sort of the user define how we solve the problem, it’s actually having them really well define the problem to us and having us come back with You know, a really great solution that makes them excited to then go, deploy it on the ground.

Um, so I think for us, it’s really about flipping that paradigm of assuming value because we’re building it and actually proving that value by solving a problem on the ground with what we’re doing and starting with one really simple problem. Or maybe it’s a really hard problem, but starting with one problem, solving it really well, and then learning about the next problem, and solving that next problem really well, and so on and so forth.

So, so then we’re building up that really strong, product over time, and we know that each incremental, you know, piece that we build is actually providing additional value as opposed to kind of deploying this big system all at once, which is what we’ve done in the past. So I’m really excited to take that approach.

I think we started building on a team that, that can do that. and I, I feel really strongly that like this feels like a very obvious path forward because it will build that incremental value over time.

Amie Vaccaro: Thank you so much for sharing that, Kelly. I think that’s super compelling and clear. And I love that sort of flipping of, just because someone gave you money to do something doesn’t mean impactful. It actually needs to solve the problem on the ground, right? Which. sounds so simple, but where there are so many layers of, complexity and different incentives, like it actually, it takes a lot of work to kind of come back to that and to keep coming back to that. Gillian, would you be willing to share a little bit from the CommCare, which we mentioned the word SaaS before, but that’s kind of how we refer to the team that runs CommCare within Dimagi, um, in terms of how you’re, you’re thinking about this.

Gillian Javetski: I think for us, one of the things that I am personally really excited by, and I know our entire team is as well, is like probably the least sexy part of tech, which is security, right? Which is like the platform and the thing that, We have lots of teams at, Dimagi that support governments that are really focused on local hosting, which, you know, makes sense in a lot of contexts.

I think for us, like going back to what Jon was saying, which is like why we, started with a SAS product for CommCare was both to like increase our impact in terms of number of users. and for us, like it’s incredibly important that those users data is protected. I think in our industry, this is like a wildly.

 Misunderstood like area. And I think going back to what you were saying, Kelly, around like a need for maybe groups like Dimagi to advocate more, I think there’s also a lot of like communicating and educating we can do as well around security and what it takes to have a secure platform. think from what we know, CommCare is the only SOC2 certified, um, global good, and there’s a lot It’s like a pretty loaded statement.

There’s a lot that like goes into understanding what SOC 2 certification is. Kelly and I were just having a conversation yesterday about it because I’m sure here also is now SOC 2 certified. Um, but I think that’s like an incredibly important, piece and something that we intentionally separate out from our roadmap.

So, I learned a lot from Kelly around focusing more on the problems that users are having, um, instead of the solution. And so we have that for our customers. From up as well on Comcare, but we always hold special place for security in terms of just like seeing that as like a completely indispensable thing.

And how do you, teach people more about it? So we’re excited. We’ll be doing, um, we’re putting out a data security playbook in the coming weeks, um, and also talking to Digital Square about doing a webinar as well on security just to like make the zone to other organizations. But I think that’s something that we’re, we’re looking forward to.

Amie Vaccaro: That’s awesome. Thank you, Gillian, for sharing that and, um, definitely want to, uh, we can add a link in the show notes to the data security playbook and webinar if that’s out when we publish this. and I think it’s also been, I think, heartening to see. Dimagi leading on the security side. And also that so many of our clients are really, as you said at the top, like really valuing security more and more, um, and really taking, data security seriously as, as they should be.

So, it feels like we’re, we’re pushing the market forward where it needs to go in that place. And there’s, we are getting some reward for that. Jon, I wonder if you could share. in the last couple of minutes, a little bit on the CommCare Connect side. And I know that we haven’t talked a ton on this podcast about CommCare Connect, and we actually do have a dedicated episode coming up in the coming weeks and months around more information about CommCare Connect, but maybe you could share a little bit about your, your take there.

Jonathan Jackson: Yeah, I think CommCare Connect, for our listeners who aren’t familiar with it, we, we can drop a link to our latest update on the blog on it. But it’s a, it’s a vision to help frontline workers opt in to doing additional paid purposeful work. and the. Really exciting part about how we’re designing and developing CommCare Connect is we’re extremely fortunate with, the Steel Foundation for Hope, that we have a significant amount of capital up front to really build this in a product first mentality.

You know, so testing with users, pushing out a push notification out of the blue to users saying, do you want to opt in to learn how to do vaccine promotion and just seeing what happens. You know, and so we have no, donor pressure on making sure the answer to that’s yes. Um, you know, we can run these tests and say 80 percent of our users are opting in, 80 percent are passing the digital learning, 80 percent are moving through certification and 80 percent start delivering those home visits.

And it’s incredibly exciting and fulfilling to be able to meet our number one five year strategic objective of creating better jobs to achieve better outcomes. In a way that’s taking this product first mentality, um, but it’s incredibly hard to stay in that mindset all the time. Like it is so easy to fall back into, Oh, but if we added this feature, maybe we could sell it to this donor for this reason in this country, um, as opposed to, you know, is this creating a better job for the CHW workforce, um, that we’re trying to target or.

In the future, all frontline workers. Um, so yeah, it’s been really exciting. And we’ll talk a lot more about that in a future episode, but I do want to highlight one thing Kelly touched on and Gillian as well, um, it’s taken us 20 plus years to build this business and it’s really hard to have the financial flexibility.

Flexibility and stability of our business that allows us to focus on things like Kelly said, of kind of rethinking how she’s doing product, um, and for Gillian to really invest in double down on security and a lot of the other areas that our SaaS team is doing. Um, and so I get asked a lot by younger entrepreneurs, you know, how to, how to get into that state where you can make these.

Choices and kind of control your own destiny. And it’s hard, you know, like it took us many, many years of having hybrid business models, all mixed together, all very complicated internally before we were finally able to say, okay, Kelly, you take your team and just go create an amazing product. Gillian, you take your team and go create an amazing product services team, go make as much impact as you can, you know, in all these different ways.

Um, and, and so it, it is really challenging and I’m sympathetic to how hard it is to take that product mentality. Into the global health market. And so I think that, um, you know, the sooner donors, governments, the ecosystem can support faster value based feedback loops, the better products we’re going to get and the easier, hopefully the easier it’s going to be to build companies in the space because those feedback loops are there.

Kelly Collins: Yeah, Jon, I might just like add that I think the gravitational pull to, to go work with, um, you know, to get money to build something is always going to be there for startups. And I, I think that, um, you know, if there was any advice that I was giving to sort of like young entrepreneurs trying to be out there, I would, I would, you know.

Sort of say, don’t get into that cycle, um, to begin with. I mean, it’s a really hard, it’s definitely like a siren call, right? Cause it’s money, it’s free capital. And so I think, especially in a space where it’s really also hard to raise venture capital, when, when you’re trying to work in the impact space, um, that pull is almost too much to, to sort of walk away from.

And I would, I would suggest that we should all be doing our best to really keep users at the forefront of what we’re doing and to try to walk away from that as much as possible. Um, because ultimately, if we’re not having impact on the ground, I do think we are helping sort of create this cycle of false markets.

And so the more that we can be doing to like, push away from that and make sure that the value that we’re creating is not just sustainable from a funding perspective, but that we’re creating true, um, You know, value on the ground from an efficiency perspective, from a health outcome perspective, from a, you know, workforce perspective, that’s going to, you know, ultimately drive global health outcomes in a much more positive light.

Amie Vaccaro: Love it. Well put. Um, Gillian or Jon, any final words you want to add in before we close out?

Jonathan Jackson: That was great. Closed by Kelly.

Gillian Javetski: Yeah, that was great, Kelly. It was, Mic drop. yeah. great job. Thank you.

Thank you to Kelly and Gillian for joining us for this lively conversation. I waited a couple weeks after recording the conversation to record this closing because I wanted to let the conversation marinade a bit.

 I heard something yesterday that really helped me put the whole conversation in context. And that was awareness creates choice. Practice creates capacity.

This is a quote from Amanda Blake author of your body is your brain. And the context is around somata X and somatic intelligence, but I think it actually applies here.

Let me unpack each of those statements awareness creates choice. Donors and aid obviously currently play an important role in global health and development, but we need to be careful that we don’t, over-rotate towards pleasing a funder at the expense of building a product or an implementation that users will love and need. Ideally as our building tech products, we do.

So without any donor funding and a pure focus on solving problems for our users that they’re willing to pay for. But if that’s not possible, And donor funding is at play. Then keen awareness is important. Let’s be outspoken about the ways that donors might be influencing product development.

And from there, look for ways to choose a different way.

The second element I want to unpack there is practice creates capacity. So I agree with what Kelly shared . Around needing to move towards a world where tech is purchased like a commodity and not seen as something that should be free. Free software creates all kinds of risks, particularly around privacy and security, which we heard from Chilean as a key focus on Comcare.

So let’s each look at the ways that we can begin to practice a more market driven approach to products in global health.

If you’re building products, this means getting really focused on solving problems for your users. It’s not enough to just get funding. You need to show value. And if you’re using tech products, look for ways to move towards purchasing software as a commodity, as opposed to finding ways to get it for free. Have candid conversations with your tech partners about creating value in your work?

The availability of free software for limited times, doesn’t help anyone create long. Sustained. Value. Which is what we need to be creating in this space.

The third piece I want to add here. Is that collaboration creates progress. So when you’re considering building something custom or buying something off the shelf, I consider focusing you and your team’s time on what’s most differentiated and high value that you can do. And it might not be building a custom tool that you could pay for. The cost of building a digital tool in-house may seem more palatable in the short term. But over time, maintaining a secure. Uh, modern system takes a lot of bandwidth and resources that may not be the best use of your time.

Let’s build on each other’s work and focus where each of us can create differentiated value. Let’s not recreate the wheel. That’s our show, please like rate, review, subscribe, and share this episode. If you found it useful, it really helps us grow our impact and write to us@podcastatdimagi.com. With any ideas, comments, questions, feedback.

This show is executive produced by myself, Michael Kelleher  is our producer and cover art is by Sudhanshu Kanth.