Global good partners in profile: Taylor Downs, OpenFn
Each quarter, Digital Square shines the spotlight on global goods and innovators in our community through our Global Goods Community Newsletter. Taylor Downs is the Head of Products at OpenFN, whose mission is to increase the efficiency and effectiveness of public health and humanitarian interventions around the world. Taylor oversees product strategy and development and is responsible for the long-term sustainability of the solutions that OpenFN provides for the “technology for development” sector.
Tell us about your background and how your career has evolved to bring you into the global digital health sector.
In 2008, I’d just taken the medical college admissions test and started a year-long internship with an HIV-prevention NGO based in South Africa. I was interested in gaining some practical public health experience before coming back to the United States for medical school. About nine months into that year, I’d fallen in love with public health, binned my medical school application, and accepted a full-time job with Grassroot Soccer, doing facilitation, training, and curriculum development. Over the next three years, I worked in about a dozen countries, mostly in Southern and Eastern Africa, providing support to local partners as they adapted/localized our curriculum and helping put in place the monitoring and evaluation systems that would enable them to measure the effectiveness of their work.
Many of our partners were spending huge amounts of time and money collecting data that never fed back into their programs. It was not only a waste but a missed opportunity to make these interventions more effective. At Grassroot Soccer, we started building out a custom implementation of Salesforce that allowed us to track programmatic outcomes and create automated feedback loops to bring these data to life and start showing people, across the network of partners, the performance of their interventions.
Other NGOs in the public health space soon wanted us to build similar systems for them. Within the year, Karti Subramanian, Zak Kaufman, and I had started a company called Vera Solutions to do just that. Vera has now built data systems and helped to create cultures of performance and data-driven decision-making for more than 350 different organizations.
I served as CEO of Vera for its first four years, and during that time we found that more and more of our implementations required sophisticated integrations with existing systems and cross-technology workflows. By the fall of 2014, I’d shifted a lot of my focus to this “integration problem” and by 2015 that work (which began as internal tooling to save time and money across our consulting engagements) became the first incarnation of the OpenFn integration platform. Save a short sabbatical to study technology policy and its impact on wealth inequality, I’ve worked on data integration, business processing modelling & automation, and interoperability ever since.
While OpenFn is used by organizations working on a variety of issues, from poverty alleviation via agriculture to wildlife conservation, our primary focus is on health and humanitarian interventions at the iNGO and national government level.
What excites you most about the digital health space?
Health is not only fundamental but also a catalytic investment. I’m excited about the large-scale change that targets structural inequality—the kind of durable injustices that are baked into systems of debt, fiscal sovereignty, and international monopolies on violence. Ultimately, those changes can only come about if we provide more people with more quality life years—free from the pressures of disease and malnutrition—so that they can create the conversations, political projects, and transnational movements that will lead to larger, systemic change. Given my own positionality, I may not be the one to lead those movements, but I feel that I can support them by strengthening the health and humanitarian systems that enable their success.
Beyond that, on a more day-to-day basis, the digital health space is exciting because it’s technologically diverse, and practitioners really understand the importance of integration. We’ve found that ministries, iNGOs, and even funders are more willing to invest in secure, stable, scalable data integration in health than they are in other areas. My guess is that in the health sector, it’s easier to quantify the cost of bad data. Human error in cumbersome export/import processes, delays in manual cross-agency referrals, or even security issues related to system administrators inadvertently accessing patient data can have both immediate and far-reaching adverse effects on patient health and trust in the healthcare system itself. This means that, right from the start, implementers are considering how their technologies will work together, how they will tie into existing systems, and how they will reduce the risk of errors or delays across the ecosystem. For someone who gets fired up about efficiency, it makes digital health an incredible space to work in.
How has your work evolved during the COVID-19 pandemic?
We’ve seen our work change in a number of ways during the COVID-19 pandemic, beyond learning to work with each other and our clients purely remotely. A number of existing clients have had to extend their systems to handle COVID case tracking and make significant updates to their OpenFn implementations to handle the new features. We’ve also engaged with many more NGOs and government ministries as they try to tie in case-tracking and vaccine-tracking systems into their existing workflows. There are a host of new technologies that are coming onto the market and we’ve seen that an effective COVID-19 response requires tight integration across a number of different systems.
A final area in which our work has expanded quite significantly is in business process modelling. During emergencies, I sometimes feel as though people are reaching for technological solutions to processes that haven’t been properly designed. Yes, data sharing agreements or referral processes can always be operationalized/automated by the platform, but in the last 18 months I’ve noticed that our products and processes have helped organizations in a big way by facilitating that data flow design and memorialization work.
How has your work been impacted by the support of Digital Square?
Digital Square has been hugely supportive of our open source initiatives. OpenFn has an “open core” business model which combines SaaS revenue from our proprietary iPaaS with a huge collection of completely free and open source technologies—the Open Source Integration Toolkit—and provides our users with the flexibility to move on or off iPaaS as their needs change. Part of the Open Source Integration Toolkit is OpenFn/Microservice, the server-only technology that allows an OpenFn platform user to run a full OpenFn project on nothing but free and open-source software. Digital Square took that from a basic prototype to a product with documentation, reference implementations, and Instant OpenHIE compatibility.
Beyond their work with Microservice via the shelf-readiness grant, the whole team at Digital Square has been willing to engage with and support OpenFn in so many ways, helping to advise on everything from open-source community development to sustainability planning across our products.
How do you think Digital Square is helping to bring together the global good communities?
Digital Square’s role as a convener is crucial. I’ve been working in the ICT4D sector since 2008 and focusing on data integration since 2014. Frankly, at times, it has felt like a disjointed space. It may be because there’s a legitimate diversity of needs, it may be because outcomes are harder to measure, or it may be because customers don’t talk to one another enough. Whatever the cause, it has meant that there are a ton of diverse technologies, and—you guessed it—they often don’t play nicely together. In a way, I see the role of organizations like Digital Square as enabling higher quality interoperability because so much of the heavy lifting involved in making technologies work together revolves around getting people together, developing shared language and understanding, and finding alignment among differing political goals. The Digital Square community strengthens communication and collaboration across the sector. Without those things, integration projects are very hard.
How will COVID-19 impact the digital health sector over the next five years? How do you generally see the digital health sector evolving over the next five years?
I don’t know, but I’m equal parts hopeful and concerned. First, for the hopeful bit, COVID-19 has made plain the precarity in which so many people live. It has shone a light on the problems of austerity and wealth inequality, not just “absolute” poverty. When the world was asked to lockdown, the rich ordered groceries from Amazon, did knowledge production work from home, and took up “COVID-hobbies”. The poor went back out into the streets as they do everyday, hoping to find work and earn enough money to eat that night. Over the last 18 months, it’s become easier to see that this system we’ve built doesn’t work. Altruism aside, more and more rich people are realizing that a system like this doesn’t serve them well! (Among other things, it has contributed to the second, third, and fourth waves). It’s sad that it took a global pandemic to raise awareness, but I think that in a post-COVID world we’ll see increased spending on public health and related re-distributive interventions. We’ll see more investment in digital public health infrastructure and in the systems and data standards that allow countries to work together to battle the spread of disease, rollout vaccines, and provide health and human services.
On the other hand, I’m worried about privacy. During the pandemic, there were massive land-grabs in the data privacy space. Extraordinary powers of surveillance, granted during an emergency, become quickly normalized and I’m not certain that we’re prepared to handle the long-term implications. It will take a long time for us, as a global community of citizens, technologists, and policymakers, to help determine and establish new norms and rights around digital privacy. Infectious disease outbreaks present a tricky dilemma; how we balance our individual rights to privacy with others’ rights to health in a global community needs careful consideration and, above all else, active and informed participation from the public.
What are some of your other interest areas?
I spent my time off from OpenFn looking at the relationship between existential threat language and deregulation in state-level artificial intelligence policy. I am a supporter of initiatives that help build a ground-level understanding of and engagement with technology policy. Check out the work coming out of Digital Grassroots or the Ada Lovelace Institute, or from Grassroot Technology.
Apart from technology, I like to spend as much time outside as possible! I think most folks who sit in front of a computer probably say something like this, but living on the coast in South Africa and India helped me fall in love with the ocean. I get out in the water whenever the opportunity arises, and this summer I was able to spend most weekends hiking and camping.