Week 1: Status Update and Review Product, Processes, and Current Business Model

1. Week 1: Status Update and ReviewProduct, Processes, and Current Business Model FOR DISCUSSION 11July 2011

2. Week 1 Progress Report • Goals and Process • Initial Findings • Strategic Questions • Week 2 Agenda Week 1: Product and Process Review v. 1.0

3. Week 1: Content Goals GOALS AND PROCESS • Understand internal direction, capacity, and processes, specifically: • Mission • Product • Delivered Value • Process and Task • Organizational Capacity • Business Model • Create synthesis baseline of current organization • Identify strategic questions for D-tree leadership Week 1: Product and Process Review v. 1.0

4. Complete In progress Not started Week 1: Progress GOALS AND PROCESS Tasks: • Conduct formal and informal interviews with key D-tree staff • Research D-tree “who we are” and process documents • Gap assessment: what exists and what’s needed • Validate findings with D-tree leadership • Send invitations for external interviews Progress: Week 1: Product and Process Review v. 1.0

5. Initial Findings Mission The mission of the organization, as understood by staff and represented in public documents The core offering of D-tree, or the product, as understood by staff and represented in public documents Product Delivered Valued The value of D-tree to its partners organizations and to the health system, as understood by staff and represented in documents Process and Tasks Standard processes and tasks of D-tree, as understood by staff, including business development and product development Org. Capacity Skills and competencies that exist in the organization, as assessed through management interviews, observation, and practice Business Model The business model as it exists, based on interviews with management and understanding of processes Week 1: Product and Process Review v. 1.0

6. Mission INITIAL FINDINGS Strong mission and passionate staff… …But breadth of mission leads to some confusion • Mission of D-tree is relatively well understood: To transform the way healthcare is delivered in the developing world But broad and open to interpretation by staff, Board, donors… • Management is passionate about mission and believe in leader’s vision • How mission relates to everyday operations is not explicit • Confusion exists between operations—delivering mobile health support—and broader mission • D-tree’s unique role in health system transformation is unclear and management not aligned on strategy to achieve mission Week 1: Product and Process Review v. 1.0

7. Product INITIAL FINDINGS • Product is clear: Decision support tools on mobile devices for health workers in the developing world • End-to-end product, from protocol development through implementation and support • User tested and evaluated for efficacy and in accordance with medical community standards • Can be divided into distinct products in each step, each with its own value: • Organization has targeted different users and disease areas without explicit product development strategy • CHW vs. clinic settings • Infant and child, maternal, AIDS protocols and patient populations • Geographic focus has been consistent Week 1: Product and Process Review v. 1.0

8. Delivered Value INITIAL FINDINGS • Consensus among all staff that D-tree is delivering value to its customers, but value is not clearly articulated or consistently measured * TBC Week 1: Product and Process Review v. 1.0

9. Core Operating Process INITIAL FINDINGS • SEVEN Step Process: • Define— added by JC/RCB based on staff interviews & internal analysis • Design • Develop • Refine • Pilot • Evaluate • Internal Refinement— added by JC/RCB based on staff interviews Staff identified these 5 steps as current operating processes Week 1: Product and Process Review v. 1.0

10. Legend: Strong Sufficient Needs Improvement Step 1: Define INITIAL FINDINGS: PROCESS Week 1: Product and Process Review v. 1.0

11. Legend: Strong Sufficient Needs Improvement Step 2: Design INITIAL FINDINGS: PROCESS Week 1: Product and Process Review v. 1.0

12. Legend: Strong Sufficient Needs Improvement Step 3: Develop INITIAL FINDINGS: PROCESS Week 1: Product and Process Review v. 1.0

13. Legend: Strong Sufficient Needs Improvement Step 4: Refine INITIAL FINDINGS: PROCESS Week 1: Product and Process Review v. 1.0

14. Legend: Strong Sufficient Needs Improvement Step 5: Pilot INITIAL FINDINGS: PROCESS Week 1: Product and Process Review v. 1.0

15. Legend: Strong Sufficient Needs Improvement Step 6: Evaluate INITIAL FINDINGS: PROCESS Week 1: Product and Process Review v. 1.0

16. Legend: Strong Sufficient Needs Improvement Step 7: Internal Reflection/Analysis/Refinement INITIAL FINDINGS: PROCESS Week 1: Product and Process Review v. 1.0

17. Note on Organizational Capacity: INIITAL FINDINGS • Key points from Week I Interviews: • Staff is dedicated, motivated and highly capable • There is capacity in-house but because of time constraints, it is not maximized or managed as efficiently as possible • A minority of staff members have job responsibilities aligned with their full set of skills; others are working outside expertise/talent to cover gaps • Lack of protocol development and programming expertise can be a significant challenge to scalable growth • Internal capacity/time/training for formal evaluation is not a priority, which impacts all other domains of processes • Organizational structure not optimized for building expertise or communicating between projects Week 1: Product and Process Review v. 1.0

18. Other Processes INITIAL FINDINGS: PROCESS Other processes are necessary to the functioning of D-tree, but outside the scope of our direct analysis at present. Initial understanding is as follows: Business Development • D-tree states about itself, we must and want to work with partners to accomplish its mission • Process anecdotally suggests: • BD generally through contacts • Organizations approach D-tree with discretionary funds for innovation of protocols around their own topics of interest • Product development has been primarily grant-drive—reactive to BD as opposed to proactive BD to build product • D-tree has sufficient outside interest to say no to products given capacity currently • Boston staff devote significant time to grant writing • In country relations managed by in country staff Marketing and Communications • No formal research and communications staff or process • Tremendous opportunity to leverage research and projects and promote D-tree and MM’s leadership • Positive word of mouth has been strong about D-tree • More formal marketing plan to be developed Finance and Administration • Primarily done out of Boston/Harvard • 2 FTEs, also responsible for grants Week 1: Product and Process Review v. 1.0

19. Process/Capacity Summary INITIAL FINDINGS • D-tree has a range of skills within the organization; in order to function most efficiently and be able to scale, specific capabilities are necessary in these areas: Week 1: Product and Process Review v. 1.0

20. Business Model (1/2) INITIAL FINDINGS • Previous slides elucidated some aspects of business model, but must define further*: * Elements of business model taken from Global Campaign for the Health MDG Goals Draft Report, June 2011 Week 1: Product and Process Review v. 1.0

21. Business Model (2/2) INITIAL FINDINGS • Key area of interest for D-tree leadership is sustainability and growth scenarios • Current model: • Activities primarily funded through NGO partnership grants/joint projects, with some individual financing • Funding supports individual protocol development and pilot implementation but minimal unrestricted funding • D-tree sells partners “whole package”: protocol development expertise, technology development (software), technology deployment (hardware), field staff and training • Value to partner is primarily as innovator, new experimental model (TBC) • Alternative business models can be explored once other business characteristics are clearly defined Week 1: Product and Process Review v. 1.0

22. Product STRATEGIC QUESTIONS • By identifying a strategic focus for D-tree’s product, the organization could grow expertise and scale more easily • Focus could be by provider type, disease area (and therefore funder specific), geography/country/region, or product element • Mission could still be broad but having specific project development strategy could lend organizational focus • Is every product custom or are there standardized modules • Should D-tree develop and authoring system? (process decision, too) • Should protocols/software be open source or just free? Product Options Week 1: Product and Process Review v. 1.0

23. Processes and Capabilities STRATEGIC QUESTIONS Processes Capabilities • Where is D-tree’s comparative advantage in the “whole package” it delivers vis-à-vis other organizations? • What processes can be standardized across projects? • What resources are necessary for adopting more standardized procedures? • What capabilities should be internal and what should be found in partnerships or outsourced? • Where is there a need for deep expertise and where for management? • What is the appropriate organizational structure to develop and maintain necessary capabilities?

24. Next Steps WEEK 2 AGENDA • Review Week 1 Progress Update with D-tree leadership and management team • Refine and iterate on findings based on discussions • Begin discussion on strategic questions on product and processes • Continue internal interviews of D-tree management and staff to further refine initial findings • Continue scheduling and conducting external interviews with D-tree partners in TZ/USA and relevant mhealth contacts • Continue research into business models from relevant organizations • Validate progress meets D-tree leadership goals and project scope and refine as necessary Week 1: Product and Process Review v. 1.0