Over the past decade, the digital health community has demonstrated through pilots that information and communication technology can improve health services delivery in the developing world. We propose that digital health interventions will impact health outcomes significantly only when routinely used, or institutionalized, as a common practice. Achieving institutionalization requires the right leadership, solution, approach, and capacity. This paper, written by the Digital Health team, is intended to stimulate debate on what that implies for our investment and collaboration strategies.