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 8 July 2011

2. Week 1 Progress Report • Goals and Process • Initial Findings • Key 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 targeteddifferent 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. Step 1: Define Capacity Legend: Strong Sufficient Needs Improvement INITIAL FINDINGS: PROCESS

11. Step 2: Design INITIAL FINDINGS: PROCESS

12. Step 3: Develop INITIAL FINDINGS: PROCESS

13. Step 4: Refine INITIAL FINDINGS: PROCESS

14. Step 5: Pilot

15. Step 6: Evaluate

16. Step 7: Internal Reflection/Analysis/Refinement INITIAL FINDINGS: PROCESS

17. Summary Week 1: Product and Process Review v. 1.0

18. Note on Organizational Capacity: • 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 notmaximized 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

19. Other Processes INITIAL FINDINGS: PROCESS • Other important core processes at D-tree include Business Development before project initiation, and marketing and communication of projects and the organization • 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 * Understood process outlined on slide X Week 1: Product and Process Review v. 1.0

20. Business Model (1/2) INITIAL FINDINGS • Previous slides begin to lay out aspects of formal business model*: * Standard 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) Week 1: Product and Process Review v. 1.0

22. Product STRATEGIC QUESTIONS • What is target health provider: • Community health worker Week 1: Product and Process Review v. 1.0

23. KEY STRATEGIC QUESTIONS • Why are these are questions • What we hope to achieve from this discussion Week 1: Product and Process Review v. 1.0

24. Closing Thoughts • Has D-tree become excellent and project implementation but is not organized to scale? Week 1: Product and Process Review v. 1.0

25. Next Steps WEEK 2 AGENDA Week 1: Product and Process Review v. 1.0