Strategic Planning Process

Strategic Planning Process August 28, 2011

Overview AGENDA • Agenda and process • mHealth ecosystem: What we read • mHealth ecosystem: What we heard • Perspectives on D-tree: What we heard • D-tree product strategy • Funding and business plans • Creating internal alignment • Strategy definition process • Appendix Week 1: Product and Process Review v. 1.0

Process AGENDA • Literature review • Reports from international agencies and organizations, D-tree published and working papers, external academic and industry articles • External interviews • 25 interviews with array of top leaders in mhealth, D-tree partner organizations, and donors • Internal interviews • Interviews and assessments with key staff in Dar es Salaam and Boston • Cumulative 11 weeks in Dar es Salaam • Project reporting, data analysis, and daily operations • Site visits and meetings with donors, peers, allies • Feedback and validation with D-tree management team • Regular check-ins throughout to summer to adjust research and validate findings • Final Report Week 1: Product and Process Review v. 1.0

mHealthecosystem overview Excerpts and analysis from the literature review

mHealth hits every part of the health system MHEALTH ECOSYSTEM Whole system efficiency improvement EpiSurveyor, Child Count+, disease surveillance, data mining EMRs Telstra/Ericsson breast cancer screening, 3G Doctor, Sana 12580 appt. booking (China), Frontline SMS: Medic, EMRs, Sproxil Medicine Link (China), MiQuit, Freedom HIV/AIDS, Mobile Medline Plus Wellcore emergency response, Orange Smartnumbers, Frontline SMS Directly observed treatments, Ginger.io, self-management applications

mHealth and health market innovations focus in the developing world and rural populations MHEALTH ECOSYSTEM Geographic mapping of programs with concentrations in South Asia and East Africa Target populations Target geography Source: CHMI

Health market innovations and programs can be categorized into 5 major areas of impact MHEALTH ECOSYSTEM • Organizing Delivery • Reduce fragmentation and informality of health care delivery 1 CHMI categorized program focus in more than 1000 programs documented 465 449 354 • Financing Care • Mobilize funds and give purchasing power to the poor 2 234 76 • Regulating Performance • Set standards, enforce and promote quality care 3 • Changing Behavior • Educate and train consumers and providers to seek and deliver better care 4 D-Tree has 6 programs categorized as Enhancing Processes with the sub-type Information Technology; total 264 programs in this category • Enhancing Processes • Apply new technologies and operational processes to improve quality, access or cost 5 Source: Center for Health Market Innovations

Organization type varies by impact area and within disease/health focus MHEALTH ECOSYSTEM Franchises make up the majority of family planning organizations that impact organizing delivering while service delivery networks and individual clinics dominate general primary care Franchising the prevailing method of family planning, but increasingly popular in other areas, emerging as potential mechanism of service delivery for prevention, screening, ongoing care. Service delivery networks and chains dominate maternal, newborn and child health, HIV/AIDS, TB, and general primary care; mergence of low-cost primary care chains and networks in rural and semi-urban settings (e.g., Kriti, LiveWell, CARE Hospitals, Saude 10, CommHealth) Week 1: Product and Process Review v. 1.0

As does legal status, funding type, and technology used MHELATH ECOSYSTEM Space still dominated by not-for-profit players with rise of partnerships Phones are technology used more than 50% of the time in health market innovations Nearly 60% of health market innovations are donor funded; percentage is far higher in the developing world; 75% are funded by government and/or donors Source: CHMI

Even if current focus on mhealth is a bubble, opportunity for ICT in healthcare is significant MHEALTH ECOSYSTEM Source: McKinsey GMSA Report

And mobile technology is particularly enabling in certain areas of need: MHEALTH ECOSYSTEM Area of need Examples • Bringing healthcare to unserved or underserved populations Poorest and most vulnerable “tend to live in areas that are remote, that have weak transportation links and limited physical infrastructure” Remote health workers and patients enabled through data and communication “The innovative use of mobile technology, can greatly diminish the time and distance involved in obtaining services” • Increasing the effectiveness and reducing the costs of healthcare delivery Standardization, capture and communication of patient and supply data enabled • Improving the effectiveness of public health programs (incl. research) and preventing illness (incl. behavior change) Communication to large populations—both targeted and general—is enabled “Facility-based care is costly; outreach and community solutions are highly cost-effective and accessible.” “Facility-based care is costly; outreach and community solutions are highly cost-effective and accessible.” • Treating chronic diseases, and keeping people out of hospital Remote monitoring and diagnostics of patients enabled to reduce costs China Mobile

Most projects focused on simple technologies and mostly public health communication MHEALTH ECOSYSTEM Of UNICEF’s 41 mhealth projects, the large majority use SMS technology Rapid SMS used for data gather/surveillance and health care worker communication Source: UNICEF, “Mobiles 4 Development,” 2010

Even organizations with resources to develop integrated technology are stuck in early stages MHEALTH ECOSYSTEM Of UNICEF’s 41 mhealth projects, most are in early stages (blast messages are considered “one-offs”) No projects yet have come to full-scale; “pilot-itis” widely cited through mhealth ecosystem yet projects still designed with structure to scale Barrier to scale is not technology or resources but systemic problems in fragmented ecosystem, human resource constraints, program and funding design Source: UNICEF, “Mobiles 4 Development,” 2010

Without careful planning, pilots stay small through structure of system and design of program MHEALTH ECOSYSTEM • Main drivers of “Pilot-it is” • Key features of projects that scale • Complexity and fragmentation of healthcare • Lack of historical data to assess points of greatest need/impact • Partners to make system change have own agendas • Strategic partnerships fit needs assessment and gaps • Knowledge of health system, IT systems, local context, gob’t, NGOs, access to funding • Clear responsibilities not bogged in admin/negotiations • Issue-driven funding insufficient to address system change • Organizations support own agenda and “add-on” technology • Projects addressing incremental effects are less expensive • Technology and design that can replicate and scale • Economies of scale are calculated: cost per additional must decrease • Defined strategy address specific problem or set of problems • Technology, user interface, etc. all designed to specific end-user • Metrics to track outcomes part of initial study design • Projects developed without vision of scale • Impact / efficacy not tracked to make funding case for scale • Systems built that cannot possibly scale to multiple sites

Pilots generally do not measure impact or effects with rigor necessary in regulatory environment MHEALTH ECOSYSTEM • Regulation not yet an issue in most developing countries: “[Mobile health applications] are acceptable to individuals and the healthcare sector on the basis of a common-sense view of utility and risk (without the need for lengthy academic or clinical trials or ethical review)” – China Mobile/Cambridge Study • Efficacy measured by project completion, number of users, etc., not impact • Impact data—and ability to produce data of this type—may be increasingly valuable when considering major ICT investments, increasing regulation of “diagnostic devices”, etc. • Metrics of note and baselines to measure Δs: • Demographics: Patients served, Providers served plus relevant demographics • Costs: cost per provider, cost per patient, systems savings • Health outcomes: diagnoses, treatments rendered, patients returned • Efficiencies: time/patient per visit, time/patient/year • Economics: life expectancy, death

An increasing entrance of major players threatens incumbents MHEALTH ECOSYSTEM • In past, proliferation of smaller, NGO-supported players and non-profits • But health IT potentially lucrative for large companies and other for-profits • Non-profits competitive advantage may be local knowledge and content production Source: China Mobile

Partnerships important but true partnerships represent very small percentage of programs MHEALTH ECOSYSTEM • Some 60% projects still donor funded; almost 75% donor or government funded • Only 22% defined as public-private partnerships and depth or structure of partnerships not reported. • Many partnerships from CSR divisions of companies are benefiting from large NGO/non-profit brands, not investing as part of core business • Due to systemic problems with scaling mhealth initiatives, growth of national ICT sectors, and sometimes large initial investment, private sector partnerships are desirable, particularly as national networks are accessed, but hard to do right • USAID has questioned whether the value of public-private partnerships truly exists; is time and money invested more valuable than direct investment in direct services in short-term and/or long-term? • Grameen/Intel • For-profit mentality of Grameen makes natural partner to other for-profits • Large Grameen org has natural internal partners in bricks & mortar clinics • Partner in strategic areas: tech development, channel strategy • Novartis / SMS for Life • Strategically planned from outset for partners to fill in strategic roles and necessary capacities • Clear MOU of partner roles/investments and MoH to pay for and run system • Clearly defined goal with clear 1-year end-point • Defined value proposition, simple solution

Different sectors have different capacities; role definition is key MHEALTH ECOSYSTEM In building strategic partnerships, find partners to fit necessary capacities and make roles explicit

Strategic partnerships are not just public-private MHEALTH ECOSYSTEM • UNICEF’s partner map UNICEF one of most recognizable NGOs with broad reach; partnerships are 90% non-profit and public sector Source: UNICEF, “Mobiles 4 Development,” 2010

mHealth ecosystem: What we heard Excerpts and analysis from external interview

Views on the current state of mhealth EXTERNAL INTERVIEWS It is what anyone would expect at the front end of a movement: exploratory, experimental, non-economic, non-systematic, problem-specific, solution-specific The culture is rapidly changing and becoming more accepting of a paradigm shift that involves mhealthat the forefront of public health The environment is dynamic and innovative and the range of applications being designed is constantly expanding A lot of interesting pilots are what characterizes mhealth right now but no one can boast impressive numbers of users All mhealthprojects are “add-on” functions to improve efficiencies in 1 or 2 small areas at UNICEF. Not being thought as a programmatic offering in and of itself. We’ve lost the plot in mhealthas of late. The funding has been siloedinto issue or geographic focus and the technologies are not being coordinated in a way that will lead to an interoperable system Source: External Interviews

EXTERNAL INTERVIEWS A mix of believers and skeptics on potential of mhealth Believers: Skeptics: mHealthis a passing fad to some extent. it is an overoptimistic notion to think that mHealth can solve problems with much deeper roots than the solutions that are currently available mHealth has a lot of power to create efficiencies in small areas but should be seen as a tool for the health system and not a means to address protracted health issues mHealth is way over-hyped. There is a lot of excitement but it is not going to be transformative because it is being implemented on top of a broken system. mHealth is similar to the Internet bubble. The mhealthbubble will burst. Finding out how to position an organization in an imminently bursting bubble is the main challenges of players in the mhealthecosystem. The potential for mhealthto transform healthcare delivery is incredible and is already happening Source: External Interviews

Though technology is transformative, ecosystem faces considerable challenges in creating more believers EXTERNAL INTERVIEWS Pilots and gadgets vs. Scale and systems: mHealth offers great potential but not in the way that it is currently being implemented. Not many pilots have succeeded because they were not conceptualized to go to scale but were instead focused on gadgets. This is less of a tech problem and more of a problem of the approach to doing such projects. Understanding, from conception, how the technology can be rolled out on a countrywide scale is essential to anything that will succeed. The hard part has been done—creating technology that can support an mhealthmovement. Now we have to think about the systems that will support radical change. The vast majority of people that are in mhealthare not systems people and do not have systems background so they’re focusing predominately on tech solutions (i.e. silver bullets) and not the systems. This is the current challenge. Siloes and interoperability We’ve lost the plot in mhealthas of late. The funding has been siloed into issue or geographic focus and the technologies are not being coordinated in a way that will lead to an interoperable system Source: External Interviews

Technology is not barrier, but key components may not yet allow growth and change EXTERNAL INTERVIEWS Governments are not on board: There is not enough understanding on the part of governments about how to guide the mHealth work being done in their countries. This is going to be a necessary component of ramping up support and funding if any of these technologies are going to scale. Scale is technologically possible but not with the current political and funding landscape. Governments are the only force that could take any of the mHealth pilots to scale. Proliferation of smart phones is making it difficult to think about potential to scale due to it being cost prohibitive unless there is a subsidy from the government or industry Governments are not ready to revamp their health systems using mobile technology. Most governments do not even have a policy in place. This needs to happen before seeing mHealth scale in a major way. Capacity/Human resources: People are eager to talk about the potential or technology but they overlook the human resources required to run these systems. We can get programmers, even local IT support but we are missing project management skills. We’re trying to build strength in local capacity but it is difficult when we have donors who want to see results within certain time frames Source: External Interviews

An added challenge in leadership: Who is responsible for setting the mhealthagenda? EXTERNAL INTERVIEWS Leadership Role of mHealthAlliance Donors set agendas and run on five-year, trending timeframes Not sure there are leaders as of yet The mHealth Alliance is convening cross sector groups including the ministry of commerce, transport, regulatory affairs bodies, ministry of health and education. The mHealthAlliance is trying to align all pieces of the puzzle Rockefeller and Gates must take the reigns and coordinate the movement. Tell people to be on one platform over another There is no regulatory body or global architecture that is coordinated to guide the progress in mhealthright now. We need to be thinking strategically and start setting targets at this point now that we have multiple actors working on many levels in the field. Without strategy or targets, we have no ability to compare data and don’t know the kind of impact that we’re making. Source: External Interviews

EXTERNAL INTERVIEWS No consensus on area of greatest need and/or impact and best technology Community Health Worker vs. Facility (Nurse) Smart Phone vs. Java Basic Phone • Pro CHW: • “CHWs are the holy grail right now” • Pro Facility: • “All the applications that are targeting CHWs are a fad and are less impactful. The tech will overwhelm CHWs, which would have negative health consequences” • Pro Basic Phone: • “The proliferation of smart phones is making it difficult to think about the potential to scale” • “It’s bull that you need anything more than a basic feature phone. The limiting factor is the behavioral issues not the technology” • Pro Smartphone: • “We all know what they can do but they have not trickled down to the field. It’s just a matter of time before they can be use effectively” Data suggests as many funders support facility as CHW programs Source: External Interviews

Sources of acceleration remain unclear EXTERNAL INTERVIEWS • Evidence can be powerful • Or not… • Anytime a RCT is published is a moment of acceleration in the field. Anyone can do a pilot. The real changemakers are the RCTs, which have the clout to demonstrate real change. Successful applications will drive growth, not evidence-based, academic research. People love to say that there is no evidence no mater what evidence is available. Evidence is useful and a lot of people are calling for it but it is not clear that these people are decision-makers. In fact, asking for evidence usually is a good indication that you are not a decision maker. Source: External Interviews

A few “market winners” are getting the majority of attention—Competition is increasing Week 1: Product and Process Review v. 1.0

Perspectives on D-tree:What we heard Excerpts and analysis from external interview

General impressions PERSPECTIVES ON D-TREE • Feedback was positive and encouraging • Confusion in terms of D-tree’s focus and mission CHW vs. Facility Rural vs. Urban Tanzania or cross regional What technology Role of HSPH Everyone wants to work with D-tree. They are at the forefront. Everybody wants to partner with them because they’re nice, smart, sincere, flexible, nimble, open. These are all characteristics of partners we want. D-Tree is specialized in maternal health and HIV D-Tree is innovating tools aimed at health system strengthening Mission is to find ways to empower rural healthcare workers to do their jobs better Trying to improve quality of care of CHW by using enabled phones They are mission driven and committed to achieving high quality work in Tanzania Source: External Interviews

Organizational strengths PERSPECTIVES ON D-TREE • Positive track record • In the right spaces at the right time • Pioneering new fronts of mHealth Board is invested and supportive of D-tree—demonstrates external belief in the organization’s mission and potential to transform healthcare delivery worldwide Creating the right protocols for the right parts of the world is what makes (or could make) D-tree indispensable D-tree’s Bihar project was phenomenal D-tree is at the leading edge of exploring more sophisticated use of mobile technology, especially when it comes e-IMCI Source: External Interviews

Organizational challenges PERSPECTIVES ON D-TREE • Org is structured and staffed to pilot and de-bug technology—not poised to scale • Dependent on Marc for driving vision, maintaining daily operations, securing partnerships—he’s wearing too many hats Disappointed with the development of current protocols as most repeatedly say “refer patient to doctor.” This presupposes that there is a doctor present. This is not always the case. Marc comes off as professorial and academic, not the prototype of entrepreneurs that high profile donors invest in Marc is D-tree’s greatest strength and weakness. In either case, he is what is driving the organization Committed, technical but lacking specialization in medical areas with some protocols such as the nutrition protocol in Zanzibar Good at pilots but too project focused—need more planning and evaluation of strategy Hesitant to step up and take on more responsibility with MoH in Tanzania Source: External Interviews

External challenges PERSPECTIVES ON D-TREE • Value of protocols does not translate to general public • Resistance to use of smart phones is a challenge for D-tree’s expansion • Funding landscape is only getting more crowded No one understands the value of protocols. There are no low hanging fruit when it comes to protocols. It is subtle. Getting people to adhere to protocols does not mean they are guaranteed to make better decisions. D-Tree’s strength is not the winning story in mHealth. The staff may see the value in it but others are not paying attention. It might be the case that people will never get excited about protocols no mater what anyone is saying CHWs are currently seen as the holy grail to improving health outcomes in the developing world Smart phones are prohibitively expensive and are a liability to CHWs Lack of overhead due to restricted funding

D-tree product strategy

Competitive Advantage D-tree’s current portfolio is diverse but competitive advantage is location-based PRODUCT STRATEGY • Evidence-based orientation: Research could provide evidence-base currently lacking in mhealth ecosystem • Harvard and academic affiliation • Published papers • Location-based: Tanzania office with local expertise • Contacts in local NGOs and government • Understanding of national context and experience in local customization • History of success piloting in TZ D-tree functions as solutions provider to wide range of projects, not developing deep expertise or reputation in a specific medical area or technology CA is limited to geography and even then has possible weaknesses in resources

D-tree is at an inflection point, having built credibility and now must define clear direction PRODUCT STRATEGY • From interviews and research, it is clear that D-tree needs to define its core offering with an understanding of internal strengths/weaknesses as well as the external environment • What is the demand for D-tree’s future core product? • Who are the current competitors? • Who is likely to enter ecosystem (i.e. future competitors)? 2008 2009 2010 2011 2012 on… • 2008-2011: • Built reputation as a competent solutions provider • Customized technology to context and implemented pilots from start to finish with focus on technology • Demonstrated ability to raise and manage $100-200K grants, partners Where to next? Continue status quo Continue with focus on M&E Specialize as product developer Consulting and research Hybrid of above

A more robust competitive advantage depends on building a defendable niche through org focus PRODUCT STRATEGY Decisions on direction start with a definition of D-tree’s organizational structure and focus: Custom solutions to projects for individual clients, from project design through implementation and training Single product or system of products that clients purchase with potential customization or add-on services Expertise in project design and evaluation offered as service to range of providers from MOH to start-ups

Benefits, drawbacks & differing considerations concerning internal structure exist for each option PRODUCT STRATEGY Week 1: Product and Process Review v. 1.0

Industry analysis and organizational position vary based on choice of org focus PRODUCT STRATEGY

Regardless of exact focus, D-tree should anticipate serious competitors in near future PRODUCT STRATEGY • Mhealth bubble in non-profit, NGO, academic, and private sectors  big players increasingly paying attention and recognizing value of access to certain markets (e.g., health applications as access to women) • Investment and expertise needed to bring mhealth solutions to scale does not exist in non-profit sector • Existing big player involvement, e.g., McKinsey consultant to Tanzanian Ministry of Health, will increasingly exclude small NGO and non-profit involvement, particularly for non-specialized providers • Large solutions providers, e.g., IBM, have the resources and experience to build complex systems rapidly and take advantage of economies of scale. Advantages include: • Components outside of mhealth sphere • Complex systems integration • Complex regulatory knowledge • Experience with large-scale roll-out • Internal EOS • Deeper pockets for trial and failure • Threats also exist from small innovators with specific products that are easily adapted • Increasingly, mhealth technologies from developed world will be adapted and available for emerging markets as BOP models increasingly viable Software development is cheap to do and hard to maintain an advantage in; to combat these threats and make a name for itself now, D-tree should adopt specific and deep expertise—do one thing really well

And be strategic about defining product outside current competitor’s expertise areas PRODUCT STRATEGY Product differentiation is essential to success of strategy Sana “Sana's mission is to revolutionize healthcare delivery for rural underserved populations. To this end, Sana provides an open-source Android-based telemedicine platform for clinical research and best-practice health care delivery.” Dimagi “Dimagi is an award-winning, socially-conscious technology company that helps organizations deliver quality health care to urban and rural communities across the world. At Dimagi, we build custom solutions that work in resource-poor settings, bridging the gap between developmental needs and technological constraints.” D-tree must present a clear, differentiated position among competitors

No structure is without flaws, but re-organizing as a product developer puts D-tree in the best position PRODUCT STRATEGY • Achieve Scale beyond pilots given resources required • Effective develop internal assets • Compete against a likely less expensive and more agile Dimagi • As a solutions provider: CANNOT • As a research and consulting: • Currently attract the necessary talent and clients given current staff, scale, and reputation at present • Compete against large consulting organizations and NGOs • As product-focused organization: • Use current assets to differentiate against competitors • Create internal expertise and external niche strategy • Scale one core product in multiple locations CAN • Strategy analysis: • External compatibility (within industry): Increasing competition in all areas where provides solutions • Internal compatibility (within organization): Have internal assets in M&E, training, admin, grant writing • Sustainability: Best option for sustained competitive advantage

A long-term view reveals hybrid possibilities in future PRODUCT STRATEGY Solutions Provider Product Developer Research/Consulting In short-term, D-tree must maintain contracts as solutions provider and will function as a hybrid of solutions provider and product developer Over time, D-tree should transition away from solutions provision and use extensive experience to be a hybrid of product developer and research/consultant

To determine product strategy, consider D-tree’s assets Assets: • Content:e-IMCI (validated) • Organizational: local knowledge of Tanzania, good reputation • Partnerships:UNICEF, relationship with Ministry • Affiliations: Harvard, Norad? • Technology:OpenMRS, select protocols Week 1: Product and Process Review v. 1.0

Defining a core offering as a product developer, requires decisions in multiple areas PRODUCT STRATEGY • Content • Focus area • Point of Impact • Demo- / Geo-graphy • Hardware • Software • Client Decision support for referrals MOH/WHO-approved medical protocols Custom protocols Data entry Medical record systems • Maternal health • FP • ANC • Child health • Nutrition • IMCI • HIV/AIDS • TB • Chronic disease • Facility • Doctor • Nurse • Counselor • Lab • Community • CHW • TBA • etc. Rural Urban Tanzania East Africa Africa South Asia Developing world Cross regional Basic phones Android Tablet computer CommCare ODK Collect Mango Logic OpenMRS Others Local NGOs International NGOs Ministry of Health Private sector Academia

Recommended potential areas of focus and differentiation, either alone or together PRODUCT STRATEGY • Content • Focus area • Point of Impact • Demo- / Geo-graphy • Hardware • Software • Client Decision support for referrals MOH/WHO-approved medical protocols Custom protocols Data entry Medical record systems • Maternal health • FP • ANC • Child health • Nutrition • IMCI • HIV/AIDS • TB • Chronic disease • Facility • Doctor • Nurse • Counselor • Lab • Community • CHW • TBA • etc. Rural Urban Tanzania East Africa Africa South Asia Developing world Cross regional Basic phones Android Tablet computer CommCare ODK Collect Mango Logic OpenMRS Others Local NGOs International NGOs Ministry of Health Private sector Academia Given analysis of mhealth ecosystem and competitors, specialized, tested, and bug-free products are best positioned for growth and success

A deep dive into recommended selections reveals reasoning PRODUCT STRATEGY • Focus area • Point of Impact • Demo- / Geo-graphy • Content MOH/WHO approved medical protocols Medical record systems • Maternal health • FP • ANC • Child health • Nutrition • IMCI • Facility • Doctor • Nurse • Counselor • Lab Urban Tanzania • Creating e-protocols from validated MoHor WHO paper protocols positions D-tree for: • Closer relationship with MoH/WHO • Less time creating protocols internally • More medical credibility • Easier transfer among countries • Validated protocols as core, not tech • Already considerable strength in this area, may as well state it as such: • Considered MCH organization by some donors/NGOs • Significant % of current and available funding • Trending but fits well into general care • Can include PTMTC within vertical • Facility focus best D-tree from competitors and integrates better into the health system: • Complexity of protocols/technology more easily adopted in facilities • Only facilities have HR and resources to manage smartphones • Only facilities can give treatment • Mostly recommendations for short-term focus: • Demography: • Urban populations generally better educated and invest more in healthcare • Urban populations less expensive to reach • Geography: • Work only at district level • Local knowledge and advantage in TZ

Decisions on content and point of impact will determine appropriate software and hardware choices PRODUCT STRATEGY • Software • Client • Hardware Android ODK Collect Open MRS International NGOs Ministry of Health • Though speed of adoption of 3G technology slower in most developing countries, this hardware best suited to complex medical protocols • Video, phone capability for product expansion • Software and open source discussions often a foil: technology matters less than functionality. That said, ODK Collect has a community behind it and a pool of developers • Additional productdecision about whether software designed only for programmers or can be authored by practitioners • NGOs and MoH most eager to add tech component to work and need contractors to do so, but client selection is less about which clients D-tree chooses, and more about howD-tree does business development • Proactive instead of reactive • Identify strategic partners to fill capacity needs and invest time and energy into development, e.g., instead of leadership going to TZ 4x yearly, go to Geneva to meet WHO • Only partner with NGOs who commit money and resources to taking on project themselves at completion

Scenario analysis: e-IMCI to scale PRODUCT STRATEGY • Content: eIMCI with OpenMRS to scale/evaluate • Focus Area: Child Health • Point of Impact: Facilities, doctors and nurses • Geography: District-level and above, start in TZ  expand to three countries • Demography: Urban and rural • Hardware: Agnostic, may be easier to scale with basic now, even if it’s not ultimate goal • Software: ODK Connect, existing • Client: UNICEF, WHO, MoH and district-level health offices Program sesign Why it works • D-tree among organizations most familiar with protocol, proof in ability to roll out and evaluation • Capitalize on research study • Most complex protocol in portfolio  use as standard for level of work • WHO / MoH validated in many countries  ease of adoption • Strong ties to UNICEF / WHO  ability to move more easily to another country • Ability to add-on additional content and features, be incremental (e.g., maternal, adolescent, dynamic/probabilistic decision support) • Significant funding available

Design the system for scale PRODUCT STRATEGY • Build incentives to ease adoption, create demand • Frontline provider • Doctor • Patient • Eliminate roadblocks • Contract local external hardware managers • Evaluation • Determine metrics to measure impact at outset • Track what happens after referral • Growth strategy • Know where want product to go next (e.g., maternal, probabilistic decision trees, authoring tool, etc.) and design for compatibility

Strategic Planning Process