In a recent episode of High Impact Growth, Dimagi staff delved into the challenges and opportunities in the evolving digital health market. This discussion highlights the complexities of building impactful ICT4D tools today, when donors increasingly expect free custom-built software solutions.
From procurement challenges to shifting market dynamics, the conversation posed a key question: How can the sector move toward a sustainable, user-centered model for digital health?
Donors Struggle to Buy Digital Health Solutions
Dr. Kelly Collins, fresh from the World Health Assembly, set the tone by addressing a fundamental disconnect: the global health community often struggles to procure software effectively. Unlike physical commodities such as diagnostics or medical equipment, software is perceived as something that can be custom-built or acquired for free, rather than as a scalable, reliable product. Free software is a costly business.
This perception undermines the potential for impactful, sustainable software solutions. As Kelly explained, software requires significant investment not only in development but also in maintenance, security, and user support. Without a shift in understanding, the market risks perpetuating inefficiencies and missed opportunities for innovation.
Kelly’s call to action was clear: “We need to teach the market to buy software as a commodity.” This shift would enable organizations to focus on creating products that are indispensable to users, rather than perpetually chasing donor funding. To achieve this, developers and implementers must center their work on solving real problems for users, prioritizing value over compliance with donor-driven metrics.
Gillian Javetski echoed this sentiment, highlighting the increasing importance of security in digital health. As the only SOC 2-certified global good in its category, Dimagi’s CommCare sets a standard for protecting user data. Gillian emphasized that robust security isn’t a luxury—it’s a necessity that must be baked into any software used in global health.
Challenges in Digital Health Market Dynamics
Despite progress, the digital health market remains fraught with challenges. Jonathan Jackson described a paradox: while the need for scalable, off-the-shelf solutions is clear, procurement processes still favor custom-built tools, often at the expense of long-term sustainability. Governments and donors hesitate to invest in proprietary solutions, fearing vendor lock-in. Yet, this resistance prevents the market from maturing, leaving many tools underfunded and unsustainable.
Kelly and Gillian noted another critical tension: the growing emphasis on localization. With organizations like USAID directing more funding to local partners, the need for cost-effective, scalable tools is greater than ever. However, security requirements and other market demands are driving up costs. Balancing these opposing forces—lower budgets with higher expectations—remains a significant hurdle.
While donor funding has been instrumental in jump starting many ICT4D initiatives, it has also shaped the market in ways that are not always beneficial. By prioritizing compliance and short-term impact over long-term sustainability, donors risk creating “false markets” that fail to deliver lasting value.
Kelly argued for a paradigm shift: rather than designing for donors, organizations should focus on building products that users are willing to pay for, even at a small scale. This user-centered approach would drive more meaningful outcomes and reduce dependency on external funding. It’s a bold vision, but one that Kelly believes is essential for the future of ICT4D.
Opportunity Cost of Building Bespoke Solutions
Another recurring theme was the opportunity cost of building custom software in-house. While the appeal of creating tailored solutions is understandable, the long-term costs—both financial and operational—can be prohibitive. Jonathan pointed out that building software is not just about the initial deployment; it’s about maintaining and improving it over time. For many organizations, these resources could be better spent addressing unsolved problems or scaling proven solutions.
Gillian added that Dimagi’s SaaS model exemplifies how centralized platforms can provide secure, scalable solutions while freeing up resources for other priorities. By focusing on areas like data security and user experience, SaaS tools allow organizations to achieve more with less, reducing duplication and improving outcomes.
The conversation also highlighted the need for a cultural shift within ICT4D. Kelly described how her team is adopting a product-first mentality, focusing on solving one problem at a time and iterating based on user feedback. This incremental approach contrasts sharply with the traditional model of deploying large, monolithic systems that often fail to deliver sustained value.
Similarly, Jonathan shared insights from Dimagi’s work on CommCare Connect, a platform designed to enable community health workers to take on paid, purposeful work. By prioritizing user needs and leveraging initial funding from the Steel Foundation for Hope, Dimagi is building a product that can scale organically, independent of donor-driven pressures.
Key Takeaways for ICT4D Practitioners
- Awareness Creates Choice: The first step to change is recognizing the limitations of the current system. Donors and implementers must be candid about how funding influences product development and actively seek alternative approaches. This includes advocating for market-driven procurement processes that prioritize long-term value over short-term compliance.
- Practice Creates Capacity: Moving toward a sustainable model requires practice and experimentation. Developers should focus on solving clearly defined user problems and iteratively improving their solutions. For implementers, this means treating software as a commodity, investing in tools that are secure, scalable, and well-supported.
- Collaboration Creates Progress: The ICT4D community must work together to build on existing solutions rather than reinventing the wheel. By pooling resources and expertise, organizations can create differentiated value while avoiding the pitfalls of fragmentation and redundancy.
A New View for Digital Health Solutions
As the episode concluded, the panelists reflected on the opportunities for growth in ICT4D for global healthcare.
- Gillian underscored the importance of educating the market on data security and the true costs of building and maintaining software.
- Kelly emphasized the need to listen to users and let their problems—not donor expectations—drive product development.
- Jonathan highlighted the value of hybrid models that balance donor funding with market-driven strategies, enabling organizations to scale sustainably.
For practitioners in global health and development, the message is clear: the status quo isn’t enough. To create lasting impact, the sector must embrace a user-centered approach, prioritize sustainability, and rethink its relationship with donors. By doing so, ICT4D can unlock its full potential, transforming not just how tools are built, but how they empower communities around the world.
