High-Impact Growth

Tim Wood has been at the forefront of building and investing in technology to improve health outcomes in low-and-middle-income countries over the last 3 decades - including work at the Grameen Foundation and the Bill & Melinda Gates Foundation (BMGF) where he served as a Senior Program Officer. During his time at BMGF he led a transformative, platform-level investment in Dimagi and its technology that breaks the mold of the industry’s tendency to invest in projects rather than core technology. In this episode, Jonathan Jackson and Tim Wood tell the story of how that investment happened, why it was so important, and their reflections on the challenges and opportunities in global health and development today. In the course of the conversation, you’ll also hear advice for getting funding from a funder like BMGF. This is part 2 in a 5 part series highlighting pivotal moments in Dimagi's history in honor of Dimagi's 20th anniversary.

Related Resources:

Digital Square - https://digitalsquare.org/

Grameen Foundation - https://grameenfoundation.org/

Bill & Melinda Gates Foundation - https://www.gatesfoundation.org/

World Health Organizations (WHO) Classification of Digital Health Interventions - https://www.who.int/publications/i/item/WHO-RHR-18.06

Episode Highlights:

3:01 - Making the move from for-profit to impact-driven work and how Tim Wood made the decision to leave Microsoft to work in global health

4:36 - Why the global health and development industry needs people from the private and government sectors

7:22 - What made the BMGF grant to Dimagi unique

9:10 - The challenge of creating organizational sustainability when projects scale and the surprising disconnect between scale and revenue in digital health

10:20 - How core funding from BMGF supported achieving national scale projects at Dimagi

11:15 - The challenge of developing robust and impactful technology in global development

12:07 - "Pilotitis" in digital health: What is it? Why does it happen?

13:20 - How Tim Wood made the case to BMGF to invest in Dimagi at a platform level

16:50 - Turning the corner on sustainability at Dimagi and speaking to health impact

21:13 - Tim Wood’s advice for social entrepreneurs seeking funding from BMGF or other foundations

25:20 - A trend of increased collaboration across funders in global health to help address country priorities

29:00 -  The challenge of rolling out horizontal technology within a ministry of health and the need ensure you’re working with stakeholders with a broad enough mandate to make your vision a reality

32:50 - What’s concerning to Tim Wood and Jonathan Jackson when it comes to the use of technology to achieve the Sustainable Development Goals

37:30 - How might we create a common language and ways to measure success of technology implementation to make better decisions and make investments in global health more effective?

40:00 - The tax on users of digital health pilots

41:00 - The need to have a plan for moving from paper to digital

42:40 - What is most exciting looking ahead in digital health?

43:40 - Co-investing across donors

47:30 - How can other Digital Public Goods be successful? What is the role of Digital Square?

Jonathan Jackson is joined by 4 early Dimagi employees who were most involved in the creation of CommCare, the digital platform for impactful frontline work. CommCare is a low-code application builder that allows NGOs and governments to build applications to enable their frontline teams to deliver impactful services and collect data. It has been used by 1 million people all time and across 130 countries. The journey to create CommCare spans 14 years and is quite unusual: it's a story of tenacity, humility and continuous learning first and foremost from our users. You'll hear from Dr. Neal Lesh, Dimagi's Chief Strategy Officer, Dr. Brian DeRenzi, Dimagi's Global Director of Research Strategy, Cory Zue, Dimagi's CTO from 2007 - 2017, and Clayton Sims, Dimagi’s current CTO, about the pivots, disagreements and key decision points along the way. And you'll walk away with fundamental lessons for building software to tackle some of humanity's thorniest and intractable challenges. This is part 1 in a 5 part series highlighting milestone or turning point moments in Dimagi's history in honor of Dimagi's 20th anniversary. 

Jonathan Jackson and Gillian Javetski, Dimagi’s Chief of Staff, discuss why it’s imperative in international development and global health to collaborate vs compete. We unpack fundamental lessons about collaboration gleaned over the last few decades at Dimagi. You’ll learn: What distinguishes good collaboration from bad collaboration? What makes an exceptional collaborator? How has Dimagi developed a collaborative culture? And despite that, why have people called Dimagi uncollaborative? Why is it so important to be selfish when it comes to collaboration on shared impact? When should you re-evaluate a collaboration? And, when should you decline a meeting?

Related Resources:

Dimagi’s 5 Year Strategy Document: https://dimagi.com/blog/dimagis-5-year-strategy/

TecSalud: http://www.tecsalud.io/

Ona: https://ona.io/home/

Medic: https://medic.org/

Select quotes:

“When you have limited resources, everybody kind of needs to be in a mindset of how do we make these resources go further? And so competition can be extremely healthy when there's plenty of profit and you want to let the best firm win and you want to just drive price down. But with global development, we're running extremely challenging projects. You have many different stakeholders and partners, and you're constantly trying to innovate as well. So you're not just selling widgets. And when you add all that together, your core skill is much more how do you successfully collaborate versus how do you successfully compete.” - Jonathan Jackson

“It's also important to recognize when collaborations won't work. You know, you can have a shared problem but there's just cultural mis-alignment between teams or organizations. Prioritization can be a huge issue. Timelines can be a huge issue. So while we are huge advocates of out-collaborating over competing, collaborations are certainly difficult. And it does take a lot of skill and muscle building, both as an individual and as a team and as an organization to get good at this.” - Jonathan Jackson

"One of the things that I I find is really important is to step above the transactional nature of the collaboration. You know, what's the immediate problem you're trying to solve- whether that's integrating two digital systems or aligning on the national CHW framework -to the higher level problem. What is the public sector really trying to get out of this project? What do patients really want to see from a change in terms of the healthcare services they're experiencing? How can you really make somebody's job better? And when you level up to that problem statement, it's actually a lot easier to find common ground on what's driving a collaboration. And so it's important, obviously the transactional and operational work needs to happen. But when you can align to that bigger level question, both organizations or many organizations are struggling with, it creates a lot more room for alignment that you can then bring down into the more transactional and operational work." - Jonathan Jackson

Dimagi has put a stake in the ground that to improve health and development outcomes and reach universal health coverage, we NEED to improve Frontline Worker jobs. Frontline Workers such as Community Health Workers are a critical part of health service delivery and many studies have proven just how impactful they are. We are facing a massive healthcare provider shortage globally which will likely be filled by Community Health Workers and non-specialized providers in a lot of contexts. But, they are underpaid, under-supported, and under-recognized. 70% of Frontline Workers are women, 86% are not fully salaried, and they deal with massive burnout. To improve outcomes, we need to improve the jobs of the people who create those outcomes. Jonathan Jackson and Dr. Neal Lesh share how this strategy came to be, why it's become so important, and how we are working to reach it.

This is the final in our series exploring Dimagi’s 5 Year Strategies, focusing on Strategic Priority 1: Improve Jobs to Improve Outcomes.

Related Resources:

Dimagi’s 5 year strategy: https://dimagi.com/blog/dimagis-5-year-strategy/

Community Health Impact Coalition: https://chwimpact.org/

Resiliency Work with Johnson & Johnson: https://sites.dimagi.com/resilience-working-group

What does it mean that Dimagi is aiming to "Exceed Market Expectations" over the next 5 years? Dimagi has set out to creatively over-deliver on value today while shaping market alignment and raising expectations for tomorrow. In today's episode, we sit down with Ismaïla Diene, Managing Director for Dimagi's Solutions Division, and Fatou Sow, a Project Manager on our Solutions Division team, to dig in on a key consideration of this strategy: deepening our partnerships to drive national scale. Find out why achieving national scale for digital solutions like CommCare is so important to long-term impact, what makes it so challenging to achieve, lessons we've learned over two decades, and how we are approaching national scale partnerships going forward. You'll also hear about national scale projects in Burkina Faso and Madagascar. 

Related Resources:

Dimagi’s 5 year strategy: https://www.dimagi.com/blog/dimagis-5-year-strategy/

CommCare in Madagascar: Improving Health Outcomes in Remote and Low Connectivity Settings: https://dimagi.com/case-studies/access-madagascar/

CommCare in Burkina Faso case study from Exemplars in Health: https://www.exemplars.health/emerging-topics/epidemic-preparedness-and-response/digital-health-tools/commcare-in-burkina-faso

Research showing a 24:1 return on investment for CommCare (see page 41): https://cpb-us-w2.wpmucdn.com/voices.uchicago.edu/dist/0/2830/files/2021/09/SROR-21.03.12_clean-3.pdf

Jonathan Jackson and Amie Vaccaro speak with Dev More, Sr Director of Product at Dimagi, in part 3 of our deep dive into Dimagi’s strategy of sustaining exponential growth. A big part of exponential impact growth at Dimagi is scaling CommCare by continuing to invest in its self-service capabilities. Dev is responsible for CommCare roadmap and product development and in this episode he shares how he is thinking about scaling CommCare to 1 million users, and specifically about how we are making CommCare most useful as an enterprise technology platform for data collection and service delivery for nonprofit organizations. You'll also hear how these same functionalities can support governments and national scale use cases of CommCare.

Central to Dimagi's strategy of sustaining exponential growth is building and scaling a thriving partner ecosystem, a community of local developers and implementers that can create content, build applications and drive innovations with CommCare to suit specific localized needs. 

In today's episode we talk to Rowena Luk, Dimagi's Chief Connector, about the role of partnerships in creating high-impact growth. You'll learn about Rowena's journey to global digital health, including how a Canadian physician working in Ghana convinced her of the need for technology to improve healthcare in Africa. She discusses what it was like being one of the first female hires at Dimagi, and why she left Dimagi for a sabbatical after 12 years. And we dig into what brought her back to Dimagi - a desire to build out the technology ecosystem in Africa. 

Rowena shares how the partner ecosystem can help topple what she calls the hubris of aid: "The hubris of aid is believing that we can help people better than they can help themselves. And that's not a mistake that we're making. There are people in these communities that understand agriculture that understand finance and understand health and malaria and HIV so much better than we do and can speak to the communities we serve so much better than we can. And being able to open up this ecosystem of partners is how we unlock the potential for these communities to lift themselves out of poverty."

Even though investing in partner companies could be directly in competition with Dimagi, Jonathan shares why he was eager to do this: "We've always believed the communities have the answers and that we could be great at providing the digital infrastructure. But the solution itself would always be locally driven."

Dimagi recently published its 5 year strategy for High-Impact Growth. In this episode, we discuss Strategic Priority #2: Sustain Exponential Growth. Jonathan Jackson is joined by Dimagi's Director of Engineering, Danny Roberts, to unpack a key consideration: we prioritize platforms over projects. You'll learn:

Why Dimagi won't accept linear growth, and how we plan to go about achieving exponential growth to reach and support Frontline Workers globally

How Dimagi's focus on platforms has allowed us to develop CommCare with project-based funding 

How Dimagi's engineering team thinks about building new requests into the platform and how this allows CommCare to be priced at a fraction of the cost

How the idea of investing in platforms is also a path forward for better supporting global health workforces

In part 2 of the founding story we'll discuss some key moments in Dimagi's story such as shifting to open source, launching a software as a service model, and the impact of early hires on the trajectory of the company.

We'll also hear from Dr. Neal Lesh, Dimagi's Chief Strategy Officer about why he joined Dimagi and the role Dimagi has played in the mobile health and digital health space over the last 2 decades. 

And we'll explore how Dimagi's culture has evolved in the last 20 years as the company has grown. 

Learn about the very earliest days of Dimagi from our co-founders, Dr. Vikram Kumar and Jonathan Jackson. You'll learn:

Who Dimagi's founders are and what drives them

How the founders met

How they came to focus on the problem of improving healthcare with digital technology

What Dimagi's first project was like and why Dimagi ultimately decided to walk away from it

How design under the mango tree became a core ethos

The genesis of Dimagi's focus on creating value for the end user