Making good on the promise of digital: The growth of Digital Square
By Skye Gilbert, Alice Liu, and Amanda BenDor
This article was originally posted on PATH.org
Imagine this: your community is threatened with a disease that kills one of every two people infected. You hear rumors about new cases that seem to be drawing closer to your neighborhood, but official reports disagree. You see international groups coming in to help. But they won’t let you bury your loved ones. They say they must “track” you with their mobile phones since you were at an event with someone who was exposed. How do you know that your local health facility is equipped to handle this disease or that health workers know the proper treatment? What information do you trust?
This isn’t a world we have to imagine. This was a reality for hundreds of thousands of people in Sierra Leone, Guinea, and Liberia during the 2014–2015 West Africa Ebola outbreak. It is still the daily reality of communities in eastern Democratic Republic of Congo. More than 10,000 people lost their lives in 2014–2015, many of whom were health workers who fell ill while serving their communities. This epidemic taught the global health sector many hard lessons—it was one of the first times the global community leaned on the promise of digital tools and realized its failure to deliver on that promise.
Digital Square was born from this outbreak. A global initiative designed to connect health leaders with the resources necessary for digital transformation, Digital Square is dedicated to ensuring that the promise of digital health reaches the most marginalized communities. When health systems are successfully digitalized, governments, health workers, and outbreak response efforts are better equipped with comprehensive sources of data, rather than fragmented sources. As a result, responses to disease outbreaks can make better use of data and routine health services can be strengthened. Health systems can build trust with their communities and connect individuals to better quality services more quickly.
In the three years since Digital Square launched, we have brought together investors, innovators, and government leaders, working collectively on country digital transformation efforts. We have identified investment opportunities for donors, strengthened the use of global standards, and created new connections between country leaders and resources that support their national digital health strategies. At its core, Digital Square is about creating a community—one that intentionally designs, funds, and uses digital tools and approaches to improve health care.
“Digital Square funds critical software development that no one else is willing to fund. It’s been game-changing for the digital health community.”
Regional & Country Systems
Governments are leading digital transformation of health care systems at regional, national, and sub-national levels. Long-term sustainability requires new skillsets within health systems. Digital Square works with national and regional leaders to enhance these skill sets. In our first three years, we have connected five investors to peer learning networks like the Asia eHealth Information Network and the African Alliance of Digital Health Networks. Through the African Alliance, we have supported the Digital Health Leadership Program, which develops the technical capacity to manage and direct in-country digital health programs and investments. We have utilized the work of the Joint Learning Network for Universal Health Coverage to ensure country voices inform the development of software products. We have also worked directly with government leaders in multiple countries on digital health initiatives.
Global Goods
You can’t talk about digital health without talking about software. In the health sector, software can range from a simple text message system for a community health worker, all the way to a country-wide enterprise system used to manage a country’s health data. Digital Square is committed to supporting a selection of high-quality, open source software that gives countries affordable, quality options that meet their needs. Known as digital health global goods—or “global goods” for short—these tools are a key component to making digital health more equitable.
To date, Digital Square has provided funding to 20 of these digital health “global goods”—totaling more than US$13 million. These 20 global goods support health services in more than 70 countries around the world. Investments from Digital Square allow for the core functionality of the software to be maintained and improved, as well as for the communities around these tools to flourish. We encourage collaboration and transparency among global goods by supporting interoperability. Interoperable global goods work together through technology solutions like APIs and global standards that guide how data is shared between systems. By the end of 2020, we expect 15 of these digital health innovations will be interoperable with each other—enabling a more comprehensive system of digital tools for countries to use.
In addition to providing financial resources, we support global goods in other ways. This year, we launched version 1 of the Global Goods Guidebook. The first resource of its kind, the Guidebook provides information about the software Digital Square has invested in and how they support health systems. Investors and countries now have a single reference to learn about these tools. We also work with global good developers and implementers to identify new donors and build a community of practitioners that can learn and grow together.
Co-Investment
Digital Square started with one donor and $5 million. Over the last three years, we have committed ourselves to understanding the priorities, requirements, and interests of investors in order to create flexible, thoughtful ways of connecting investors together.
In parallel, investors recognized the need for increased coordination and alignment in digital health, and in October 2018, launched the Principles of Donor Alignment for Digital Health. The principles include important tenets such as committing to collectively support country-developed digital transformation strategies.
Digital Square provides a way for donors to coordinate investments and align to these principles. Whether direct investment, coordinated investment, or pooled procurement, Digital Square’s flexibility across different types of funding vehicles allows donors with different rules, regulations, and operational requirements to work together despite those differences.
Today, Digital Square has 14 investors and has catalyzed more than $35 million of investments for digital health.
“Digital Square gives me access to great technical talent, high-quality digital products and services, and a cost-effective way to co-create and fund activities with others.”
Better together.
The success of the Digital Square initiative is, at the end of the day, the success of our partners. In the last three years, we have seen increased interoperability of tools, greater uptake of software and data standards, and focused investments into the most promising activities. The momentum building in the community will continue to drive the success of the digital health sector to accomplish more and have greater impact on the health of communities.
There is always more work to do. Digital Square continues to bring new donors on board and create new mechanisms for investment that encourage collaboration and increase our collective impact. We are identifying global goods that meet the health systems needs of countries, and we continue to support those countries to enhance their capacity to manage and expand these systems.
We came from a world where fragmented systems made a complex outbreak response even more complex—where digital tools created silos instead of insights. Learning from this past, countries and their global supporters are digitalizing systems in a more comprehensive, strategic way. Today, the Democratic Republic of Congo is fighting Ebola with improved digital coordination in its Emergency Operations Center, and Digital Square continues its mission to help connect the world for better health.