Health First, Innovation Second. Smisha Agarwal on what needs to change in global digital health.
04/16/25 • 44 min
Dr. Smisha Agarwal (Johns Hopkins University Global Center for Digital Health Innovation) joins me to unpack some hard truths on the Global Perspectives on Digital Health podcast.
🛑 Why global health systems remain fragile
📉 How digital tools often scale without legitimacy
📊 What’s wrong with our fixation on "did it work?" and significance values
🔁 And how global health is stuck in systems that haven’t evolved
💬 “We’re brought into a system of aid and global development that has stopped questioning how things were done. And the world has progressed, but our field hasn’t.”
🔑 But Smisha also offers a way through:
Thinking differently about evaluating system level impact
The work of the Oxford Open Health Journal to increase visibility and representation of people's research in LMICs
👉 If you work in digital health, research, policy, or global development this is for you.
About Smisha:
Dr.Smisha Agarwal, PhD, MPH, MBA, BDS is the Director of the Center for Global Digital Health Innovation and Associate Professor in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health. She brings expertise in advancing primary health
care through strengthening community health systems and leveraging innovative technological solutions including digital devices. A part of her research has focused on using predictive analytics and machine learning algorithms based on routine monitoring data to enhance our understanding of quality of care, create safety nets to care for high-risk populations and improve effectiveness of reproductive health services.
Over the last two decades, her research has been leveraged by normative agencies like WHO to develop guidelines on national digital
transformation, donors to guide investments in primary health care, and governments to develop their national digital health strategies. She is the Editor-in-Chief of the Oxford Open Digital Health Journal.
- (00:00) - Introduction, Smisha's background
- (05:01) - Impact of Global Health Aid Cuts
- (10:03) - Challenges in Monitoring and Evaluation
- (15:35) - Health First: How to think about outcomes, measuring the right things
- (20:54) - Supporting healthcare workers as a goal
- (26:37) - Impact: Measuring what matters
- (28:39) - Donor decision making dynamics
- (30:09) - Rethinking system level success: from yes/no to more nuance
- (33:50) - Innovations in Academic Publishing
- (37:37) - Challenging the Status Quo in Global Health
- (42:20) - Upcoming events in Global Digital Health
Dr. Smisha Agarwal (Johns Hopkins University Global Center for Digital Health Innovation) joins me to unpack some hard truths on the Global Perspectives on Digital Health podcast.
🛑 Why global health systems remain fragile
📉 How digital tools often scale without legitimacy
📊 What’s wrong with our fixation on "did it work?" and significance values
🔁 And how global health is stuck in systems that haven’t evolved
💬 “We’re brought into a system of aid and global development that has stopped questioning how things were done. And the world has progressed, but our field hasn’t.”
🔑 But Smisha also offers a way through:
Thinking differently about evaluating system level impact
The work of the Oxford Open Health Journal to increase visibility and representation of people's research in LMICs
👉 If you work in digital health, research, policy, or global development this is for you.
About Smisha:
Dr.Smisha Agarwal, PhD, MPH, MBA, BDS is the Director of the Center for Global Digital Health Innovation and Associate Professor in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health. She brings expertise in advancing primary health
care through strengthening community health systems and leveraging innovative technological solutions including digital devices. A part of her research has focused on using predictive analytics and machine learning algorithms based on routine monitoring data to enhance our understanding of quality of care, create safety nets to care for high-risk populations and improve effectiveness of reproductive health services.
Over the last two decades, her research has been leveraged by normative agencies like WHO to develop guidelines on national digital
transformation, donors to guide investments in primary health care, and governments to develop their national digital health strategies. She is the Editor-in-Chief of the Oxford Open Digital Health Journal.
- (00:00) - Introduction, Smisha's background
- (05:01) - Impact of Global Health Aid Cuts
- (10:03) - Challenges in Monitoring and Evaluation
- (15:35) - Health First: How to think about outcomes, measuring the right things
- (20:54) - Supporting healthcare workers as a goal
- (26:37) - Impact: Measuring what matters
- (28:39) - Donor decision making dynamics
- (30:09) - Rethinking system level success: from yes/no to more nuance
- (33:50) - Innovations in Academic Publishing
- (37:37) - Challenging the Status Quo in Global Health
- (42:20) - Upcoming events in Global Digital Health
Previous Episode
Digital mental health research insights
Bringing research to implementation.
Shubs is joined by Lucy Cesnakova from DiMe in this quick dive into an important piece of research bringing insights to advance digital solutions that serve mental health, DiMe's work here was great here because Lucy and the team intentionally sought out input from different countries, access levels and other demographics across the ecosystem. It's great that the Wellcome Trust funded this work. And more of this type of research would clearly be, ahem, welcome.
Why should I listen?
This will be useful if you are building solutions with underserved communities in mental health and applies both to high income and LMIC settings.
If you are researching digital endpoints and biomarkers in mental health or involved in health system transformation for mental health this is well worth a listen.
We cover the big commonalities across all geographies, plus what we can learn about local nuances as well as some key a-ha moments Lucy and the team gained.
Check out my substack article for a written reflection on this episode.
Chapters
00:00 Introduction to DiMe and Lucy's work
03:57 Current healthcare context
06:01 Methodology of Research and Data Collection
08:27 Key Findings: Universal Commonalities in Mental Health Technologies
16:04 Unique local insights
Here's the full report: https://datacc.dimesociety.org/mental-health/
DiMe society:https://dimesociety.org/
About Lucy:
Lucy Cesnakova, MS, is a Program Lead at Digital Medicine Society (DiME).
At DiME Lucy has led several projects in the space of digital measurements and technologies for health: a flagship pre-competitive collaboration project to advance the digital measurement of nocturnal scratch; an initiative that explores path forward for sensor-based digital health technologies for mental health; or recent work on use of patient-generated health data in development of medical products and health technologies.
At DiMe she works with industry, patient organizations, regulators, clinicians and payers to create resources that will improve adoption of digital technologies in research and care. In the past, Lucy has led technical development of digital endpoints or other software solutions as a product lead.
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