How Co-Investment Sparks Collaboration

By Amanda BenDor

People often think of innovation in digital health as a new device or tool. But innovation most often doesn’t materialize into an object that one can ever touch or feel. Whether it be approaches to scale or investment models, the real innovations in digital health are the approaches taken to navigate hurdles to help countries appropriately harness digital systems and tools to improve health outcomes. Digital Square fully embraces all kinds of innovation in the digital health space. We are at our core, an innovative investment mechanism, supported by a growing consortium of donors; something very unique in the global health ecosystem.

Virtual collaboration with an emphasis on transparency

Coordinating investments in a dynamic, fast-paced space like digital health requires innovation and flexibility. Digital Square offers a unique approach to investment coordination. Several times a year, Digital Square holds an open call for proposals whereby organizations can submit concept notes for new global goods investments using an Open Proposal Process via an online platform. This platform enables users to post their ideas in an open forum, and seek input and feedback from the community to refine the concept or broaden their consortium for implementation while they develop their concept note into a submitted proposal. The very open process also builds the community around global goods while reducing redundancy and duplication of effort. An expert Peer Review Committee (PRC) reviews global goods proposals according to technical and programmatic criteria and makes recommendations to the Digital Square Governing Board for investment.  

Transparent and proposal are two words that don’t normally go together, but at Digital Square, we are shaking up how the digital health space normally does business. In fact, the Digital Square Open Proposal Process is a paradigm shift in how to engage implementers, funders, and users of digital health systems and tools.  Innovative ideas and creative solutions to harnessing digital tools are often held close to the chest of implementing organizations and are rarely openly discussed with donors. Digital Square encourages more transparency in this space, believing that if we improve our collaboration and coordination, we will reduce duplication and increase efficiencies in the global goods deployed for use in low- and middle-income countries.

Implementing organizations have begun embracing this novel approach and recognizing the value of obtaining feedback from their peers. The African Proverb, “If you want to go fast, go alone.  If you want to go far, go together,” is realized through this process, with the understanding that it takes a community to advance the complexities of digital health software development, user engagement, and system deployment.

There are currently seventeen global goods receiving funding from Digital Square to support activities in core software development,  the enabling environment, or applications. Jembi is among those partners, who have participated in the open proposal process and been successful in securing approval and funding for their applications.

"Jembi is an enthusiastic participant and beneficiary of the Digital Square program and see a great deal of value in the collaborative, co-creation process,” Dr Chris Seebregts, Founder and CEO of Jembi Health Systems NPC.  “We are seeing the creation of substantial value for low-resource countries through development and adoption of open source global goods and expect this to grow in the future as other funders and contributors follow this lead."

Co-investment approaches

The mechanism of Digital Square allows for multiple donors to buy-in to the project, thus Digital Square is poised to advocate on the behalf of a multitude of partners. At Digital Square, we work with these potential donors to highlight the needs in the digital health ecosystem by using the global good proposal content as a way for donors to see the needs across the space and avoid duplicate investments. While not intentional, duplication and inefficiencies in funding digital health has been a major barrier. By setting up a publicly accessible Open Proposal Process  reviewed and vetted by the PRC and Digital Square Governing Board, which includes investors in digital health, we are showing investors the needs in this space and providing a venue for greater donor coordination.

Digital Square takes several other approaches to facilitate co-investment in global goods.  

  • We spend a lot of time helping donors understand the digital health landscape and the health systems disease of “pilotitis”. Through these accelerated advocacy efforts,we work with donors to shift their thinking in how they traditionally fund digital tools towards a more holistic approach of digital tool investments.

  • Digital Square also helps investors understand their priorities and interests, and then aligns these preferences with identified needs in the ecosystem.

  • To gain a broader understanding of the needs in the global good space, Digital Square is internally mapping the gaps and capacity-building efforts to further ensure that the highest needs are prioritized.

Another co-investment strategy is to leverage other partner resources to fund global good work. One example is with the Digital Impact Alliance (DIAL), who recently co-invested in a proposal submitted through Notice B to support OpenCRVS, an open source civil registration and vital statistics project. Digital Square approved to support the health information system portion of work, while DIAL is providing resources to support the core platform development. DIAL is one of the growing number of co-investors collaborating with Digital Square.

"At DIAL, we work hard to increase the reach and maturity of technology used in the international development & humanitarian sectors. One of the ways we do this is by advocating for more collaborative, targeted and sustainable funding. That’s why we’re so excited about the role Digital Square is playing in digital health. DIAL is pleased to join a growing field of donors to help both increase the amount of co-investment in digital health solutions and better leverage these investments as common resources that projects can use to collaborate and further their important work,” says Jake Watson, Senior Director, Platforms & Services, Digital Impact Alliance at United Nations Foundation.

Digital Square also supports global good implementers funded through the project by offering a basket of services to augment their implementations. These include community coordination, strategic communications workshops, and quality assurance support. We look to find economies of scale across multiple global goods to facilitate smarter investments. We also work to support the development of standards for interoperability to show common needs across multiple health verticals for data exchange. Many global goods face the same data exchange challenges. Digital Square works through standards development to identify common solutions to data exchange and other challenges for all implementers.

Challenges to Co-Investment

Even with the best intentions and herculean efforts of Digital Square, challenges remain. Probably the most obvious is the lack of available resources and the huge gap in funding needed to support global goods for health. Where resources are available, fiscal requirements from different funding streams funnel to Digital Square and the global good implementers we support, requiring global good support to be flexible, agile, and adaptable.

When Digital Square releases a call for proposals, we are not always able to say which specific donor regulations will have to be followed in the award implementation stage. This is because throughout a Notice cycle, we are constantly fundraising. It is not until we have all of the submitted proposals on the table that the Governing Board is able to make decisions on approved investments. We greatly value transparency, but we do face challenges in communicating donor requirements with partners when we do not know the funding requirements at the beginning of a notice process.

A final notable challenge is that a lot of investor money is tied up in specific country implementation work. Through Digital Square, we are trying to close the funding gap for global goods core software development and support to improve the enabling environment. Most mission driven investments in digital health do not allocate funding for these necessary efforts, but rather prioritize scaling that particular global good in one country. Again, through our advocacy efforts, we are hoping donors will see that by investing in the core software, they are impacting and accelerating deployment at the country-level with a much firmer ground for sustainability.

Digital Square matters

Digital Square cultivates an efficient, fair, and open marketplace of digital health solutions innovations by building on what works. We are committed to supporting investments for interoperable, adaptable digital health tools with the highest potential for success. By facilitating coordination and collaboration with partners, donors, and other stakeholders, we are helping to maximize the impact of every dollar spent in digital technologies. Through our unique Open Proposal Process, and engagement with donors and investors, we gain insight into the most promising tools and approaches, and accelerate collaboration in the development of critical digital health tools.  

Notice D will launch early next year. We encourage any and all global good implementers, stakeholders, and champions to participate. You can get involved in the vibrant global digital health community by submitting a concept note for an idea or giving feedback on the ideas posted to the Open Proposal Site.