Global Perspectives on Digital Health

Overview

We are joined in this episode by Ruchit Nagar, the CEO and Co-Founder of Khushi Baby. For his efforts to deliver scalable public health impact, Ruchit has been recognized as a Forbes 30 under 30 leader in Health Care, a World Innovation Summit in Health Young Innovator, and a Distinguished Young Alumnus by by the Yale School of Public Health

This episode covers into the role of India's Community health workers, or Accredited Social Health Activists (ASHAs). We hear from Ruchit's experience implementing with Khushi baby the challenges of integrating technology to support health workers.

Ruchit also gives us a lowdown on India's digital public health approach and shares his key learnings and insights for people looking to implement tech in rural areas.

We get into the challenges in policy, the data infrastructure layer and the importance of funding for sustainable health initiatives. Ruchit also emphasizes the need for better support and resources for ASHAs, the impact of technology on healthcare delivery, and the necessity of aligning incentives to improve health outcomes.

Chapters

00:00 Intro

03:53 Khushi baby origins

05:10 Challenges in Community Health Delivery

07:18 The Role of ASHAs in Healthcare

12:28 The Need for Integrated Solutions

14:14 India public health digital ecosystem 101

19:51 When "too much digital" gets in the way of good care

22:28 Pitfalls in funding and investment approaches

23:20 The 3 I's that drive implementation success

31:56 Leveraging Data for Health System Strengthening

35:53 Challenges in Health System Integration

41:35 Measuring Impact and Effectiveness

47:44 Aligning Incentives with Ground Realities

53:56 Navigating Quality, Evaluation and Regulatory Challenges

56:48 Future Directions for Khushi Baby

01:02:02 Ruchit's top takeaway for developers

References

Khushi baby website

Book reference: Poor Economics by Abhijit V. Banerjee and Esther Duflo
TB free India 2025

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Implementation. What does it mean? Why is it hard? How do we get it right?
Failure. Are we, in Global Digital Health, thinking and acting in a way that doesn't help us move forward?

Caroline Perrin, Director of the Geneva Digital Health Hub joins us on the Global Perspectives on Digital Health podcast to share her views on this.

This episode is for the people doing the work to ensure digital health tools actually work for people.

It's about the messy realities - people, process, managing change and looking to constantly improve as our assumptions get updated. How to work through the hard, day to day challenges towards real outcomes for people experiencing and delivering care.

We hear about:

• How the Geneva Digital Health Hub's Implementome maps out implementations across the world, especially the Global south and brings together a Community of people wrestling similar problems for knowledge exchange and connection
• The key challenges in getting digital health tools adopted, and how to use good implementation principles to get through the messy, day to day realities
• Challenges in Monitoring and Evaluation, and how to get the balance right between impact on what matters and what is in your locus of control.
• How our industry and ecosystem needs to rethink how we talk about failure, and how we're opening up this conversation at the Geneva Digital Health day on 22 May 2025
• Plus some great examples and ways you can share challenges to contribute to the ecosystem.

Links:

• Building and Implementing? Join Implementome: https://gdhub.unige.ch/implementome/main
• Digital Health Atlas: https://gdhub.unige.ch/implementome/projects
• Geneva Digital Health Day: https://gdhub.org/25gdhd/
• Implementation Reports: https://medinform.jmir.org/themes/145-implementation-report
• iCHECK-DH Guidelines: https://www.jmir.org/2023/1/e46694

Chapters (with quick links)

00:00
Introduction to Digital Health and Geneva Digital Health Hub

07:40
Understanding Implementation in Digital Health

12:22
A community of implementors

20:09
Approaching Implementation as Founders and Developers

26:19
Monitoring and Evaluation Challenges

32:45
Future of Digital Health in Underserved Communities

35:31
Navigating Uncertainty in Digital Health Projects

38:45
Rethinking Success and Failure in Health Evaluations

45:46
The Need for a Paradigm Shift in Global Health

49:53
Creating Safe Spaces for Sharing Failures

54:04
Building Communities of Practice for Learning

57:30
Finding Hope in the Face of Challenges

About Caroline

Caroline Perrin is the Executive Director of the Geneva Digital Health Hub (gdhub) and has over 15 years of experience in digital innovation, programme management and multi-stakeholder collaboration. She specialises in using technology to improve the efficiency, sustainability and impact of health care.

With a PhD in Global Health, a Master's in Information Systems Management, and a Bachelor's in Business Administration, she has led large-scale digital health initiatives and worked with governments, international organisations, and the private sector to drive innovation and policy alignment.

Previously, she was a project manager for the RAFT telemedicine network and the Geneva University Hospitals eHealth and Telemedicine Service, focusing on the development and evaluation of digital health solutions to strengthen health systems. Caroline is passionate about bridging technology, strategy and policy to create scalable, high-impact solutions.

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Implementing a digital mental health solution in Rwanda.
What does real, meaningful co-design look like?
What does it mean to truly engage with a community to develop a solution they actually use and that addresses their problems?
What incentives and mindsets allow us to, instead of 'driving' a certain technology into a context, stop and listen, and go in with no pre-conceived notion of what would be built?
How do we get procurement and policy to really value and elevate equitable solutions?

These are some of the great questions we covered in the latest podcast episode with Dr Jana Alagarajah. His wide experience, and work implementing a digital mental health tool with young people in Rwanda gives us some great talking points. Jana shares what he learned working with people and community leaders, as well as carers, and how they approached co-design and evaluation.

We also talked about his insights from working in partnership with UNICEF, USAID, the King's Fund and Health Foundation.

Dr Jana Alagarajah (MD MPH): Digital mental health specialist, UK-trained public health doctor, and psychiatrist co-designing equitable and impactful digital health innovation in Africa with young people as Technical Lead at YLabs. Partnering with UNICEF, USAID, and Gates Foundation, he leverages digital tools to strengthen health systems.

Linkedin: https://www.linkedin.com/in/janaganalagarajah/

YLabs: https://www.ylabsglobal.org/
Grand Challenges Canada: https://www.grandchallenges.ca/

Key Resources:

• Design:
  • Co-design: YLabs’ Youth-driven approach to digital health focussing on co-designing with youth.
  • Designing for diversity: Importance of co-creating culturally adapted tech to address health inequalities in diverse populations - report from NHS Race and Health Observatory.
  • Regulation: Co-developed Africa’s first evidence-based digital mental health regulation (‘HealthTech Hub Africa Digital Health Policy Blueprint 1.0’) with the Rwandan Ministry of Heath, Africa CDC, Jhpiego, Novartis Foundation covering key design elements such as interoperability, data privacy and UX approaches to meet the needs of diverse populations.
• Implementation:
  • Digital stigma reduction tool: ‘Prepare for a Better Tomorrow’ (Rwanda, 2021): Rwanda’s first youth-driven, holistic digital learning and peer support platform to increase mental health literacy and psychosocial support for Rwandan youth aged 10-19 years old. Funded by Grand Challenges Canada.
  • Digital tools for mental healthcare workers: ‘USAID Kijana Nahodha’ (Tanzania, 2023): digital mental health education and referral tool for community health workers in Tanzania as part of a $5.4M USAID grant, impacting 140,000 youth and 250 community health workers.
• Evaluation:
  • Evidence generation: A systematic literature review evaluating the efficacy of digital mental health technologies for youth in low and middle-income countries: Alagarajah J, Ceccolini D, Butler S. Digital mental health interventions for treating mental disorders in young people based in low-and middle-income countries: A systematic review of the literature. Cambridge Prisms: Global Mental Health. 2024;11:e74. doi:10.1017/gmh.2024.71
  • Innovative approaches to digital evaluation: At YLabs, we have utilized traditional evaluation methodologies such as cluster RCTs to evaluate our digital interventions. However, given the challenges in evaluating digital health solutions, novel methodologies, such as cyclical evaluation, can be used to maximize usability, and support integration into health systems.

Episode 2: Practical Solutions to Health Data Poverty

In this episode, we continue our exploration of health data poverty, showcasing a team that's making a real difference based on the issues discussed in Part 1 with Dr. Xiao Liu.

We're thrilled to have spoken with Prof. Alexandre Filho, a Professor of Machine Learning in Sao Paulo, Brazil. He shared insights on how his team has been maximizing the impact of data-driven technology in Brazil. Prof. Filho's remark, "The world is becoming more like Brazil," sets the stage for a discussion on what the global community can learn from Brazil's approach to data diversity, especially in serving underserved communities.

Key Topics:

• Global Lessons from Local Successes: How Brazil's high-quality, diverse data sets serve as a model for the world.
• Overcoming Data Challenges: Tackling issues with data availability and the performance limitations of algorithms developed in affluent settings when deployed in rural areas.
• Leveraging Local Data: Details on the team's work, including a paper on neonatal mortality prediction using routinely collected data.
• Direct Benefits to Data Providers: Ensuring that those from whom data is collected see benefits from its use.
• Balancing Impact and Scalability: The trade-offs between highly tuned, local solutions and the need for scalable models that perform well across broader contexts.
• Benchmarking for Better Health: Extended efforts in the ITU/WHO focus group on AI for health, evaluating the performance of models across different LMIC settings.
• Advancing Local Impact: The use of transfer learning to enhance model performance and impact locally.
• Prof. Filho’s Recommendations: Key advice for innovators and implementers in the EU, US, and UK.

Guest Bio:
Alexandre Chiavegatto Filho is an Associate Professor of Machine Learning in Healthcare at the Department of Epidemiology, School of Public Health, University of São Paulo. He directs the Laboratory of Big Data and Predictive Analysis in Health (Labdaps), which includes a team of 30 researchers focused on developing AI algorithms to improve healthcare decisions.

Find the team's work on Google Scholar

Practical breadth and depth on the global state of regulation from someone at the cutting edge of regulatory policy.

Shubs welcomes Hugh Harvey, founder of Hardian Health and a regulatory expert in digital health. Shubs and Hugh discuss the complex landscape of medical device regulation worldwide, with emphasis on how these frameworks impact digital health innovation in low and middle-income countries (LMICs).

Guest Background

Hugh Harvey is a former radiologist who transitioned to the digital health industry. After working at Babylon Health and serving as Clinical Director at Kheiron Medical (where they secured Europe's first CE mark for a deep learning-based breast cancer detection device), Hugh founded Hardian Health to help companies navigate regulatory pathways for AI and digital health solutions.

Key Discussion Points

The Global State of Medical Device Regulation

• Regulatory Variation: Hugh explains the significant differences in regulatory approaches between regions like the EU (stricter) and the US (increasingly deregulatory)
• (Some) LMIC Contexts : Only about 40% of African countries have actual medical device regulations, with only South Africa having comprehensive frameworks
• Cybersecurity Risks: Medical health data sells for more than financial data on black markets, making robust regulation essential for protecting patients

Challenges for Digital Health Innovators

• Founder Misconceptions: Many startups allocate insufficient resources for regulatory compliance. Regulatory compliance should represent 5-10% of a company's overall budget.
• Regulatory Debt: Postponing regulatory considerations creates compounding challenges that become increasingly difficult to address later down the line
• Large Language Models: Hugh's skepticism about LLMs in healthcare, noting they're "massively overrated" for medical reasoning tasks and face significant regulatory hurdles, and yet Hugh sees some promise over the hill.

Practical Guidance for Digital Health Companies

• Getting the mindset right: Thinking about it in the same way you might approach a driving test.
• Universal Standards: Quality management systems (ISO 13485) are increasingly harmonized globally
• Approach in LMICs: Thinking about deploying in an place where there is little to no regulatory structure? You might want to consider securing certification in countries with established regulatory pathways prior, and then work with the local government.

What Regulators Could Do Better

• Proactivity: Regulators should be more proactive in providing guidance on novel technologies
• Transparency: More open sharing of regulatory decisions would help the entire industry move forward
• Capacity: Governments should increase funding for regulatory bodies to reduce backlogs and improve efficiency

Chapters

00:00 Introduction and Background
04:22 The State of Regulation in Healthcare
06:36 Why so regulated?
09:24 Global Perspectives on Regulatory Approaches
16:53 Harmonization of Global Standards
19:34 Recommendations for Regulators
31:53 Regulatory strategy for founders: The Driving Analogy
42:14 What if there is little or no regulatory enforcement where I operate?
43:59 The Five Stages of Regulatory Grief
47:44 Hugh's spicy takes 🌶️

Key Quotes

• "Regulations are written in blood... the reason regulations/FDA are as they are today is because of events like thalidomide.
• "What's the cost of not being compliant? Well, it's everything, it's your entire business model."
• "The attack surface vector, especially under these generative AI models, is huge, vast, and frankly, completely unknown."

Hugh provides a compelling case for embracing regulatory requirements as not just necessary obligations but strategic advantages. While acknowledging the challenges of navigating complex regulatory landscapes, particularly for innovators working in regions with limited frameworks, he offers practical guidance on approaching compliance as a foundation for long-term success in digital health. You can find Hugh and his work at hardianhealth.com

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