Building the infrastructure that makes scales impact

What is often missing is the layer that allows these systems to work together, and allows innovations built for one context to be reused in another.

India has many of the systems needed to deliver public services at scale: Large public health networks, millions of frontline workers, government programmes that reach deep into communities, and digital infrastructure that can connect people and services. What is often missing is the layer that allows these systems to work together, and allows innovations built for one context to be reused in another.

Philanthropy

Health care offers a useful example. A patient may move between a primary health centre, district hospital, specialist and community health programme. Each may use different software. Patient records do not always move with them. Health workers may enter the same information multiple times. Referrals and follow-ups become harder to track. The result is that even when individual programmes work, their benefits can remain confined to the programme that built them.

The Open Healthcare Network Foundation’s CARE offers a different approach. CARE is an open-source Digital Public Good that provides a common digital foundation for health care. It supports patient records, clinical workflows, referrals and data exchange, and is built around open standards such as Fast Healthcare Interoperability Resources (FHIR). It can be self-hosted and adapted to different settings, allowing organisations to build on and reuse the technology as their needs evolve.

This is where open, shared infrastructure creates a different kind of value. A new programme does not have to start by building its own digital backbone. It can build on capabilities that already exist, adapt them to its workflow and contribute improvements back to the common infrastructure.

Over time, the value compounds. Technical components, integrations, workflows and implementation knowledge developed through one deployment can reduce the work required for the next. Each deployment can strengthen the foundation for others to build on. That creates an important distinction between a standalone product and digital public infrastructure. A standalone product primarily creates value through its own deployment. Infrastructure can create value through the applications and systems that others build on top of it.

This kind of infrastructure is also difficult to fund in its early stages. Its benefits are distributed across programmes, institutions and future deployments, while the demand and funding models needed to sustain it may still be developing. The organisation building it, therefore, has to invest ahead of the market it is creating.

This is an important role for philanthropy. Philanthropic capital can fund the early development of public-good infrastructure, support deployments that generate real-world evidence, and help build the partnerships needed for adoption. It can give infrastructure the time and space to mature before its value is fully visible to governments, implementers or other funders.

ACT’s work with OHCN has followed this trajectory. We supported CARE through its early Covid-era deployments and subsequent development into broader public health infrastructure, including Ayushman Bharat Digital Mission (ABDM) integration, palliative care and Health Management Information System (HMIS) capabilities. Our support has also extended to strategic partnerships, ecosystem connections, fundraising and organisational capacity. The objective has evolved alongside the platform. Early support helped establish and test the infrastructure. As CARE has matured, the focus has shifted towards expanding deployments, strengthening the organisation that stewards the platform and building the ecosystem needed for others to adopt it.

This is the compounding potential of infrastructure. When a new programme can build on existing digital foundations, it can start further ahead. When standards and integrations already exist, less effort is spent rebuilding them. When implementation knowledge has accumulated across deployments, future programmes can learn from what came before.

For India, this creates an opportunity to think about impact beyond individual interventions. The country will continue to produce ambitious solutions to large social challenges. Some of the greatest long-term value may come from building the shared infrastructure that allows those solutions to connect, adapt and travel.

Philanthropy can help create that infrastructure while its broader value is still emerging. The return on that support can extend well beyond the original grant, as the technology, standards and knowledge become a foundation others can use and build on.

(The views expressed are personal)

This article is authored by Madhavika Bajoria, partner, ACT Grants.