![Female doctor using tablet apps](/sites/g/files/omnuum10826/files/styles/hwp_21_9__1920x825/public/2025-08/health%20tech.png?itok=dY6LLqnV) # Build With, Not For: Making Public Health Tech That Actually Works Successful public health technology depends on co-designing solutions with agencies and residents, while prioritizing trust, compliance, and real-world needs. August 26, 2025 [ Khahlil A. Louisy ](#khahlillouisy) ## The Opportunity Hidden in Plain Sight American public health infrastructure stands at a crossroads. The recent pandemic demonstrated what's possible when resources and attention converge on public health innovation, yet as current emergency funding recedes and federal support shifts, we're witnessing a concerning trend: the momentum that could modernize our public health systems is rapidly disappearing. This creates a unique window of opportunity for public-private partnerships (P3s). Local and state health departments, many still operating on decade-old technology and shrinking budgets, need sustainable solutions that don't require massive upfront investments. Meanwhile, the private sector, from established health tech companies to venture-backed startups, is looking for stable, scalable markets beyond the increasingly saturated consumer health space. The challenge isn't a lack of innovation or need; it's a fundamental mismatch between how private companies typically build technology and how public health systems actually function. Too many well-funded health tech startups end up in a graveyard of beautiful dashboards, clever AI, and zero adoption. Why? Because they built *for* public health rather than *with* it. Public health isn't just another vertical, it's its own terrain of bureaucracy that is high-stakes, trust-bound, and excruciatingly slow by design. No one really gets to disrupt it; you only get to work inside it, or not at all. To build something that sticks in public health, private sector partners must unlearn the habits of Business-to-Business (B2B) hustle and Direct-to-Consumer (DTC) polish and instead, they must start with both the human and technical systems and ask: who holds the data, who feels the friction, and who pays the procurement officer? This process means learning to speak the language of regulatory compliance, legacy system integration, community trust, and slow coalition-building. When done right, which means taking the long and unglamorous route of "building with" rather than "building for," public-private partnerships can create technology that isn't just usable, but indispensable. Here's how to do it: **1. Start With the Mess** Public health departments are where you'll find ten-year-old desktops, half-built data warehouses, and heroic administrators juggling ten mandates on ten-year budgets. The private sector instinct might be to slash and burn and start clean, but attempting this would be catastrophic for P3 success. Instead, start inside the mess by watching workflows, sitting with frontline staff, and figuring out what breaks under stress and what's held together by muscle memory and paper forms. These organizations don't chase shiny objects, they chase stability because it’s the only thing keeping the systems together. Your product must feel like taking less risk, not more. This reality creates specific opportunities for private partners willing to work within constraints. Consider building solutions that integrate with existing workflows rather than replacing them, or developing tools that enhance current systems rather than demanding wholesale adoption of new platforms. The most powerful thing your technology can do is show up where it's needed without demanding a reinvention of everything around it. For P3s, this means structuring partnerships that acknowledge the existing infrastructure investment public agencies have made, while gradually introducing improvements that demonstrate clear value without disrupting essential services. **2. Co-Design or Die** The most overlooked product spec in public health tech is *who's in the room when you build*. In successful P3s, five groups matter most: frontline workers, backend admins, budget holders, compliance officers, and if it touches the public, community members. Each has veto power and if you ignore any of them, your rollout stalls, your pilot fizzles, or your tool becomes shelfware. The workaround is to bring them in early, not just to validate your prototype, but to actually design it together. Run co-design sessions, test in context, and work through trade-offs in real time. If the feature slows down a nurse during triage, kill it. If the admin can't deploy it without IT overhauls, simplify. If the budget won't flex for your pricing model, rework the model. This collaborative approach is where P3s can truly shine. Private sector partners bring technical expertise and innovation capacity, while public sector partners contribute deep domain knowledge and operational reality. The reward for building this way is more than product-market fit, it's organizational buy-in and internal champions who'll navigate procurement processes and advocate for continued partnership when budget cycles turn challenging. **3. Bake In Compliance from Line One** Health tech founders love to think of regulation as a hurdle to clear at the end, which is a fundamental mistake for P3 success. In public health, compliance is architecture and HIPAA is just table stakes. Any partnership hoping to build solutions with adoption potential must navigate Food and Drug Administration (FDA) rules, state and county laws, city procurement codes, and federal audit trials. Design around them from day one, build role-based access, make your data governance airtight, and document everything. It's tedious, but it's also the difference between a pilot and a system-wide rollout. No public health official will risk their career on a product that cuts corners and no smart private partner should want them to. This compliance-first approach actually creates competitive advantages in P3s. Private companies that master public sector compliance requirements can offer this expertise as a service to other potential government partners, creating sustainable revenue streams beyond individual product deployments. **4. Interoperability Is Not Optional** Here's the tech reality of public health: systems are old, siloed, and often incompatible. If your solution doesn't plug into existing machinery, whether that's outdated databases, low-bandwidth networks, or clunky Electronic Health Records (EHRs), it's not getting deployed. Use standards like [HL7 FHIR](https://www.hl7.org/fhir/), support low-tech deployments, and build with flexible infrastructure (on-premises, cloud, hybrid). In American public health, you must design for the world as it is, not as you'd like it to be. Your tech must cooperate before it can innovate. For P3 structures, this creates opportunities for private partners to offer integration services as part of broader technology partnerships. Rather than selling standalone products, successful partnerships often involve private companies taking responsibility for connecting disparate systems, managing data flows, and ensuring seamless operation across multiple legacy platforms. **5. Trust is the Real User Interface** You're not just shipping software, you're intervening in systems that touch lives, rights, and often trauma. Public health systems don't adopt based on slick pitch decks; they adopt based on evidence. This means private partners must show their work through published evaluations and transparent impact metrics. This is especially critical with AI deployments. If you're developing models that triage risk or allocate resources, explain how they work, audit for bias, and be transparent about limitations. If communities can't trust your tech, they won't use it and if health departments can't explain your outputs, they won't approve deployment. In P3 contexts, this transparency requirement creates opportunities for private partners to differentiate themselves through rigorous evaluation and community engagement. Companies that invest in building trust through evidence and transparency often find themselves preferred partners for multiple government contracts. **6. Rethink Your Business Model for P3 Success** Here's a startup truth most don't want to hear: public health doesn't work on Annual Recurring Revenue (ARR) timelines. Government agencies operate on annual budgets, multi-year cycles, and strict procurement rules. However, there's substantial funding available through grants, contracts, and structured P3 arrangements; it just flows differently. Some of the most successful public health tech companies subsidize early implementations with foundation support, then scale through government contracts. Others develop tiered pricing models or integrate services into existing reimbursement streams. [HealthSherpa](https://www.healthsherpa.com/agents/features), for example, initially used Robert Wood Johnson Foundation funding, then partnered with state and federal marketplaces once they proved effectiveness. They now operate under formal contracts with the Centers for Medicare and Medicaid Services and other government services. For P3s specifically, consider models like: - **Risk-sharing arrangements** where private partners invest in technology development and receive payment based on demonstrated outcomes - **Build-operate-transfer models** where private companies develop and manage systems before transitioning ownership to public agencies - **Service-based partnerships** where private companies provide ongoing technology management rather than selling products - **Hybrid funding structures** that combine foundation grants, government contracts, and private investment The key is flexibility and patience. Anyone serious about P3s in public health should be ready to play the long game. ## A Framework Worth the Friction For private sector companies serious about public health partnerships, here's your blueprint: **First, do the ethnography.** Shadow users, map constraints, and study workflows. The importance of this step cannot be overstated because it's where you discover the difference between what public health systems say they need and what they actually require. **Second, design together from the start.** Co-create with all relevant stakeholder groups before any development takes place. Attempt to design *for* rather than *with*, and watch your solution go nowhere fast. **Third, launch small pilots** that collect real-world data and build social proof. For P3s, successful pilots become the foundation for larger contracts and expanded partnerships. **Finally, plan for scale** by building support structures, compliance frameworks, and sustainable funding models from day one. These processes won't be fast and they certainly won't be easy, but if you want to create lasting public-private partnerships that improve health outcomes, this is the path. The reward won't just be a working product; it's a solution that can evolve with changing needs while providing sustainable value to both public and private partners. As public health funding becomes increasingly uncertain, the organizations and companies that master this collaborative approach will be positioned to fill critical gaps while building sustainable businesses. The opportunity is substantial, but it requires abandoning the traditional tech playbook in favor of something more complex, more collaborative, and ultimately more impactful. ## About the Author ### Khahlil A. Louisy ![Headshot of Khahlil Louisy](/sites/g/files/omnuum10826/files/styles/hwp_1_1__100x100_scale/public/datasmart/files/khahlil_louisy_headshot_bw.jpg?itok=9woX8Yjb) Khahlil is a contributing author and former Senior Data-Smart Fellow at the Data-Smart City Solutions program at The Bloomberg Center for Cities at Harvard University and a former Technology & Human Rights Fellow at the Carr Center for Human Rights Policy at the Harvard Kennedy School. Khahlil is an applied economist focused on issues of public and global health, economic development, and technology and innovation. His work centers on the development and application of technologies for public purpose, while researching their implications for issues of inequality, health outcomes, and human rights. He is the former Head of Global Implementation at PathCheck Foundation - an organization founded at the Massachusetts Institute of Technology (MIT) to develop novel technologies in response to health emergencies. He currently serves as President of the Institute for Technology and Global Health and Co-Head of AI and Technology for Public Health -Outbreaks, within the joint World Health Organization (WHO) and International Telecommunications Union (ITU) initiative on Artificial Intelligence for Health. His work has spanned several countries globally and he remains committed to issues of equality, equity, and global poverty. See also:- [ Innovation ](/topics/innovation) - [ Operations ](/topics/operations) - [ Public Health ](/topics/public-health) Share on:- [ Facebook ](#) - [ Twitter ](#) - [ Linkedin ](#)