Episode 12 · International
Health first, innovation second: Smisha Agarwal on what needs to change in global digital health
Dr Smisha Agarwal · Director, Center for Global Digital Health Innovation; Associate Professor, Johns Hopkins Bloomberg School of Public Health
Apr 2025
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About this episode
Some hard truths on global digital health from one of the field's most clear-eyed researchers. Why health systems remain fragile, how digital tools scale without legitimacy, what's wrong with our fixation on 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.”
Dr Smisha Agarwal
What we cover
- 01Why global health systems remain fragile - and how digital tools often scale without legitimacy
- 02The impact of USAID aid cuts: abruptness, trust, and what was lost
- 03What's wrong with our fixation on significance values and yes/no impact questions
- 04Health first: starting with the health outcome you want, then asking whether digital can help
- 05Community health workers - unpaid, unsupervised, yet expected to power digital systems at scale
- 06Outcomes proximal to your locus of control: a more honest approach to impact measurement
- 07Rethinking system-level success: contribution lines, business spreadsheet thinking, and nuance over binary answers
- 08The Oxford Open Digital Health Journal: challenging colonial structures in academic publishing
- 09Questioning the status quo - because the field hasn't evolved with the world
About the guest
Dr Smisha Agarwal
Director, Center for Global Digital Health Innovation; Associate Professor, Johns Hopkins Bloomberg School of Public Health
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. Her research focuses on advancing primary healthcare through community health systems and innovative technology, including predictive analytics and machine learning based on routine monitoring data. Over two decades, her work has informed WHO guidelines, donor investment strategies, and national digital health strategies. She is Editor-in-Chief of the Oxford Open Digital Health Journal.
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Transcript
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