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Unlocking Opportunities for People and Communities in Tanzania Annual Report 2015 1


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Photography courtesy of Sala Lewis (Cover, pp 2, 5, 7, 13, 14, 17, 23, 25, 29, 30, 35, 36, 39, 52, 56, 58, 59, 72), Benjamin Eagle (pp 6, 8, 10, 21, 40, 41, 45, 49, 70), Dieter Telemans (pp 26 & 50), Young Zhan (pp 62 & 67, Sameer Kermali (p24), Mark Tuschman (p64). All other photos courtesty of CCBRT/Kupona Foundation. No images in this document may be reproduced without the prior consent of Kupona Foundation.

Table of Contents Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 A Word from Our Sister Organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Why Tanzania? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 CCBRT: A Leader in Local Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Our Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Unlocking the Potential of People and Communities . . . . . . . . . . . . . . . . . . . . . . . 14 Making Motherhood Safe for Tanzanian Women and Their Newborns . . . . . . . . . . . . . . . . . . . 15 Family Planning: The Power of Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Rebuilding the Lives of Women with Obstetric Fistula . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Socio-economic Empowerment for Women with Obstetric Fistula . . . . . . . . . . . . . . . . . . . . . 34 Bringing People with Visual Impairments Out of the Darkness . . . . . . . . . . . . . . . . . . . . . . . . 38 Restoring the Smiles of Children with Cleft Lip/Palate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Helping Tiny Feet Take Their First Steps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Improving the Mobility of Children with Burn Scars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

Enabling the Sustainable Growth of Life Changing Programs . . . . . . . . . . . . . . . . . 52 Eliminating Waste and Improving Efficiency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Supporting CCBRT’s Evolution into a Social Enterprise . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Addressing Skilled Human Resources Shortages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Building a Bridge Between the U.S. and Tanzania . . . . . . . . . . . . . . . . . . . . . . . . . 62 Guiding Our Journey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Governance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Financials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 With Special Thanks To . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

Looking Ahead to 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72

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Foreword When we consider Kupona Foundation, CCBRT and the future of our partnership we always come back to one thing: opportunity. Our programs are unlocking opportunities for people in Tanzania that had been stolen from them by a lack of access to quality healthcare. Receiving an education and securing meaningful employment is more likely when a person is healthy. This is transformative – not just for the individuals in question, but for their families and communities too. We also see huge opportunity for individuals and institutions in the United States. We enable our supporters to feel connected to tangible impact and to play a direct role as part of a community that is changing lives. We empower our supporters to invest in programs with the confidence that they combine transparency, sustainability and creativity, driven by a deep rooted understanding of the local context. 2015 was Kupona’s most successful year yet, mobilizing over $1 million in financial and in kind support for a range of programs, all designed to provide high quality services not only for the people in need of care today, but for future generations. This is more than double our programmatic spending in 2014. We’d like to take this opportunity to thank all of our supporters for the role you have played in Kupona’s growth in 2015, and for your contributions to unlock the potential of people and communities living in poverty in Tanzania. Following four years of committed leadership, Yoni will step down as Chair of the Board of Directors in 2016. Yoni will continue to serve as a member of Kupona’s Board, and is looking forward to supporting the incoming Chair and their vision for the future of our organization. We hope that this Annual Report will provide an encouraging update to our current donors and partners, and entice new supporters to join us. Stories of individual lives changed, figures that depict the scale of our collective impact, and testimonies from fellow members of our community all come together to encapsulate a year where we embraced opportunities to unlock potential like never before. We’re excited to see what 2016 will bring.

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Abbey Kocan

Dr. Yoni Barnhard

Executive Director

President, Board of Directors


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A Word From Our Sister Organization 2015 was a key milestone in CCBRT’s organizational development. We implemented several initiatives to increase efficiency and improve quality, and broke ground on our new private clinic to scale our social enterprise model in order to become more financially independent. Knowing that we have the dedicated support of Kupona, our little sister, is so encouraging to the team here in Tanzania. With Kupona tapping resources we would otherwise struggle to access, we at CCBRT are able to focus on our two biggest priorities: our patients and our people. The financial support for service delivery and training, the advice from technical experts, and the supplies donated in kind provide comprehensive support for our full range of programs, helping us to manage significant growth without compromising quality. Kupona’s unrelenting focus on finding the best solutions for the local context, and their commitment to uncovering creative ways to help us realize our ambitious goals, means that we never feel alone. They adopt our vision as their vision, our challenges as their challenges. They are an invaluable part of our team. Thank you to the entire Kupona community for your contributions to our success in 2015, and congratulations on achieving the biggest year in Kupona’s history. Lives and communities have been changed by your support.

Erwin Telemans CEO, CCBRT

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Background Kupona Foundation (Kupona) is a nonprofit committed to unlocking the potential of people and communities living in poverty in Tanzania. It starts by improving their access to quality, comprehensive healthcare. Kupona’s vision and mission are directly aligned with our sister organization, CCBRT (Comprehensive Community Based Rehabilitation in Tanzania). CCBRT is a leading provider of affordable, high quality healthcare in Tanzania. Together, we fuse sustainable strategies and transparent practices with deep rooted local expertise to direct resources to programs with the greatest potential for long term change. Our collaborative partnership with CCBRT gives individuals and institutions in the United States the opportunity to foster direct, local impact, empowering people and communities to realize their full potential. Kupona convenes a community of donors, technical experts, advocates and volunteers to find and support creative ways to mobilize resources and activate awareness, with a view to enabling CCBRT’s lifechanging programs and sustainable growth. Together, we can change the face of healthcare in Tanzania, and set people and communities on the road to a brighter future.

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Why Tanzania? Healthy people build healthy communities. Tanzania is a relatively low risk country with a growing economy. However, despite promising economic growth,

67% of the population lives on less than $1.25 a day. Poverty levels indicate a significant need for support. The wider political and economic climate means that a donation towards the development of Tanzania has the potential to make a significant long term impact.

Capital City Dodoma

Region East Africa

Population 47.6 million

Area 364,000 sq. miles

Currency Tanzanian Shilling

Official Language Kiswahili

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CCBRT: A Leader in Local Care Starting as a small Community Based Rehabilitation unit over 20 years ago, CCBRT has grown to be the largest indigenous provider of disability and rehabilitation services in Tanzania. Focused on providing healthcare for poor and marginalized members of the community, CCBRT provides high quality clinical and rehabilitative services for people with impairments such as obstetric fistula, cleft lip/palate, cataract and clubfoot. In order to lay the foundation for sustainable healthcare service delivery, CCBRT works in partnership with the Government of Tanzania. Together, they improve the quality of care provided to mothers and newborns in public healthcare facilities and conduct nationwide health education campaigns to empower individuals to seek the care they need. Every year, through treatment, training and advocacy, CCBRT changes the lives of over 1 million people in Tanzania.

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Our Model

Fundraising Kupona Foundation mobilizes funding from institutional partners and individuals in order to fund life changing programs.

Capacity Building Kupona Foundation connects CCBRT with highly skilled individuals, able to fill critical resourcing gaps on the ground and train the teams in Tanzania.

Strategic Storytelling Kupona Foundation raises the global profile of our partnership with CCBRT, strengthening our capacity to mobilize support and raise awareness around the causes we champion.

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Impact by the Numbers: OVER OVER

life changing programs

2 partnerships

with top tier business schools

Over $90,000 of equipment and supplies distributed

to public healthcare facilities

332 people gained access to family planning services and advice

dignity restored to

920 women living with obsetric fistula

people able to see

delivered safely at supported facilities

repaired

the world around them

78,000 babies

397

smiles

7,800

$1 million

provided in support of

619 new patients enrolled in the clubfoot treatment program 12


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Unlocking the Potential of People and Communities It starts with their health. Improving an individual’s access to high quality healthcare creates a ripple effect that reaches far beyond the individual. At optimal health, people are able to access the educational and employment opportunities they need to build safe and healthy futures for their family, and become active and productive members of their wider community. Kupona Foundation supporters enable the provision of a range of high quality, affordable healthcare services for vulnerable groups, and facilitate health system strengthening initiatives that improve the quality of care for future generations.

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Making motherhood safe for Tanzanian women and their newborns Tanzania is one of the most dangerous places in the world to become a mother. Every year 8,000 women die as a result of pregnancy or childbirth related causes. 160,000 more develop an injury, infection or disability like obstetric fistula. Every year 39,000 newborns won’t survive their first month of life.

Over 80% of these deaths are preventable. In urban areas like Dar es Salaam, rapid population growth places deadly strain on the healthcare infrastructure, leaving hospitals overwelmed and ill-equipped to manage the volume of patients. Kupona Foundation supports CCBRT’s efforts to address the root causes of maternal and newborn mortality in the Dar es Salaam region.

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Dar es Salaam is one of the fastest growing cities in the world. The city’s healthcare infrastructure was built to serve

~750,000 people.

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The current population is over 4 million, projected to exceed 7 million by 2025.


Building capacity for quality care CCBRT works with 22 public healthcare facilities in Dar es Salaam in close partnership with the Government of Tanzania. Through direct collaboration with clinical and managerial teams, CCBRT builds capacity and ensures that patients presenting at these facilities get the quality of care they deserve. In 2015, Kupona connected CCBRT with financial and technical support for this life saving, game changing program.

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What does ‘building capacity’ actually mean? Training & Mentoring

Embedding technical advisors in clinical teams to provide skills training and on-thejob mentoring for all cadres of frontline healthcare workers.

Equipment & Supplies Distributing life-saving equipment and supplies to public healthcare facilities to ensure clinical teams have the tools they need to do their jobs.

Infrastructure Development Refurbishing operating rooms and labor wards to improve patient flow, physical accessibility and patient experience so that every woman and child receives high quality, respectful care: no exceptions.

Data Collection & Analysis Strengthening data collection practices and training teams in monitoring and evaluation so that every death, incident and success is counted, evaluated, and learned from.

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In 2015, over 78,000 babies were delivered safely at supported sites. CCBRT distributed

over $90,000

of critical equipment and supplies to public facilities.

CCBRT provided training and mentoring to 473 healthcare workers across the region.

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Safe surgery: Filling critical skills gaps in Dar es Salaam In 2015, Kupona continued to fund the secondment of Dr. Sierra Washington, a Harvard trained OB/ GYN, to CCBRT. Thanks to the support of Kupona donors, Dr. Washington was able to provide focused and high quality surgical skills training at a facility with one of the highest caseloads in Dar es Salaam, and adapt and implement new safe surgery checklists based on WHO guidelines at all sites. Dr. Washington took the lead in addressing two of the biggest risks to maternal health in the region - a lack of access to adequate safe blood supplies and the unmet need for family planning. She was instrumental in developing plans and securing necessary approvals to establish a dedicated blood bank at CCBRT Maternity and Newborn Hospital, and in developing a strategy for integrated family planning services across the spectrum of care at the new facility. Dr. Washington also instigated the formalization of academic partnerships through a consortium model, structuring the way CCBRT will work with academic institutions for knowledge exchange, capacity building and research in the future.

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Prevention is better than cure Quality maternal and newborn healthcare is critical to the prevention, early identification and treatment of impairments, whether congenital or acquired during pregnancy and childbirth. In addition to broader improvements to the quality of care available to pregnant women, CCBRT also builds capacity for early identification and referral of impairments. In 2015, over 600 patients under the age of 5 were referred from supported sites for further treatment at CCBRT’s Disability Hospital.

A donation of $535 will provide a safe, quality delivery for mother and child.

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Since CCBRT’s maternal and newborn healthcare capacity building program began in 2010:

The maternal mortality rate in Dar es Salaam has fallen by 30%. The average quality of care score across the 22 supported facilities

is now nine times higher. 22


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CCBRT Maternity and Newborn Hospital A critical new addition to the healthcare infrastructure in Dar es Salaam, CCBRT Maternity and Newborn Hospital will be a specialist referral center for emergency deliveries, high risk pregnancies, and sick newborns. In 2015, the team continued to make progress with detailed operational planning and recruitment for the new facility. New recruits are currently serving as Technical Advisors to the capacity building program, in advance of taking on their clinical duties when CCBRT Maternity and Newborn Hospital opens in 2018. Support services at the new facility are designed to provide integrated support for both CCBRT Disability Hospital, and CCBRT Maternity and Newborn Hospital. In 2015, the medical store and laundry became the first departments in the new facility to start serving patients. In October, the two units were officially inaugurated by the then President of Tanzania, His Excellency Jakaya Mrisho Kikwete.

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Due to open in 2018, CCBRT Maternity and Newborn Hospital will conduct

12,000 safe deliveries each year. The nine block facility covers over “CCBRT has been so helpful to us through the trainings they provide. Now, thanks to my training from CCBRT, I can deliver babies using the vacuum technique and handle emergencies like eclampsia and postpartum hemorrhage. My facility is performing so well now. Before the trainings, the health center scored 12% on baseline quality assessments. Now, it has scored 95%.” –Nia, Assistant Nurse In-Charge, Buguruni Health Center, Dar es Salaam

236,000

square feet. To date, CCBRT and partners have invested

$10.3 million in this project: an investment in the health of future generations.

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Family Planning: The power of information Access to family planning information and services is critical to empowering people to make informed decisions about their sexual and reproductive health. Thanks to the generous support of Kupona donors, in memory of Tim Manchester, CCBRT has been able to establish family planning services at Tim’s Corner, a kiosk and clinic at CCBRT Disability Hospital.

Refurbished in 2015, Tim’s Corner is a place to buy what you need and learn something new. The kiosk sells a range of snacks, phone credit and toiletries, while also displaying informational and educational materials on family planning. Consultations and family planning services are also offered in the discreet clinic next door, where a trained nurse provides confidential advice and access to contraceptive options, including male and female condoms, pills, injectables, IUDs and implants. In 2015, 332 people sought family planning services at Tim’s Corner, almost three times the number that visited in 2014. The Tim’s Corner nurse, Stella, was also trained in cervical cancer screening, expanding the services available. As part of efforts to promote family planning and the services available at Tim’s Corner, the team celebrated World Contraception Day and Valentine’s Day. Distributing information and free condoms to CCBRT Disability Hospital clients and staff, Tim’s Corner noted a 60% increase in kiosk customer traffic during the holiday celebrations.

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Rebuilding the lives of women with obstetric fistula Eradicated from the U.S. in the early 20th century, it is estimated that up to 3,000 Tanzanian women develop obstetric fistula every year due to a lack of access to quality healthcare during pregnancy and delivery. The stigma associated with their condition leaves women isolated from their families and communities and unable to work. Women with fistula are some of the poorest and most marginalized people in the world. A lack of awareness around the condition and treatment available means that thousands of women go untreated every year. Consequently, there is an estimated backlog of 21,400 women living with chronic incontinence without seeking medical care. Kupona Foundation’s partnerships with Johnson & Johnson, Fistula Foundation and Direct Relief have restored the dignity of thousands of women to date, helping raise awareness about the availability of treatment and supporting both clinical and rehabilitative programs at CCBRT.

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Obstetric fistula is a debilitating childbirth related injury that causes chronic incontinence as a result of prolonged, obstructed labor. CCBRT manages one of the largest fistula treatment programs globally, which is designed to treat both the physical and psychosocial effects of the condition. CCBRT provides surgery, rehabilitation, food, transportation and accommodation in the hospital free of charge. An innovative application of mobile money transfer technology, known as “TransportMyPatient,” uses cell phones and a network of trained ambassadors to facilitate patient referral, dramatically increasing the number of patients able to seek treatment. During an average three week stay in the hospital, patients participate in holistic therapy sessions including counseling, music, and art therapy as a starting point in their psychosocial rehabilitation. As part of efforts to bring high quality care closer to the community, CCBRT has established a network of six satellite fistula service providers across the country. Every facility has been assessed against CCBRT’s high standards of care, and receives financial support for the provision of high quality fistula surgery. Accredited by the International Federation of Gynecologists and Obstetricians (FIGO) as a training center for fistula surgeons in 2014, CCBRT’s team shares their skills and collective experience in fistula treatment to build the capacity of the next generation of fistula surgeons.

A donation of $700 provides a dignity restoring fistula surgery for one woman.

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In 2015, CCBRT restored dignity to 920 women with obstetric fistula, at its Disability Hospital in Dar es Salaam and through satellite facilities across the country.

Over 1,600 ambassadors volunteered to identify and refer women with obstetric fistula.

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CCBRT trained 10 fistula surgeons from across Sub-Saharan Africa.


Miriam’s Story When I went into labor with my third child, my husband and I were so excited to meet our new baby. We had been waiting many years for another child. After 12 hours, we knew there was a problem. This child did not come as easily as my other two children and after hoping for many hours that she would come, my husband took me to the nearest hospital for care. When we arrived, doctors performed an emergency surgery [Caesarian section], but it was too late. My baby did not survive. After the surgery I realized that I was leaking. My doctor told me that it was caused by obstetric fistula. I stayed at the hospital for one month to recover from the delivery, but I was told that there were no doctors nearby that would be able to treat to my fistula. When I returned home I tried to farm with my husband, but the constant leaking made it very difficult. Selling our crops is the only way we make money for our family and I felt very bad not being able to provide for them. One day, I met another woman in my village who had also developed fistula too. She had been treated at CCBRT. This woman told me that she was sure they would be able to treat my fistula as they had treated hers. My neighbor introduced me to a CCBRT fistula ambassador who was able to buy my bus ticket to Dar es Salaam using the money CCBRT sent by mobile phone. Just a few days after arriving at CCBRT, I received treatment. After surgery I realized my prayers were answered and I would no longer have to live with the shame of leaking. I am looking forward to starting to farm with my husband again. Now that I am cured, I will be able to assist in increasing my family’s income.

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New partnership announcement: Direct Relief & Kupona Foundation In 2015, Kupona Foundation was delighted to welcome Direct Relief to our community of partners. Direct Relief’s support has already facilitated vital equipment and systems upgrades to the operating rooms at CCBRT Disability Hospital. The investment will allow CCBRT to continue to provide high quality surgical care for thousands of patients every year, including the 527 fistula patients who received surgery at the hospital in 2015. Upgraded equipment has also unlocked better training opportunities for surgeons from across the continent. We are encouraged by the potential of this new collaboration, and look forward to working together to improve the health and lives of people living in poverty in Tanzania.

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New beginnings: Socio-economic empowerment for women with obstetric fistula. The Mabinti Center, ‘Mabinti’, is a socio-economic empowerment program for women recovering from obstetric fistula. An extension of CCBRT’s holistic treatment program, Mabinti runs a 12-month intensive training course for 10 women every year. Teaching sewing and other craft skills, as well as product design, business skills, numeracy and English, the program empowers women to become financially independent. Graduates from the Mabinti Center leave with the skills and confidence to start their own small business or secure steady employment. Committed to the long term well-being of every trainee, Mabinti also provides follow up support for graduates for one year after the end of their training to help guide the women during the challenging early days of independent entrepreneurship. The Mabinti Center operates as a social business, covering 50% of its expenses through revenue generated by product sales. The Center employs graduates in its production unit, tasked with making products for sale in the Mabinti Center showroom, at local craft fairs and to fulfill international orders. Recognizing the unique support fistula survivors can give to women awaiting treatment, Mabinti Center graduates also host crochet workshops on the fistula ward at CCBRT’s Disability Hospital twice a week. Having a trainer who has experienced fistula, and is thriving after treatment, provides a source of comfort and inspiration during the women’s recovery.

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In 2015, 10 women graduated from the 12-month Mabinti Center training program. 589 patients at CCBRT Disability Hospital were taught crochet by a Mabinti graduate.

8 graduates were employed in the Mabinti Center production unit.

Age of trainees ranged from

18 to 32 years old.

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In 2015: CCBRT provided over

86,000 eye consultations – the first step to providing sight restoring treatment.

CCBRT conducted over

7,800 surgeries for a range of visual impairments.

CCBRT trained 25 nurses as ophthalmic assistants, 4 Assistant Medical Officers to specialize in ophthalmology and 2 Medical Ophthalmology Residents.

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Bringing people with visual impairments out of the darkness Estimates suggest that over 740,000 people in Tanzania live with a visual impairment. These impairments create significant barriers to opportunity, limiting education and employment prospects, and restricting access to healthcare and other public services.

Did you know? 70% of blindness and moderate-severe visual impairment in East Africa is treatable. One of only three facilities equipped to provide specialized pediatric eye care, and the only facility to provide prosthetic eyes in the country, CCBRT is a leading provider of high quality, comprehensive eye care services in Tanzania. Given the volume and variety of their patient caseload, CCBRT Disability Hospital is also a sought after field placement for clinicians training in ophthalmology.


Cataract is the world’s leading cause of blindness. In 2015, Kupona Foundation’s continued partnership with WonderWork contributed to the treatment of 291 pediatric cataract patients, restoring their sight and unlocking the opportunities that abound with access to education.

A donation of $300 will provide a sight restoring surgery for a child with cataract.

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Restoring the smiles of children with cleft lip/palate Around 2,500 children in Tanzania are born with a cleft lip/ palate every year, an impairment that can have a severe impact upon nutrition and speech if left untreated. Stigma associated with the condition also leads to children being excluded from community activities, and bullying causes many children and young adults to leave school before completing their education.

Did you know? Malnutrition in children with cleft lip/palate, painful mobility in children with clubfoot or other orthopedic impairments, and learning difficulties for children with lowvision can all be prevented if medical teams present at childbirth have the training to identify and refer birth defects in the delivery room.

Cleft lip/palate can be corrected by surgery, and if treated early the impairment can be corrected before it has a significant impact upon a child’s development. In 2015, Kupona Foundation continued its long standing partnership with Smile Train to provide surgery for children with cleft as well as supporting training for surgeons from other facilities in Tanzania, building the capacity for cleft lip/palate care nationwide.

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In 2015, CCBRT restored the smiles of 397 patients. CCBRT trained

80% of patients received free transportation to the hospital through TransportMyPatient.

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3 surgeons to provide high quality care for children with cleft/lip palate.


Sharifa’s Story Sharifa is 11 months old and the youngest of three children. When her mother, Lucy, first saw Sharifa’s cleft lip/palate, she knew something was wrong, but was not familiar with the condition. “I was worried that Sharifa was not feeding, and that she might not grow. My family told me to send the baby to the hospital for treatment. No one explained the causes, but they insisted that Sharifa needed surgery. At our local hospital, the nurses encouraged me to take Sharifa to CCBRT. It took us two days to get to CCBRT by bus. Thankfully, one of the nurses from my local hospital helped to pay for the ticket. Sharifa needs to have two surgeries. I am so happy that CCBRT’s services are free for Sharifa. I would not have been able to afford two surgeries. I am not nervous about Sharifa’s treatment, because during our time at CCBRT I have already seen other babies going in for surgery and coming out well. I hope that the surgery will allow Sharifa to fit in with other children in our village. Perhaps she will soon be able to feed herself. I would love for Sharifa to be a doctor one day, just like the doctors and nurses she has met at CCBRT.

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Helping tiny feet take their first steps Clubfoot is a debilitating congenital impairment that causes the foot to turn inwards and downwards. The deformity worsens as a baby’s foot grows, and if left untreated a child with clubfoot will be unable to walk properly. As many as 2,200 children in Tanzania every year are born with clubfoot. If identified early, clubfoot can be treated without invasive surgery, instead using braces and casts to manipulate the feet into the correct position. CCBRT advocates for this course of treatment, known as the Ponseti method, wherever possible. It is widely considered to be the gold standard of clubfoot care globally, avoiding unnecessary pain and discomfort for the child. Kupona Foundation’s partnership with WonderWork supports the provision of care to hundreds of children with clubfoot every year. CCBRT’s clinical team not only provides high quality clubfoot services at the CCBRT Disability Hospital, but also trains clinicians at other facilities in Tanzania to provide the same standard of care, bringing services closer to the children in need. In 2015, CCBRT teams traveled to Iringa Regional Hospital to conduct clubfoot treatment and train healthcare teams. In addition, as part of the maternal and newborn healthcare capacity building program, CCBRT’s team trained physiotherapists and a doctor at three public facilities in Dar es Salaam, empowering them to establish weekly clubfoot clinics in their facilities and improve the frequency of early identification and referral of impairments like clubfoot.

A donation of $160 will provide a full course of treatment for a child with clubfoot.

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CCBRT treated 619 new clubfoot patients using the Ponseti method across three facilities in Tanzania. By the end of the year, CCBRT had over

CCBRT has

700 patients registered for long term treatment for clubfoot.

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CCBRT conducted 175 surgeries for complex clubfoot cases.

13 Ponseti trained clinicians on staff.


Nelson’s Story Nelson was brought to CCBRT at just one month old. When his mother, Monica, delivered Nelson at a Dar es Salaam hospital, the nurses told her the baby had clubfoot and she should come to CCBRT. “At the beginning it was really disturbing me, but I started feeling better because relatives were encouraging me and telling me it is a normal thing. So now I feel OK. At least nowadays people are aware about this abnormal condition. They used to wonder ‘what happened? Why is the baby like that?’ But people understand more now so it is not too bad. We heard about CCBRT through television ads, and the nurses at the hospital where I gave birth. We would not have been able to pay for Nelson’s treatments, so we’re really grateful that CCBRT provides the treatment for free. In the beginning the CCBRT staff told us that Nelson might need surgery, but we’ve seen results using only the casting. I can already see it working, I can see a real difference in Nelson’s feet. I’m so happy CCBRT is here. Before, there was nowhere for people with disabilities to go. Now there is a place for parents and children to find treatment and comfort. I think CCBRT is the best hospital, especially as a disability hospital. After his treatment, I hope that Nelson will be well, and be like a normal child. I hope that he gets a good education, walks and can play sports with other children.”

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Improving the mobility of children with burn scars Burn injuries are common in Tanzania, particularly affecting children, due to the widespread use of open flames for cooking and indoor light sources. If left untreated, burn scars can cause muscle and bone to fuse, causing severe pain and seriously impeding mobility. Burn scars are costly to treat, requiring complex surgeries, prolonged stays in the hospital, and physiotherapy. Given the unexpected nature of a traumatic injury, the medical costs are unplanned and place a serious financial burden on a family already living in poverty. Kupona Foundation’s partnership with WonderWork supports the provision of burn scar treatment at CCBRT Disability Hospital, helping CCBRT to provide services for free for children under 5, and at heavily subsidized rates for older patients. In 2015, CCBRT provided skin grafts, contracture releases and comprehensive physiotherapy for 70 people with burns, 67 of whom were under 18 years of age.

A donation of $600 will cover the cost of one surgery for a child with burn scars.

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Angelica’s Story Angelica was 9 months old when she fell into the fire in the kitchen. As a baby she was in severe pain, but Angelica’s parents didn’t understand the full consequences of her injuries until she was older. “At first, because she was so young, Angelica was nursed and fed by members of our family. As she grew older, scarring meant that she couldn’t feed, wash or dress herself as other children would. Her injuries also meant that she was unable to attend school, even though she was desperate to learn and play with other children. Our community joined together to fund her treatment at a local hospital, but doctors told us to go to CCBRT for special care. Once again, our friends and community helped us so Angelica’s father could travel with her to CCBRT’s Disability Hospital in Dar es Salaam.” After consultation from CCBRT’s specialist surgeons, it was revealed that Angelica would require a series of three procedures, including contracture releases and skin grafts, to reduce scarring and increase her mobility. Thanks to the high quality care provided by CCBRT, Angelica and her family are hopeful for the future. “We look forward to her having more independence, and we are excited that she now has the opportunity to attend school and achieve her dreams.”

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Enabling the Sustainable Growth of Life Changing Programs Kupona Foundation is in a privileged position to leverage expertise across sectors, calling on innovative minds to share their knowledge and help build scalable solutions, all to ensure the longevity of CCBRT’s impact on the ground. Kupona unlocks access to a network of experienced, multidisciplinary talent in the United States, connecting CCBRT to cuttingedge thinking, opportunities for partnership and innovative approaches that would be challenging to reach as a local Tanzanian NGO.

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Maximizing potential: Eliminating waste and improving efficiency CCBRT’s reputation for exemplary eye care services means that they face consistently high demand at the Disability Hospital. Increased efficiency is critical to sustain high quality services for everyone who arrives at the hospital to seek treatment. CCBRT is one of the first healthcare providers in Africa to implement lean healthcare strategies in its facilities, adapting principles of waste reduction developed in the manufacturing industry and applying them to the healthcare context. Supporting CCBRT in the early stages of its lean journey, Kupona Foundation serves as a connector, linking CCBRT with the technical support of lean experts in the United States. In 2015, groups from the CCBRT leadership team took part in 10-day training courses at the Thedacare Center for Healthcare Value in Wisconsin, led by Dr. John Toussaint, a pioneer in the lean healthcare world. In addition, Kupona facilitated a partnership with lean management consultant Chris Kita, who traveled to Tanzania for five weeks to support targeted lean healthcare pilots in CCBRT’s Eye Outpatient Department.

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Chris’s Story “After many years working in the manufacturing industry I was drawn to the field of healthcare because of the opportunity that it provides to have an immediate, tangible and positive impact on people’s lives. I served in the Peace Corp at the start of my career, and have worked as a Lean Coach at the Lehigh Valley Health Network for the last five years. I was excited to return to Africa to see how my experience and skill-set could help CCBRT. We decided that I could add the most value in the Eye Outpatient Department (Eye OPD). The department had to turn away patients approximately 35% of the time because the demand for services was greater than the medical teams could handle. Our main goal was to develop a process that would prevent patients from having to leave without receiving treatment. Every eye patient was being seen by a doctor, regardless of their condition. Our hypothesis was that approximately 30% of patients could be treated effectively by an ophthalmic technician, therefore freeing up the doctors’ time to deal with the most complex cases and reducing bottlenecks to shorten wait times for all patients. On the first day of a pilot test utilizing Ophthalmic Technicians, all Eye OPD patients were seen by 1:45pm that day, over two hours before the Eye OPD was due to close. It was a promising start! Lean is all about using data to understand problems, engaging frontline staff to develop an improved or new process, and then testing assumptions using the new process. This is just the beginning. Now that we’ve conducted the first pilot tests, we’re optimistic that we can continue moving forward with utilizing the Ophthalmic Technicians. The aim is for the Eye OPD to serve as a model cell for lean at CCBRT, so other departments can learn how they used data, frontline staff engagement, and pilot tests to solve their demand and capacity problems. The team at CCBRT is passionate about giving and supporting quality care. They really do feel the pain of having to turn patients away. Everyone at CCBRT is really committed to his or her purpose, and I admire that very much. Other lean consultants interested in working with Kupona Foundation and CCBRT will grow not only professionally but also personally from this experience. It can be truly life changing for them, as it was for me.

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Supporting CCBRT’s evolution into a social enterprise CCBRT’s focus on providing quality healthcare services to the poorest members of the Tanzanian community has been historically funded through the generosity of external donors. CCBRT recognizes the importance of increased financial independence to the sustained provision of services for future generations. In 2015, CCBRT, with Kupona Foundation’s support, took action to scale its existing private clinic model. This year, CCBRT’s private clinic served 17,000 patients across a range of services including eye and orthopedic outpatient and surgical care and physiotherapy. These patients pay a higher fee for treatment, in return receiving additional benefits including appointment based services, private inpatient rooms, and air conditioned waiting areas. Private clinic revenue is reinvested into CCBRT, enabling the provision of free and

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subsidized treatment for poor patients. With the private clinic at maximum capacity, and demand for services among middle class Tanzanians growing, CCBRT began construction on a new private clinic building to expand services and increase revenue generation. Kupona’s partnership with MIT Sloan School of Management continued in 2015, when an Executive MBA team traveled from Boston to Tanzania to support planning for the evolution into a social enterprise. The team conducted research and analysis and developed recommendations for CCBRT’s business model and organizational readiness, which fed into a roadmap and key considerations for the journey. To support the development of a workable sustainable business model, Kupona Foundation also facilitated pro bono support from Trend Discovery, a U.S.-based consultancy. Trend Discovery evaluated existing financial models, traveled to Tanzania to meet with key stakeholders and applied best practices to redesign and rebuild financial models to provide functional, user friendly tools that would be flexible in the face of changing circumstances and robust enough to support CCBRT’s needs as they grow.

When open, CCBRT’s new Private Clinic will serve 55,000 patients per year – three times the capacity of the current clinic. When the new expanded

Private Clinic facility is opened,

revenue is projected to increase by 500%. 57


Addressing skilled human resources shortages The need for high quality medical and managerial training in Tanzania is undeniable. There is a severe shortage of skilled professionals able to meet the healthcare needs of a growing population, with no established program of Continuing Medical Education for licensed medical professionals in the country. Succession planning in healthcare facilities is challenging, with insufficient training opportunities for young clinicians. There is also a growing need for skilled clinicians as the industry strives to expand the availability of quality healthcare to meet the demands of a growing population. In the coming years, CCBRT will face a steep increase in internal training requirements with the recruitment of new staff for the CCBRT Maternity and Newborn Hospital. New staff will need to complete preemployment training and credentialing, and be equipped to provide high quality care. CCBRT’s vision is to establish a Training Center to equip healthcare and managerial professionals

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across the region with the skills they need to deliver high quality medical care. By addressing both internal and external training needs, CCBRT’s Training Center will improve operational excellence, patient care and outcomes throughout the entire organization, and provide a central location to support healthcare provider training across the East Africa region. In 2015, Kupona Foundation’s partnership with UCLA Anderson School of Management continued, engaging an Executive MBA team to conduct a Strategic Management Research (SMR) consultancy to support the development of a business plan that would empower CCBRT to plan for and eventually operate a high quality, high impact training center in a sustainable manner.

“Over the course of our two week visit to Tanzania and Kenya in March, we witnessed for ourselves the need for increased access to medical care and the vital role that CCBRT plays in the region. We realized that the smallest of contributions and changes can have the biggest impact there.” - Matt Mather, UCLA Anderson School of Management Executive MBA ’15, SMR consultancy team member Funded by Kupona’s longstanding partner Johnson & Johnson, the team identified gaps and growth opportunities, conducted extensive market research and analysis, developed a detailed financial model to test scenarios for sustainable operating models, and identified potential future international partnerships. The project highlighted the opportunity for CCBRT to become a recognized leader of quality training in the region of East Africa.

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OVER

The UCLA SMR Project by the Numbers:

100,000

miles traveled, covering three continents and four countries.

A team of five Executive MBA students from UCLA.

Over 70 interviews with CCBRT’s patients,

300+ hours of research.

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medical and management teams, global educators, government officials, and other nonprofits.


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Building a Bridge Between the U.S. and Tanzania Kupona convenes a collaborative community of donors, partners, technical experts, thought leaders, advocates and volunteers to mobilize support and activate awareness for our life changing programs and the causes we champion. Our activities in the U.S. give individuals and institutions the opportunity to be a part of direct, long term change for people and communities living in poverty in Tanzania. Our partnership with CCBRT enables us to fuse our commitment to transparency and sustainability with local expertise to deliver high impact programs for the people we serve.

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Summer Cocktail Reception Generously hosted by our Board Member, James Mann, Kupona’s Annual Cocktail Reception is an intimate gathering of supporters committed to our work in maternal and newborn healthcare. Raising over $15,000, the 2015 cocktail reception supported the continued secondment of Dr. Sierra Washington to CCBRT, enabling Dr. Washington to continue her clinical work, skills based training and technical advisory. This support helps to ensure that life-saving skills and techniques are embedded in the Tanzanian healthcare system for generations to come.

Annual Golf Outing In 2015, Kupona’s fifth annual golf outing raised over $25,000 for our maternal and newborn healthcare program. As Hurricane Joaquin gathered strength off the East Coast, a determined group of supporters and volunteers joined us at the North Hempstead Country Club in Port Washington, NY to celebrate the progress of our program to date, and to support continued improvements to the healthcare system in Dar es Salaam. Money raised through the outing was enough to enable 27 safe C-Sections, 72 safe deliveries, and the training of 9 healthcare workers in quality obstetric care.

Participating in the global conversation 2015 marked a milestone in international development, with the expiration of the Millennium Development Goals and launch of the new Sustainable Development Goals, mapping out the international development agenda for the next 15 years. Erwin Telemans, the CEO of CCBRT, joined Kupona in New York City in September to participate in a series of partner meetings and side events centered around one question: how are we going to achieve the Global Goals? For the Kupona team, this week solidified our belief in and commitment to the power of partnership. Through partnerships we both maintain the integrity of our expertise and break down silos; we can share data to inform decision making and partner with others to collect and analyze information; and we can work together to divide and conquer these seventeen ambitious goals before the 2020 deadline.

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Guiding our Journey Governance 2015 saw significant changes to the Kupona Board of Directors. After over 7 years of dedicated service to Kupona’s work, the founding Executive Director, Katie Flanagan, stepped down from the Board of Directors. The first and only paid staff member in the four years following Kupona’s inception in 2009, Katie established a strong foundation on which the current team continues to build. In June and December respectively, Kupona Foundation was delighted to welcome two new members to the Board of Directors: Dr. John Brothers, and Mr. Robert Schwed.

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“I began having weekly meetings with Abbey, and found her style and commitment awesome and hard to walk away from. The visit to Dar solidified that this is an effort I wanted to stay connected with.” – John Brothers An expert in the fields of philanthropy and organizational leadership, John has over 20 years of experience in nonprofit management. He brings a new perspective to our Board, with a keen focus on strategic fundraising and organizational development specific to the nonprofit sector. John is currently the President of the T. Rowe Price Foundation, and President of the Program for Charitable Giving. Prior to his role at the T. Rowe Price Foundation, John was the founder and principal of Quidoo Consulting, a consulting firm specializing in nonprofit leadership and management. It was through a pro bono consulting grant that John first started working with Kupona. In March 2015, John traveled to Dar es Salaam to facilitate a series of strategic planning meetings with Kupona and CCBRT, helping to align our fundraising strategies and prioritize our goals. During the trip, he saw first-hand the impact and scale of CCBRT’s work to improve access to high quality healthcare for poor and marginalized people in Tanzania.

“Kupona is dedicated to doing the right things for the right reasons. I didn’t solely join Kupona’s Board to write checks. I’m looking forward to the challenge of helping however I can, and really getting involved.” – Bob Schwed A graduate of Harvard Law School, Bob practiced law for 40 years, specializing in serving private equity firms and guiding clients through corporate finance transactions and acquisitions. He is an adjunct professor at George Washington University School of Law, and a recently retired partner at WilmerHale, LLP. Bob’s interest in philanthropy, and particularly healthcare in Africa, was inspired by his family. Both his son and daughter-in-law are doctors who have worked in Africa. Bob also worked with Dr. John Brothers before they both joined the Kupona team, to build a nonprofit serving underprivileged youth and families in his local community in Brooklyn, NY. Bob was a longstanding supporter of Kupona’s Annual Golf Outing before joining the Board in December 2015.

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Board of Directors 2015 Dr. Yoni Barnhard (Chair) Dr. John Brothers (Joined June 2015) Ms. Katie Flanagan (Founding Executive Director. Resigned July 2015)

Mr. Steven Hatfield Mr. James Mann (Vice Chair) Mr. Robert Schwed (Joined December 2015) Mr. Adrian Stewart (Treasurer and Legal Counsel)

Advisory Board With such a lean team, Kupona Foundation owes much of its success to the generosity and dedication of its Advisory Board, a group of committed volunteers who donate their time to help Kupona grow. The Advisory Board brings a rich combination of experience and expertise to Kupona. Members include finance, legal, and public health experts, a global advocate for essential surgery, an investor, an entrepreneur, a technology consultant and a marketing specialist.

Kristy Bohling Jameel Farruk Elena Rubinov

Alison Carlman Dr. Jaymie Henry, MD Nick Smoot

Adam Chadroff Rohan Mehta (Chair) Tyler Woebkenberg

Alexandra Esparza Mary Mei

Interested in bringing your skills and experience to our Board of Directors or Advisory Board? We’d love to hear from you! info@kuponafoundation.org

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Financials Kupona Foundation is intentionally structured as a lean organization to ensure maximum impact for donor investments. Financial Statements and 990s are available on request.

Statement of Financial Position as of December 31, 2015

Operating Results for the Year Ended December 31, 2015

ASSETS

SUPPORT & REVENUE

Current Assets

Contributions

Cash

$79,628

Pledges receivable

$55,000

Total Current Assets Property and equipment, net Total Assets

$134,628 $1,711 $136,339

Interest Income (Less Direct Costs of Special Events) Total Support and Revenue

$159,717 $121 ($4,623) $1,058,661

EXPENSES Program Services

LIABILITIES AND NET ASSETS

Total Program Services

Liabilities Accounts payable

$9,434

Total Current Liabilities

$9,434

Net Assets

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Contributions – services and in-kind

$903,446

Unrestricted

$71,905

Temporarily restricted

$55,000

$1,034,973

Supporting Services Management & General Operating

$70,716

Fundraising

$85,813

Total Supporting Services Total Expenses

$156,529 $1,191,502

Total Net Assets

$126,905

Revenue in Excess of Expenses

Total Liabilities and Net Assets

$136,339

* Due to planned one-time strategic investments in organizational development and program services.

($132,841)*


Summary of Expenses

Program Spending (Financial & In Kind)

87%

Program Spending Allocation

CCBRT Training Center

Fistula & Mabinti Center

35%

7% Maternal & Newborn Healthcare and Family Planning

10% Management & General Operating

6%

Fundraising

7%

Cataract, Burns & Clubfoot

15%

CCBRT Core Program (Unrestricted) Cleft Lip/Palate

15%

18%

Our independently audited financial statements show that nearly 9 out of every 10 dollars we spend is invested in programs and services for people and communities living in poverty in Tanzania.

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With Special Thanks To Allen & Overy, LLP

Mr. Anthony Fuller

Mrs. Kathleen Vieira

Bill & Melinda Gates Foundation

Mr. Avery Manchester

Mrs. Rhoda and Dr. Bob Barnhard

(Matching Gifts Program)

Mr. Ed Hoyt

Ms. Elizabeth Keating

Bloomberg LP

Mr. Ed Yelochan

Ms. Joanne Moore

Cravath, Swaine & Moore LLP

Mr. George Kevlin

Ms. Jocelyn Neukom and Mr. Brian Bulloch

DA Collins Construction Co., Inc.

Mr. James Mann

Ms. Martha Schrader

Direct Relief

Mr. Jonathan Lewis

Ms. Paige Navarro

Douglas Elliman Real Estate

Mr. Josh Goldfein & Family

Ms. Patricia Potts

Drilling for Hope

Mr. Marquise Stillwell

Ms. Valerie Greer

Fistula Foundation

Mr. Marty Galasso, Jr.

PeriGen

Fulham College Boys’ School

Mr. Matt Tannin

Princeton in Africa

GE Foundation (Matching Gifts Program) Hogan

Mr. Michael Falcon

Quidoo Consulting

Lovells U.S. LLP

Mr. Paul Glist

Real Bark Mulch, LLC

Iron Roost, Inc.

Mr. Peter Haylock

Salesforce Foundation

Johnson & Johnson Family of Companies

Mr. Reggie Lenoir and Ms. Sheila Wofsy

Silicon Valley Community Foundation

Karibu Kikoy, LLC

Mr. Robert Schwed

Simpson Thacher & Bartlett, LLP

Mary Queen of Peace Church

Mr. Ronald G. Morris

Sint-Theresiacollege VZW

Massachusetts Institute of Technology (MIT)

Mr. Steven Hatfield

Smile Train

Mayer Brown, LLP

Mr. Thomas Longe

Thompson Hine, LLP

Mr. Adrian Stewart and Ms. Tara Cohen-Stewart

Mr. Timothy Godfrey

Trend Discovery

Mr. Akira Maeda

Mr. Timothy Ostrander

Vanguard Charitable Endowment Program -

Mr. and Mrs. Anton Blinkhoff

Mr. Victor Kovner

VMWare

Mr. and Mrs. Vincent D’Agostino

Mr. William Block and Ms. Kim Nguyen

WilmerHale

Mr. and Mrs. W. Steven Seaboyer

Mrs. Carolyn Chandler

WonderWork

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Looking Ahead to 2016 In 2015, Kupona Foundation built momentum and found our stride as a team. In 2016, we will look to diversify our activities and develop existing partnerships in order to cultivate continued growth. By introducing fresh and creative activities to our fundraising and strategic storytelling portfolios we aim to engage new supporters in our work and reach a broader audience. Plans for an art exhibition in New York City are already underway, and our participation in the global conversation will continue with trips to Copenhagen for the Women Deliver Conference 2016, and New York City for UN General Assembly Week. Efforts to expand and strengthen our Board of Directors and Advisory Board will also continue in order to reinforce Kupona’s support system, and initiatives to streamline systems and processes will improve the efficiency and effectiveness of our lean staff. We look forward to sharing our progress throughout the year!

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Play your part Protecting and preserving the health and wellbeing of an individual makes it easier for them to complete their education and secure a steady income. This, in turn, means they can afford to provide for their family and to send their children to school. The health and wellbeing of the next generation improves as a result, breaking the cycle of poverty. Donate today, and you will set individuals and their families on the path to a brighter future.

Donate Online kuponafoundation.org/donate

Mail a Check Checks payable to ‘Kupona Foundation’ 12 Bensonhurst Avenue Saratoga Springs, NY 12866

Stay connected Sign up to our mailing list: www.kuponafoundation.org  @KuponaFdn  /KuponaFoundation  @kuponafoundation  Kupona Foundation

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kuponafoundation.org 12 Bensonhurst Avenue Saratoga Springs, NY 12866 info@kuponafoundation.org  @KuponaFdn

 /KuponaFoundation

 @kuponafoundation

 Kupona Foundation

Kupona Foundation is a 501(c)(3) nonprofit organization. U.S. Tax ID: 26-4371825 All donations to Kupona Foundation are tax deductible to the extent allowed by law.

Kupona Foundation Annual Report 2015  

This report encapsulates a year where, thanks to our supporters, we seized opportunities to unlock potential like never before

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