Avoiding the Tragedy of the Commons

The field of digital health is at an inflection point where fundamental shifts are resulting in new levels of activity and impact. One such change is the increased use and adoption of common goods. The emphasis on common goods is beneficial for all – reducing the fragmentation of efforts, building global capacity and knowledge, and lowering costs. Common goods are typically open source and often come in the form of tools, guides, or digital platforms. Both digital health funders and implementers are becoming increasingly aware and supportive of these goods, resulting in scalability and a better understanding of what works.

Yet there is a downside. As the digital health field becomes increasingly reliant on common goods, an inherent risk emerges. Support for the common good must be kept in sync with evolving standards and the ever-relentless pace of digital technology. The owners and shepherds of common goods may not always understand the dynamics of scale and how it affects their product. In addition, it may be difficult to provide the technical support needed as adoption broadens. This puts the upkeep and sustainability of common goods at risk, particularly if the supporting institution decides to no longer care for the good. Not only will investments reliant on that good suffer, but so will related programs, data, tools, and activities. This is especially true for common goods that have become the default standard across the field.

Avoiding the tragedy of the commons — lack of funding or support following widespread use — requires a new focus and perspective on the topic of common goods. We must become more aware of the tools we are heavily reliant upon, especially those that are considered the default standard. The de facto owners of these tools must also assume a higher level of responsibility and willingness to invest in, or acquire investment for, the tool’s evolution and sustainability. Just as a digital implementation needs to evolve, so does a common good. Typical barriers to scale can be addressed by ensuring sustainability through a solid business model, enabling enterprise-grade capabilities, and building capacity to provide technical support – themes and issues that are discussed in Beyond Scale. By focusing on the key questions of scale now, the field of digital health will be able to foster a new level of maturity for common goods, further increasing its impact across the world.

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