Digital health in transition: why the Global Goods ecosystem still matters

By: Leah Ekbladh, Executive Director of Digital Square

We are at a pivotal moment in the transformation of digital health. The rapid rise of open software solutions, or global goods, has significantly improved health system efficiency and equity. However, challenges remain sustaining a resilient digital health ecosystem, Digital Square’s new Global Goods Ecosystem Roadmap, funded by the Gates Foundation, offers a way forward for shaping a sustainable future, ensuring that critical digital solutions remain viable, scalable, and impactful.  

The roadmap was developed as Digital Square approached the planned end of its seven-year anchor grant from the Gates Foundation. Around the same time, Digital Square’s cooperative agreement with USAID also came to a close. With the conclusion of these two funding sources for global goods, the release of this roadmap feels especially timely. 

For many of us working in digital health, shifting donor priorities is not a new challenge. In recent years, some bilateral donors have scaled back health and development budgets, placing the sustainability of critical programs at the forefront of conversation. Although philanthropic organizations have stepped in to bridge some of the gaps, even their increased contributions haven’t been enough to fully offset these losses. These funding constraints are testing the limits of traditional models of donor support—forcing us to reconsider how we can secure and sustain digital health ecosystems.  

This Ecosystem Roadmap identifies five persistent deficits in sustaining global good—gaps in funding, sector misalignment, not maximizing strong host country capacity, end-user needs, and a need for metrics. It builds on years of insights and firsthand experience from our partners, offering concrete recommendations to sustain the strong foundation established over nearly a decade. These include alternative funding models, development of strong metrics, and increased investment in host country innovation and entrepreneurship. Equally important, it envisions a future where the global goods ecosystem thrives: governments lead, funders align, and tools are built not just to launch, but to last. 

Looking to the future 

This roadmap is not just a reflection of the past; it is a blueprint for the future. Shifts in donor funding and evolving global health priorities reinforce the urgency of the recommendations in this roadmap. While the landscape may be changing, the need for digital public infrastructure that is open, adaptable, and sustainable is greater than ever. 

Digital Square is proud of the work embodied in this roadmap and deeply grateful to the community that helped shape it. In particular, we want to acknowledge our partners at the Gates Foundation, whose visionary and pragmatic leadership has been instrumental. Their commitment to global goods has profoundly shaped how countries implement digital strategies and develop digital tools that promote health equity. That legacy continues to guide us. 

We urge the digital health community to use this roadmap as both a resource and a call to action. Now is the time to actively build, fund, and strengthen digital systems that can deliver sustainable, meaningful health impact for everyone.