New Executive Director Bilal Mateen on challenges and opportunities in digital health
By: Laura Kallen, Digital Square Communications Officer
Last month, we welcomed Digital Square’s new Executive Director, Dr. Bilal A. Mateen. Bilal joins us from the Wellcome Trust, one of the world's largest philanthropic foundations, where he helped build out their digital technology funding portfolio. He also has a background as a medical doctor, academic, and is an energetic thought leader in the digital health space.
To get to know Bilal and his vision for Digital Square, I sat down with him to ask a few questions.
Q: First, tell us about you. What's your background? How did you end up at Digital Square?
My journey to this role did not start with the ambition of becoming a digital health technologist.
First, I went to medical school. Alongside my medical school training, I fell into the world of academia around informatics and machine learning for health. I was learning to be a doctor whilst learning to write code and figure out how you could create digital tools or software-based technologies to help solve health problems.
After medical school, in my first couple years of practice, I realized that treating one person at a time—whilst incredibly rewarding because of the proximity to and immediacy of the impact you can have—didn't scratch an itch I had to do things at scale. I was willing to sacrifice that proximity to think about how you change systems. How do you build technology that can service the needs of millions, rather than trying to do it for one person at a time?
So, I brought together my clinical and academic skills and spent the last several years at the Wellcome Trust. I did a lot of thinking about how you leverage digital tools and technology to support critical health challenges, but I was also yearning for more direct implementation. I think that yearning is a big part of why I ended up at Digital Square.
Q: Why are you passionate about digital health?
I am passionate about digital health because we will not service the needs of everyone on this planet doing things the way we have for the last 100 years. The ways we provide health care will need to evolve because there are not enough medical professionals to service needs for physical health, mental health, and everything else. Through digital health, there is the opportunity to leverage technologies to do what we haven't been able to before—and to potentially do it even better.
But we also need to be careful. There is a real risk that, in our desire to make sure that we are achieving ambitions like UHC and the SDGs, we could allow tools and technologies that aren't fit for purpose to hit the market. We need to strike a balance of making sure we’re choosing mature products, localizing them so they are appropriate for the context, and then monitoring and evaluating their impact. If we can demonstrate sustained impact, we can also build a business case for sustainable financing. It is hard to convince people to maintain digital public goods, but one of the most effective ways is showing them the benefits at the level of human morbidity and mortality, not just efficiency gains.
Bilal (second from left) brainstorms with Digital Square colleagues using sticky notes during his first week. Photo: Bilal Mateen
Q: What are the biggest challenges in the digital health ecosystem right now?
We need an entity like Digital Square because countries have fragmented digital ecosystems. Whilst a lot of progress is being made, we still have ineffective procurement processes and a lack of capacity at the local level. So, I think the first challenge is that Digital Square and our partners need to keep up the momentum and help donors realize there is a lot more investment necessary to get countries to a place in which they have intentional and robust digital health strategies. It’s not yet time for us to move on to the next “shiny object” in the digital health space—emerging technologies such as artificial intelligence, or AI—which is often the risk I see. And it’s a conundrum because I do see opportunities for AI. We just need to ensure we lay the foundation of a digital health ecosystem first.
The impact of climate change on global health is another big challenge. Climate change has the potential to shape health and healthcare in major ways, such as shifting disease burdens, climate-caused disruptions, and mass migration.
We will also likely see another disease with pandemic potential in the near future. Have we applied what we learned from COVID-19 to ensure the digital health ecosystem is in a better place than it was before the pandemic?
For all these challenges, digital health is and will be critical. For example, too many countries lack an effective civil registration and vital statistics (CRVS) system to capture mortality data. In such situations, you do not know who is dying of what. Without that data, you cannot understand how effective your health system is, and you cannot make informed decisions. At the core of that problem is building an effective CRVS system, but you also need to link it up to your information architecture, train people on how to use it, and build policies to support it.
Q: What excites you the most about Digital Square?
Digital Square is uniquely positioned around market shaping. There are very few entities out there that make it their mission and entire job to figure out how mature an ecosystem is and build a strategy around it, and that's what I think Digital Square has done with building an ecosystem of choice for global goods. By finding the global goods that are the most mature, we can then build a business case around their sustainable financing so that we can support countries with implementation.
I'm excited about how we take the ambition of shaping digital health markets and ask ourselves—what is the next emerging market for which we need to be one step ahead of the curve?
In the AI space, for example, we will need a robust regulatory system for these technologies to reach the bedside and have an impact on patient care. We need an enabling ecosystem that captures the right data. When we take a tool that was trained on data that was maybe collected in Massachusetts, but you are trying to use it in Tanzania, we need to be able to test whether it works in Tanzania without just assuming it does.
Localization is key. In the vaccine space, prior to COVID-19, the continent of Africa produced less than 1 percent of the vaccines that it consumed despite consuming over 25 percent of the global vaccine supply. This system has essentially made a continent reliant on the rest of the world for a critical health intervention. We risk doing the same for digital health technologies like AI.
Whilst developing digital tools, we need to think about the regulatory systems, manufacturing capability, and technical support capacity that would allow tools to be developed and regulated across Asia, Africa, and Latin America without regularly relying on the rest of the world. There are enough brilliant people in every country that I'm certain that if ministries of health needed support, they should be able to find it locally. The role Digital Square can play as a market-shaping entity is in bringing those folks together, introducing them to the open-source products governments are interested in implementing, and designing a novel business model that allows them to earn a livelihood whilst also supporting the maintenance of the software they're using.
Q: One final question—what book has had the biggest impact on your life?
The Last Lecture by Randy Pausch
The book that has had the greatest impact on me is The Last Lecture by Randy Pausch. He was a professor of computer science at Carnegie Mellon University, where they have a tradition of inviting professors to give a lecture as if it were the last lecture they ever gave. Pausch was dying of pancreatic cancer at the time and passed away about a year after giving the lecture.
The two biggest things I took from the book are, first, the importance of having fun at work. The other piece is the idea of brick walls—which he defines as the obstacles that prevent us from achieving the goals we've set for ourselves.
In my role as the Executive Director at Digital Square, I am sure we’ll face many obstacles, but I couldn’t be more excited to work with you all to address them. We’ve set lofty goals to help advance health equity through digital health and I know that, through teamwork, we can achieve them.
Welcome, Bilal! We look forward to doing great things together.