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🌍 Global Perspectives on Digital Health
A podcast unpacking the stories, insights, and innovation shaping health systems and underserved communities.
🎧 Listen on Apple, Spotify. Watch on YouTube
speaker-0 (00:00)
Welcome. This is the first time this podcast, Global Perspectives on Digital Health podcast has been in person. And I'm so happy to have Patty to be our guinea pig and doing the podcast in person. So welcome Patty. ⁓ This is the podcast ⁓ about ⁓
what we can learn about what it takes to serve underserved communities with tech and not leave people behind from different contexts around the world, particularly low resource settings. And I'm so happy to have you, Patti, on the podcast to share your experiences. You've been in the industry and the ecosystem for so long. You've seen so many cycles of change and what an honor it is to have you. Can you tell us a bit about yourself and what you do, what you care about?
speaker-1 (00:39)
Thanks, Shubz. ⁓ So my name is Patty Mecheal. I am a CEO and co-founder at Health Enabled and a Senior Associate Professor at the Johns Hopkins Bloomberg School of Public Health.
speaker-0 (00:50)
Before we get into it, how has Global Digital Forum been for you?
speaker-1 (00:55)
been
great. ⁓ I mean, I think ever since they moved the forum here to Nairobi last year, I feel like it was it was sort of always the intention to have it move around, but it never quite made it out of Washington DC. And and given everything that's going on in the world right now, we weren't even sure that it would even happen this year. And so it was just really amazing.
that the community rallied around tech change and ⁓ colleagues here in Kenya and in Sub-Saharan Africa to make it happen.
speaker-0 (01:38)
Yep.
And it's the first time I've been here in person. I missed out last year. And we've had Nick from TechChange who is the leader of bringing everyone together through the Global Digital Health Forum. And I think he also talked about these challenges of like, we didn't know after the energy of last year and the change that we've seen. so it's been such an amazing experience.
to be part of the conference. It's been amazing. I've been recording hot takes from people as well. We've done a fail festival there. How did that go for you? You talked about failures. I'm sure we'll talk about that again today. How was that for you? How was talking about... You've done that before as well at previous one, years ago, right?
speaker-1 (02:29)
I have. And actually the concept of the Fail Fest started as a conversation between me and a fellow early mobile phones for development colleague over brunch in New York City in, I think it was like 2009 or 2010. So still again, like early days. And in the early Fail Fest, we would get together in bars in New York City.
And we would kind of take turns over drinks sharing our, you know, small and big failures and our learnings from those failures. And it was, you know, I was at the Earth Institute at Columbia University at the time working with the Millennium Villages Project. We had colleagues at UNICEF that would come out for this ⁓ as well as some of the, you know,
early implementing partners like ComCare and Demagui and those guys. yeah, it was always like a fun event to hear and learn from each other.
speaker-0 (03:41)
Absolutely. ⁓ You've alluded to so many of the things that you've done already, but let's hear more about you and your background and your story. It's so inspiring and fascinating. So Patti, us how you're now CEO of Health Enabled, but you've had such a rich history. Tell us about you.
speaker-1 (04:03)
⁓ Sure, I'm the product of ⁓ immigrants to the United States from Egypt. And I think it's really important to share that story because my dad really wanted to work with computers. ⁓ he had studied agriculture in Egypt, but when he was studying agriculture, he took classes in ⁓ statistics and in computer programming, and he just fell in love.
with computer programming. And so he applied for immigration to any country where he thought he could work with computers. And the United States was the first one to come through. And originally he was supposed to go from New York to Denver and he stayed with some friends in New York and they were just like, no, no, just go look, go look for a job in Manhattan and see, see what happens. And, and on his first day looking for job in New York city,
he got a job in data processing ⁓ and they essentially hired him to like make a project fail. And ⁓ he didn't speak much English and so, and he went in and the irony of ironies is that he made the project succeed and he ended up having just a fantastic career in computer programming in the finance sector in New York. ⁓
went back to Egypt, married my mom. Between me and my younger sister, my mom decided that she did not wanna be a stay at home mom. And so my dad encouraged her to do an associate's degree in computer programming. So she became a computer programmer ⁓ and she had an amazing career in computer programming in the 80s and 90s in the New York finance sector. so I kind of always grew up in this tech,
family. Like we were one of the first families to get like a personal computer in our home. But I was the kid that wanted to you know help people. I was really interested in in human rights, in animal rights. I was an activist ⁓ and kind of had that drive growing up. ⁓ And and even was super into like volunteering. So I did you know I was on the
my town's local rescue squad. was an EMT in high school and, and so was kind of moving down this like pre-med path, medical school path. And, and I had the wonderful fortune of going to Hopkins as an undergrad and discovering public health and just falling in love with the idea that there were these proven, scientifically proven
public health interventions that could save millions of lives, you know, including childhood vaccination, which was already, you know, at that time, this was the mid nineties. I'm going to date myself. And so, and so just don't, don't do the math. ⁓ And so I sort of was like, okay, this is like, this is what I want to do. Like we know.
you know, how to do certain things that will help keep children alive, help keep mothers alive. And, ⁓ and how do I get into this, get into this field? And so, you know, got into international health and, and I've just been kind of looking for ways to apply, you know, science and increasingly over time technology to, you know, this
more collective approach to health and wellbeing.
speaker-0 (08:02)
And we could spend a whole podcast episode talking about all of your experiences. Have you got one story that was really formative for you that made you really have an aha moment that this is how we need to do things or not do things?
speaker-1 (08:20)
Yeah, I mean, think one of the biggest moments when I was in ⁓ my early career, I spent a year in ⁓ in South Sudan helping to rehabilitate a secondary primary health care facility, which used to be a teaching hospital in South Sudan that got bombed out during the Civil War. And ⁓ and when I was there, there was an outbreak of unknown illness.
that was making people ⁓ either die or be left ⁓ severely paralyzed. And this had been going on for, I wanna say about a year before I had arrived. And I engaged a team of young people to do a household survey. And it was the first time that anybody had done a household survey in South Sudan. ⁓
And so we called them the assessment team. And so it was these, you know, young boys who were, you know, basically from age 12 to, I want to say 17, that could speak English and Dinka and could go household to household and do this and do this survey. And we ended up mapping this unknown illness, as well as just collecting, you know, basic
health information to understand what was going on in the community. And that information was used to develop the first country strategy for public health in South Sudan. And so as my first experience of doing like research to policy, and I've done a lot of research to policy work since then, but within
Because we had all of this data and we mapped this unknown illness, we were able to get a team from CDC and WHO to look at the disease patterns and almost immediately identify that it was a lice-borne relapsing fever. And the intervention for addressing relapsing fever was antibiotics, so it was a bacterial infection.
And ⁓ basically like kill the lice. And so the way to kill the lice was to put bedding and clothing out in the sun and you could kill the lice. And so then we wrote a children's book and we were just like, what's gonna be the fastest way to educate families about what they should do if they see this? And so these young people went around and educated families. We went to churches, we went to schools,
⁓ And within months, we were able to contain ⁓ this outbreak. ⁓ so again, was just like data and having data can really help both inform policy as well as real-time response to what's happening in your community.
speaker-0 (11:46)
And I think that's such a key thing to take forward in all the accelerated, shiny, dreamy, technological, AI powered, granular data conversations, right? And, you know, going back to basics around, okay, what's the goal of it? The goal of it is not to have a shiny piece of data infrastructure. It's to inform good, responsive, real time.
accurate ground truth of what's going on so we can understand what's going on and therefore respond in the right way and in a targeted way.
speaker-1 (12:18)
Yep, no, absolutely.
speaker-0 (12:21)
Do you take any other lessons from that? Because obviously the work that you're doing now is tech-facing. So what are the nuggets that you take from the then times to now?
speaker-1 (12:32)
Well,
no, I mean, we did, we did everything by hand and on calculators. we had like, you know, we had calculators to calculate the like disease incidents of different conditions that people reported to us in this, like we surveyed 1100 households and then hand tabulated the results from 1100 households. This was like before.
We had computers in the field before we had cell phones. We got, when I was in South Sudan, we got our first sat phone, like satellite phone, and the calls were so expensive that like you didn't use it. You just kind of like left it in a box and, you know, just appreciated that in case you really needed it, it was there. Um, and we mostly relied on, you know, two way radios, um, to communicate with other people that had, you know,
two-way radios. And so, ⁓ and that was it. And so it was, it wasn't until like, you know, a few years later that I was working for a .com in New York. And while I was there, I was like, ⁓ like, what if we had this technology and could use this technology to ⁓ improve public health programs in, ⁓ in some of the places that I had worked.
in by that time.
speaker-0 (14:01)
So like there's so many things that we could go into on that. ⁓ Even around like, you know, going back to basics of like, when we talk about people missing in data now. And again, a lesson for me that I take away is like, we need to do the work to go out to the communities ⁓ to, I've done a podcast around health data poverty and some work that was going on in Brazil where, okay, well, people are invisible in data. And instead of just saying, we have data availability bias because
know, the data sets of people who invisible are just not available. They actually went out into the rural communities, like, well, let's involve people, let's get their trust, and then let's get them visible in data. And so to me, that's quite a good parallel.
speaker-1 (14:42)
Yeah, and we did, you know, in the early days, even the early days of technology, we did a lot more, you know, ethnographic work, a lot more baseline work to even just understand, you know, where people are in terms of, you know, their health status, etc. so that we could measure and monitor, like the effects of the
early health interventions on health outcomes. that building up those data, it does is a progressive process. takes time. ⁓ But it also takes the intention. Right. So, you know, so like Brazil, I love Brazil. Like Brazil was one of the countries that we studied for the digital health exemplar study. And, you know, and the findings from Brazil are incredible because
You know, they've taken this very pro equity approach to digital health that you don't find in very many places. ⁓ and so it's not like, yes, people are missing. So we'll find workarounds and we'll just, no, people are missing. Let's find them and make sure that they're not missing anymore because it's the right thing to do.
speaker-0 (16:01)
Absolutely
and just in the spirit of this podcast in terms of what we're trying to do in terms of share learning across contexts another model ⁓ That was inspiring from Brazil that I've learned about recently is so Westminster Council in the UK recently Basically deployed a community health worker outreach model that was kind of modeled it from Brazil ⁓ and actually tracked to health outcomes such as improved vaccination rates for kind of certain a target to
communities who you know socially to provide deprived communities people who were in in kind of you know a lot of poverty in these councils and they they saw that it worked in Brazil and they used it here and I was like why are we not talking about that kind of innovation that's also a great you know that's amazing everyone talks about AI I mean that's an incredible thing to be able to take from another context and apply it in and you also you sometimes you think well you know
that context has to learn from the great strong UK health system, right? And actually we can see that there can be learning from both contexts.
speaker-1 (17:06)
Absolutely. feel like, I mean, I often give talks in the U S about what America can learn from countries in sub-Saharan Africa. And just out of necessity, people have innovated to find ways to provide health information and health services in incredibly like resourced constrained communities.
speaker-0 (17:32)
Yep, not just for, I guess, like, operational benefits, which is, you know, it's hard as well. And these are often also like...
in terms of health outcomes, especially in the so-called global north, everyone's like, how do we actually move the needle on health outcomes on some of these digital interventions? But again, yeah, like you said, turning our attention to what's going on in low resource settings where people have to be kind of really scrappy about how, but really laser focus on, well, there's like literally can be no waste here. We really have to be targeted on actual, like, is this moving the needle in the world?
because we don't have many resources. yeah, absolutely. On this, so you talked about that, you alluded to, ⁓ you give talks about what the US can be learning. Have you got any examples of where you've seen, because the US, the UK, the EU, everywhere has places of social deprivation and healthcare deserts.
Do you any examples of where those landings have been taken from a digital perspective and where they can or have been applied?
speaker-1 (18:45)
Sure. mean, even like one of the, I mean, the thing in the United States that kind of kills me a little bit is that, well, not a little bit, a lot actually is that, you know, in most other parts of the world, you know, health is a basic human right. And we all start from that premise, ⁓ in the United States, like health is a business and that makes it really hard to provide, you know, the types of services and, ⁓
that you wanna provide in resource constrained settings and or with vulnerable and hard to reach populations. ⁓ One of the ⁓ reverse innovations that I had the privilege of watching as it was happening was the text to baby kind of innovations where ⁓ learning from
you know, projects like the mama project, the mobile Alliance for maternal action, the United States, you know, implemented a similar program ⁓ using, you know, age and stage based text messaging, building on the baby center model. And, and that was done, you know, in collaboration with the U S ⁓ CDC. ⁓ Some of the smoking cessation.
messaging programs as well ⁓ have been, you know, reverse, like, innovated. And then we've seen similar, you know, to your example about the community health worker program, we've seen, you know, very similar models, like taken from the Millennium Villages project, the community health worker ⁓ efforts there with the mobile phones, with the ⁓ standardized protocols, et cetera, for households.
outreach being implemented in New York City. And so it's really, we have seen those types of reverse innovations that are really exciting and important. And they're the sorts of things that actually provide service and value ⁓ and reach people where they are.
speaker-0 (21:06)
And there's so many examples of digital innovations coming now. And at source, where they have been created, in the context they've been created, they've been built intentionally low cost. So even hardware with software in it, or AI powered hardware, for example. And they've been built at low cost, with the intent for scaling in low resource settings.
And suddenly it becomes quite a compelling business case also. So I've been to conferences where I've seen these innovations developed in low resource settings. I'm like, what are you guys doing here? And they're like, we are selling into healthcare deserts in the EU and the US. I'm like, this is what I'm talking about. This is so powerful and we're only going to see more of it, I think.
speaker-1 (21:55)
Yeah, no, absolutely. And when you're, you know, designing and developing tools in constrained settings, you account for the constraints as part of the design, right? ⁓ And you also account for the local contexts and very diverse populations that you're working with in a very different way than you do when say you're developing technology in a vacuum in say Silicon Valley, in
you know, the United States. And so you're trying to develop and build technology that's going to be as generalizable as you possibly can. At the same time, you may be actually exposing people to unnecessary, like an unintended harm and unnecessary risk. ⁓ And some of the stuff that we're seeing now with, you know, the proliferation of
you know, misinformation, disinformation over social media, et cetera, is really making it difficult for, you know, people, you know, working in public health systems in Senegal, in Kenya, in India to, you know, push this uphill battle, ⁓ against things like, you know, misinformation around
immunization or vaccination and trying to sustain high levels of immunization coverage in their populations.
speaker-0 (23:30)
And you know again, but I think I lost my train of thought. And those the patterns of those types of problems are similar, right? ⁓ And they might, it kind of makes me think about trust and scale, right? And it's come up a lot in the conference. It comes up a lot in every conference.
And people are like, we want scalability. We want this thing to be scaled as soon as possible. Once you've created value locally, how does this go to the next, don't know, scaling up either nationally or it needs to be beyond this context. And everyone's like, OK, rush to scale. And on the other side of the spectrum, it's the conversations about trust and what you talked about with immunizations and communities. And that's also because of distrust. And doing things that build trust.
Involve doing things that don't scale ie Taking the time to listen to people and so, you know to me I struggle with the notion of okay, let's go for scalability ⁓ Which is what everyone's talking about and everyone's also wants trust, but we need to build that local value and trust first Do you have any thoughts or wisdom to share about how we square that circle?
speaker-1 (24:50)
I mean, absolutely. think there are really great examples from FemTech that do this. I was first introduced to feminist theories of technology when I was doing my PhD research on mobile phones and health in Bangladesh and Egypt in like the early 2000s. And a lot of the feminist theories of technology look at some of the key core values that
you know, women prioritize in how we live, but then it gets like built into and designed into technology. And one of the core values of femtech is a safety and privacy first approach. And this is so
critical and what we've seen is that they're now.
quickly building FemTech digital health interventions that are scaling faster than anything we have seen ever before. And it is because they're sort of this safety first, ⁓ privacy first approach and building trust.
as they're developing the technology and rapidly scaling it.
speaker-0 (26:29)
And so I guess is that the safety and privacy like a clear signal in, I guess like the interaction with, I don't know if it's an app or something like that, right? And there's lots of talk about data privacy of apps, et cetera. ⁓ Is that what it is? Is it more than that? ⁓ Is it to do with an interaction of like, hey, trust us, we've baked this into how we're developing and designing. ⁓ We're designing with you. Like, what does that look like?
speaker-1 (26:58)
Yeah, I mean, like we had an example at the forum on the main stage in the opening in one of the opening, you know, AI evaluation sessions on ⁓ on the like MDoc experience and you know, some of what they're doing is taking that approach, but they're also being incredibly transparent about how well the AI algorithm is working, you know, and
And I think that's also incredibly important for building trust is like, Hey, this is like a probabilistic model. Like we know that it's going to work, you know, 80 % of the time, not a hundred percent of the time, you know, and we're going to tell you what we're learning as we're learning it. And people like want to be treated like adults, right? Like they don't want you, you know, ⁓
They want you to appreciate that they can be critical thinkers alongside you in the things that you're exposing them to.
speaker-0 (27:59)
To me, as you're saying that, it feels like such a... Maybe antithesis is too strong. Not everyone is doing smoke and mirrors. But if you look in lots of parts of the world, it's like, this is a game-changing model with like, know, 99 % accuracy. That's been a trend to kind of hype that up for so long, right? And, you know, the way to get there is through checking...
there's lots of massaging of like methodology or et cetera, so that you can have this like shiny PR statement that you want, right? And there's so much noise of that. And I reflect that as you're saying that, I think the signal through that noise that people are looking for is, it's someone who's actually like doing this the right way and gets it and...
is appreciative of the nuance here and not trying to hype this up and recognises that this is a kind of growing field and we're stuck, we're just understanding it and there's a jagged edge of progress and here's where we're doing well, here's where we're still struggling etc and that to me is the signal and it seems like similar to what you're saying.
speaker-1 (29:15)
No, absolutely. I that is the signal you want that there was somebody who posted, you know, something on LinkedIn last year where they reviewed 200, like health AI applications or something like that. And like 3 % of them actually did the thing that they were claiming that they could do.
This is, you know, we're doing, this is, first of all, it's unethical. know, health is, you know, such, like we have to take this kind of safety, do no harm approach. Like when, doctors become doctors, you take this oath, you know, and unfortunately, know, tech providers don't take this oath. know, and, and so they can kind of get away with.
doing this stuff, but without having the ethics and the code of conduct that they should have in order to be developing technology for use for people's health.
speaker-0 (30:22)
Totally. it makes me draw a parallel to, you everyone wants to compare the doctor performance and the LLM performance. We're talking about healthcare, so I'm just using the example of like AI scribes or things like that, right? And just to draw a parallel, right? ⁓ You know, at the moment we're making all these extrapolations based on, basically it was just a medical, like the written multiple choice medical exams that we do. Like that's not what makes a doctor. That's like literally like the first level of gate that you have to go through.
So what we're doing is, oh, it passed this thing, and now we're saying, okay, go and put yourself out in a clinic and say, hey, I'm a doctor and I've got 97 % diagnosed. Does any doctor sell themselves like that? Do we judge our doctors on their, I guess, like, maybe a primary care doctor or something. They don't have things outside their clinic of their accuracy rate. And so there seems to be more to.
what a doctor-patient relationship is than just like this narrow area of work, right? And so we have to remember when we're thinking about the performance and shifting of to certain tasks, and by the way, this is a whole other thing, but yeah, what exactly is good, right? What exactly is, so being correct at a certain definition of correctness is important, but the other aspects are trust, like what is the bedside manner of this doctor? Did they take my lived experience? And so
I think these are also things that engender trust between a patient and a human doctor, but would still apply also to a patient and a robot or an AI-powered ⁓ health tool.
speaker-1 (32:04)
Yeah, yeah, no. And I think what's interesting too is I think a lot of times the things that we think are going to be the things that people like want and need are not necessarily the things that people want to need. And then we're like surprised when we find like certain other things that, you know, have come out. And, know, I remember in the early days of the, you know, mom connect program in South Africa, when the head of the national department of health was like, we're going to, you know,
scale this to every pregnant woman in South Africa. And, you know, I want us to create a ⁓ complaints and compliments like phone line that people can like call in and whatever. And so of course everybody assumes that, you you create this kind of phone line and everybody's going to call in with like lots of complaints because that's human nature. And it was the exact opposite. You know, people were calling in.
with incredible compliments because they were like, I'm getting these messages and I feel like somebody understands my needs. Like before I understand my needs and somebody once described it as like getting a hug, you know, like feeling like they were getting this like hug that somebody really cared about them and their pregnancies and, and that they were commending the nurses in like the clinics. And so then, you know, having this like positive,
like reinforcement of like good experiences and behaviors. know, that's, you know, that was sort of like, ⁓ wow. Like, and anytime anybody like, you know, like I, this year I was a mentor for the women in GovTech challenge. And, you know, everybody wants to set up like the equivalent of 311, the government, like, you know, services complaints line where you can like get your local government to like do
like these services. And so my group was designing one for like Tunisia. And I kept, you know, encouraging them like, do a compliments and complaints line because, you know, you want to like fuel the positive where you can. Because so many, so much of like today's society is like, you know, the amount of hatred that's being spread and the amount of
know, mistrust that there is and misinformation and, um, you know, misogyny and, all of those things is kind of like a bringing everybody down. And so how do we get back into, you know, like compassion and care and bringing, you know, bring the care back into healthcare, right? That's like the whole purpose of like medical
you know, in medicine was to help like heal people and make them feel better and, to care for the sick. ⁓ and how do we start to bring some of those like positive vibes back into, you know, the work that we do.
speaker-0 (35:16)
Patty, that's such an important message, right? In a world where we're focused on economic growth, the whole business cases around AI technologies in healthcare and the whole narrative, the whole sales narrative is around efficiency, productivity, ROI, dollars, which are of course important, But there's this other inherent value of remembering
Well, what if we were like actually inherently, what if we were also optimizing for all of the things you just said? You know, I'm a clinician, right? ⁓ I also experienced a lot of that. I'm not doing the things that I love about medicine anymore. ⁓ so.
what if digital health companies said, on the path to, and by the way, those are the things that will get clinical end user adoption, right? How do we make sure we optimize the experience of delivering healthcare?
Because that will also improve the experience of receiving healthcare from people. And so therefore what tasks are worth outsourcing, right? That bring the joy back, that don't de-skill clinicians, that actually support all the extra things that take away from actually looking at a patient in the eye and say, hey, what's going on with you today? Right? I've got the head space to have an interaction that is...
a high quality, in-depth interaction with what's important to you, right? How do we release the space to do that? That's why a lot of people went into medicine and are just like, yeah, get burnt out because they're not doing that part anymore. They're just like glorified note takers or, hey, I would love to be able to do these extra things to you, but I literally don't have time. There's only one problem per 10 minute or five minute that we have, or sometimes even like, I don't know, in some health systems like 2030.
seconds, optimizing for that and people are like, well, what's the ROI or dollar value? What do we need to like, isn't that just inherently valuable itself is always like my soapbox. But yeah, so you touched on that so important.
speaker-1 (37:32)
Yeah, and I think the ROI will follow. you know, I think I don't, one, I don't think we need a million services. I think we need a handful of services done really well that really meet people's needs in a way that people can really delight in and support health workers to like provide services in the way that like make them feel good about the work that they're doing and the sacrifices that they're making.
to do the work that they're doing. ⁓ It can be a really thankless job to be a health worker. ⁓ I remember in some of the early days ⁓ in mobile health working with some of the ⁓ baby center ⁓ people, and they would say things like, we want pregnant women to delight in their pregnancies.
And I remember hearing the word delight and I was like, wow, like I want to delight. And it was, it sort of coincided with my own pregnancy. And I was like one of the baby center moms in the United States. I was like, I want to delight in my pregnancy. And it was, it was like, they designed this service that, you know, made me excited about what I was learning about my body and the development of, you know, of
you know, what was happening to me physiologically and my pregnancy and my child's development and all of that. And they did it in this like way that was both, you know, educational, entertaining, as well as, you know, ⁓ like medically sound ⁓ and personalized to me, you know, and where I was in my, you know, in my pregnancy. And, and I just loved that. And
And I'm like, why are we not just doing this like with everything that we're doing, you know?
speaker-0 (39:31)
And it's a headspace thing, right? And it's a like, I'm literally only thinking of this as a paradigm of success, because this is like my current pain and problem. so like, how do we extend beyond, okay, there's this other intentional utopia that we could get to instead of just, I guess, like the anti pattern I see is that because FOMO, because once in a generation opportunity, and because no money, we let's
we know everyone's telling us that automation is the solution, right? And let's just put it into everything. And instead of saying, okay, here's what we want healthcare to look like, like that's a great picture that you painted. What type, what changes do we need to make to a system and a delivery of healthcare? And then which of those things and tasks can be removed or
augmented by technology, some of them might be LLM based technology. And then you've got like you're working backwards. And this is something that you've been such a proponent of, which is basically you're describing a kind of a theory of change, right? Can you tell us about that? Because you've been a big proponent of theory of change. And we've talked about it kind of in another podcast as well. But I think that's a good segue into that and being intentional instead of just like shoehorning stuff and hoping for the best.
speaker-1 (40:53)
Yeah, no, I think a lot of times people will start with like the inputs and the outputs in mind and they have a technology that they're pointing at whatever problem it is that they think they're trying to solve for instead of like charting out like the vision, right? Like what, what is the world that you like want and then working your way backwards and then, know, and then really thinking through, like what are the health outcomes that
like I'm interested in achieving. And then what are the health system outcomes? And then what are the, you know, technology related interventions that could, when paired with health interventions, could give me the, you know, either the health system or the health outcomes that I want that are on the path to the vision that I'm trying to achieve.
And a lot of times when you do this sort of theory of change, can like, you know, you may have a very comprehensive theory of change and you may only pick one or two pathways that you are kind of like designing and developing technology for, but you're doing it in a broader, you know, context of the other opportunities that you might have to, you know, extend those services.
speaker-0 (42:15)
fixated
on your consumption.
speaker-1 (42:17)
I guess. know, other either health areas or, you know, other, ⁓ functional areas of, of health service delivery. So it, you know, I think we, we, we need to get back into those things and also into kind of like maximizing measurable outcomes and theories of change, like lend themselves like well to that. ⁓ because then you can, you know,
flesh out indicators and et cetera against the different components of your theory of change to measure and monitor your progress over time.
speaker-0 (42:57)
And I feel that that's really helpful. I've used that with companies that I work with ⁓ or a version of it. And I guess a more scrappy version of it because sometimes people feel really intimidated about a theory of change. ⁓ But actually, it kind of is just like, OK, which direction are we going?
what's measurable and what are the steps to get there. What's in my locus of control. So therefore where are the lever points in the solution I'm building and the system I'm integrating into. So I can focus also all my efforts on these areas. And I've got a dotted line to the broader health outcomes which might take three to five years. And I think that's how people get from.
the things that they struggle with, which is, okay, I've got this model that's got some accuracy, a level of accuracy, which then everyone gets hyped about. But then the second point of what you talked about, is it changing people's behavior? And is it getting engaged with and useful? And so either patient end users or clinician end users are actually using it and finding it useful and behavior is changing. And you've tracked those behaviors to then intermediate points. ⁓
And then those are leading to the health outcomes. And when you say it in that way, people are like, yeah, okay, that totally makes sense. can see how that makes sense.
speaker-1 (44:14)
And it doesn't take much to do it. And then the other ⁓ piece that is very complimentary to that as well is like, the behavioral models. And we don't do enough in terms of integrating like behavioral models as part of the work that we're doing in technology and health, even though a lot of the early work on behavioral models that's driving social media, stickiness and adoption, et cetera.
came from the early days of mHealth and the work of BJ Fogg at Stanford. And the Fogg model is this sort of like nudge model that kind of gets people to, you know, be motivated and take action and change behavior and leads to like sustained adoption of, you know, he had developed it for like healthy, like nutrition and for healthy physical activity and wearable.
technology. ⁓ It's been weaponized in many ways by social media companies in very negative ways to keep our eyeballs stuck to our devices and is what has led to this doom scrolling phenomenon. ⁓ But it's something that as I think a digital health community, we need to re-appropriate and bring back into
like the work that we do in a really intentional way.
speaker-0 (45:45)
Totally. on this bit that we were saying around, you're a digital health company, you just started, you're a startup. You're like, oh, this kind of fits with how I could approach like clinical evaluation and health outcomes, but it feels so intimidating. Like I need to start somewhere. I don't have much budget. I need to be really scrappy here. Like, have you got any advice on how they think about this or how they approach this in a bootstrapped kind of way?
speaker-1 (46:13)
You know, I think we need more collaborations and partnerships. think, you know, I think the, like even the bootstrapping pieces, you know, go out there and get some resources because, like, yes, you can do an early prototype and you can test out what you're doing, but I think for too long, we've been designing with little and getting little.
⁓ And I do think that we need to be looking at new models for financing of innovation and looking at private equity, looking at public-private partnerships.
speaker-0 (46:59)
Do
think though that they are patient enough to, I guess like, be patient for the scale to arrive, which is what we talked about, like the building of trust, that's what we need in this space, right? Do you think public-private partnerships and people who have the financial means to like support this? ⁓
you they need their returns quickly as well. you think they have the patience or do think there people out there who have the patience to kind of make that happen?
speaker-1 (47:29)
I think we're seeing it. I think we're getting to like more realistic conversations about this very thing of like where we have enough, you know, private sector players that have been, you know, multinational private sector players that have been in this for like a long enough period of time where they know that the trajectory is much longer. ⁓ We're seeing more interest in like blended finance between like
private philanthropy in like the early days, but with this like intention to have both an economic return on investment and ⁓ like, you know, health outcomes based business model where people are tracking the health outcomes and health accountable for both. ⁓ And I remember, you know, in a previous life I was ⁓ executive vice president for the personal connected health Alliance.
and the then CEO of Philips, ⁓ know, ⁓ Franz Van Houten was very articulate about, you know, health outcomes based business models that we, know, as a company that had just sold off their, you know, electric, you know, light bulb company and their electronics,
you know, arm and they were doubling down on health tech. And, you know, for him, he was like, if we're going to double down on health tech, we have to be accountable on like the health outcome side alongside, you know, return on investment. And, and I think it is these companies, you know, like the pharma life sciences companies, the health tech companies that are now, you know, partnering with smaller startups. Yep.
you know, knowing that these things take time before you can see, you know, a return on investment.
speaker-0 (49:31)
And the other discussions I've had is that, you know, they're the pros of the kind of private ⁓ influence.
and perhaps like impact investment influence is to move us out of let's bring out the elephant in the room this year after USAID, right? And people are talking about how do you create like viable business entities, right? How do you create, if the health outcomes are gonna take five to 10 years, how do you make sure that that startup is around in five to 10 years and wins in the market, right? To still be around, you know,
what do you think needs to happen there? Do you think ⁓ that that's possible? you impact investors are, at least, I guess my reflection is that there are impact investors out there who are like, hey, yeah, we're putting all the foundations through investing. We're not marking this money to say, hey, you only have to use it for this or this. The investment is in making this thing an economically viable entity.
And so that was at least a reflection that I had got from Rowena Look on a previous podcast. But yeah, I don't know if you have any thoughts on that. And you could also talk about USAID.
speaker-1 (50:47)
Yeah, no, mean, think, you know, overseas development assistance, you know, has skewed the markets, right? You know, it's, you know, particularly for health, you know, where a large chunk of country health budget was coming from, you know, foreign assistance. ⁓ and so for some settings, you know, they're kind of like,
not terribly upset at not having, you know, USAID around in some ways. ⁓ I think how it was done was incredibly like cruel and awful in a way.
speaker-0 (51:29)
Without
a chance to just like put the safety nets in place,
speaker-1 (51:33)
And I feel like there's just this like unconscionable aspect to it of like where has like the human dignity and the like human respect gone? And to me, as an American, it was like incredibly heartbreaking that a country that used to be viewed as sort of like the moral compass of the world
is now like has become this like very hateful, very cruel ⁓ country and done this thing in this like really awful way. And I don't think a lot of Americans fully appreciate how influential the United States is and how influential things that happen in the United States are.
in other places. yeah, I mean, I think, you know, in the end, I feel like we need just a lot more of ⁓ compassionate leadership that can kind of like bring ethics and integrity back into into leadership ⁓ and who we are as a country and how we operate in the world.
speaker-0 (52:49)
⁓ and on the ethics part. At this conference, at all conferences, everyone's talking about responsible AI. Everyone's talking about responsible ⁓ implementation of digital health tools. ⁓ Ultimately, having worked in a digital health company,
you know, all talk about policy and regulation and kind of ethical and responsible AI. Kind of also, you know, seeing this at the level of ⁓ a developer who's making everyday product decisions and trading off between, the revenue thing to do, the thing that's going to bring in revenue versus, hey, we need to do these things that like drive inclusivity and access and making sure we do the hard yards for trust and making sure we.
you know, designing for accessibility, et cetera. Those are harder things. They take longer. They affect shipping timelines. And so people have good intentions. But what I've observed is that the market and procurement are prioritizing and creating selection pressures for other things like safe costs immediately. Those are the signals in the market. Those are the selection pressures. And so
What do you see as what needs to happen to create the selection pressure so that people who do take the effort to do that and make those decisions, they have a business case around it. It actually helps them win in the market.
speaker-1 (54:14)
Yeah.
I mean, I people look at the market a little bit in different ways, right? I think there's a dollar and cents market and I think there's a who actually buys and pays for health. Yeah. Um, in most settings it's women. Women are the largest buyers of and decision makers in terms of health services, health products, health apps.
⁓ when you look at who is searching for health information, ⁓ it's generally women and they're doing it on behalf of their families, their parents, their children, ⁓ themselves. And, ⁓ and so, you know, I think the, the market needs to change how it thinks about the market in many ways. ⁓ and I think we do need a lot more.
you know, women in leadership roles. We need a lot more women ⁓ in the data. I think we need a lot more women in the development of technology and all of these things. And I think, you know, women are an important entry point for addressing the digital divide. They're an important entry point for health and wellbeing in general. ⁓ But we're also like the largest consumers of
of technology and some of the health products that are out there. it's ⁓ a huge missed opportunity. I ⁓ think McKinsey estimates it at over like a trillion dollar missed opportunity is this market. ⁓ And employing women and having diverse teams has also
speaker-0 (55:47)
So that's how the market will decide.
speaker-1 (56:10)
⁓ improved the, ⁓ the productivity of companies and the bottom line of companies and has made companies a lot more innovative. And so like, like, why wouldn't you like just, just do that? ⁓ but to do that, you have to create even within organizations, you know, compassionate and caring cultures within organizations. Cause we're seeing a lot of women leaving.
the workforce and silent resignations ⁓ because they're burned out, because they're working in environments that are not like psychologically safe. They're not feeling supported. And so how do we start to redesign kind of like how we think about work and life and the market. And I think when we start to do this, we're going to see some real incredible like things happen.
speaker-0 (57:08)
When is that going to happen, Patti? Because, I mean, what I see in some countries is there's like a shy turning away from this kind of conversation.
speaker-1 (57:20)
I think there is, I think in other places we're starting to see like a huge push for it. ⁓ There was a wonderful interview between Jacinda Ardern and John Stewart recently. And she was talking about how in the acceptance speeches of the prime ministers of Canada, Ireland and Australia, that the words kindness and compassion came out of the words of
men in strong leadership positions. I think people are kind of over the hatred and the lying and the misogyny and all of that. And I think there is going to be this and there is a turning to, and I think it is going to be, you know, I call it mom energy of like, kind of like bringing in these sort of values. ⁓
into leadership, into everyday interactions, being more joyful, you know, just bringing the positivity kind of back in because I think we're all just like at the end of 2025, we're all like tired and burned out and we're all fried.
speaker-0 (58:40)
And what do we do where we want to do that? We just want to go back to mom's house.
speaker-1 (58:43)
Exactly
and eat mom's cooking and you know and get a hug. Get that like that hug that makes you exhale. And I think we all just need we need to do that for ourselves and have kind of like self-compassion and care and we need to do that for each other.
speaker-0 (59:02)
That's such a great ⁓ place to, I mean, I could talk to you for hours, Patti, before we wrap up. couple of, maybe one quick fire question or two. Who's someone that inspires you?
speaker-1 (59:18)
Ooh, I mean, so many people inspire me. Today, I had a wonderful conversation ⁓ with Asiyatu, who used to be at Speak Up Africa and led the African women in digital health. And she is now doing, she has her own ⁓ West African.
speaker-0 (59:20)
The global digital health space. So many people.
speaker-1 (59:43)
nonprofit that is doing community-based innovations. And I think that is the way that we have to go. think we have to like start supporting women on the continent who are stepping up and starting to do things in the way that really brings the community and community voices into the work that they're doing. I can name a million such women. ⁓ But she's one that I just had this conversation with this afternoon and I
Just want to give her a shout out.
speaker-0 (1:00:14)
And maybe two more actually. Your fail festival story and smashing the patriarchy was so awesome. Do you have any other quick failures that you've learned from? Like a big one that you've learned from?
speaker-1 (1:00:27)
⁓ So many big failures. ⁓ I'd say probably, mean one of, ⁓ you know what, come back to me on that one. Like it's so funny because I feel like I'm like scrolling through my Rolodex. Which failure should I, actually no, I have it. ⁓
speaker-0 (1:00:47)
Where do you want me
speaker-1 (1:00:55)
When I was the executive director of the Health Alliance, there was a moment in time where we were ⁓ getting funding to do things that were not what the Alliance was created for and that people were still looking to the Alliance to like continue to like play its role. And so there was this mismatch. And so we're continuing to do the new things alongside the old things. ⁓ And there was a moment in time where
Like I felt like I had to kind of like do it all. And I feel like I was like carrying like the weight of, you know, the organization, the field ⁓ and everything ⁓ at a time when we were also making the strategic decision on whether or not to wind down the ML of Alliance. And I was on a team retreat and I ⁓ had taken on I think a lot of like very
you know, what I thought were like more like masculine leadership characteristics. And I was like, I'm not going to cry in front of my team and I'm going to be the strong one. And, you know, I'm going to be a strong leader and a powerful leader and like all this stuff. And and I couldn't hold it in anymore. And I just like started I was like talking to my team at this retreat and I just like started crying and and
And in some ways I felt like I was like failing myself in that moment to not be the leader that I like wanted to be. And one of my colleagues, know, Bill Filbrick, like stood up and like came over to me and just like hugged me and said, know, Patty, he's like, where are your team? Like you are not alone. You know, we are here.
you know, for you and for the organization, this is not yours alone to carry. And, and it was like one of those like situations where I felt like I had failed, but I learned so much about vulnerability and being a leader in that, in that experience. ⁓
speaker-0 (1:03:10)
⁓ So many people listening to this will find that so probably even in in like what's going on with them now like so useful to remember. Yeah. Yeah. Patty, it's been so valuable and insightful talking to you. We've talked about your background, long history in digital health, in the work that you've done on the field. We've talked about various insights you've had on like what nuggets of value you've taken to for, you know, technology now.
what choices do we need to make to have actually inclusive and socially responsible technology, but also not just heading the clouds. Like how do we make sure that that is like meeting the market where it's at, the market's there to pay for that, how we finance that. So really grounded in like actual reality. And yeah, I loved what you talking about about, you know, we need a return to mom energy after this year we've had.
And the other thing, maybe you want to also talk about the Dare to Share campaign.
speaker-1 (1:04:11)
Sure. ⁓ the Geneva Digital Health Hub, ⁓ you know, led this campaign ⁓ and Health Enabled was really thrilled to be one of the partners on that and to, you know, they had started it out as a means of mobilizing people to share their stories, their digital health journeys and digital health stories, ⁓ and to get more, you know, ⁓
digital health interventions to participate in the Digital Health Atlas. ⁓ They very kindly extended it to the Global Digital Health Monitor, which is a platform that HealthEnabled has been the technical lead and the steward for for many years ⁓ alongside the World Health Organization Global Initiative for Digital Health ⁓ and the Center for Digital Health Innovation ⁓ at Johns Hopkins School of Public Health and the Center for Digital Health and
implementation science at the University of Gondor in Ethiopia. so all these partners came together and we each took a week and we encouraged, you know, the broader digital health community to dare to share your, you know, digital health story and journey. We hope people will continue to dare to share their stories. think stories are such a powerful way to learn and inspire kind of each other. We've all
experienced probably some of the same things ⁓ in many of the Dare to Share stories. I remembered aspects of my own story that were tied to the stories of colleagues and it just such a heartwarming and powerful way to continue to connect this global community that has become like family over many years.
speaker-0 (1:06:00)
felt it here. It's such a great community. It's awesome. Yeah. Paddy, what a pleasure. I could talk to you for hours. Thank you so much for your insights. It's been such a great first in-person global perspectives on Digital Health podcast. This is the only podcast, if you're a founder in digital health, if you're a product team, if you're a designer, if you are in policy, if you're in academic research and you care about impact for underserved communities.
and learning from other contexts around the world. This is the podcast for you to learn from others. People like Paddy, people, innovators, policymakers, et cetera. And so if you've found this useful, please like, please share it with someone who would find it useful. Leave us a review. We're on YouTube, we're on Spotify, we're on Apple, we're on all of them. And yeah, if you have a story to share or your grantees, if you're a donor, have a story to share, get in touch.
I really care about this space and so I talk to people who also really care about this space and the idea is to all learn from each other. So thank you for listening and yeah, it's been really, really great. Thank you.