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Empowering People and Communities in Tanzania Annual Report 2014

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Table of Contents Celebrating Kupona’s Inaugural Annual Report . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Unlocking Potential Through a Shared Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Why Tanzania? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 CCBRT: A Leader in Local Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Partnerships for Progress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Impact by the Numbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Changing the Status Quo for Mothers and their Newborns . . . . . . . . . . . . . . . . . . 12 Dr. Sierra Washington: Advance Planning, Advocacy and Action . . . . . . . . . . . . 15 Building a Legacy: Family Planning at CCBRT . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Nurse Stella: Empowering Her Patients through Education . . . . . . . . . . . . . . . 21 Restoring Dignity to Women with Obstetric Fistula . . . . . . . . . . . . . . . . . . . . . . . 22 Repairing the Smiles of Young People with Cleft Lip and Palate . . . . . . . . . . . . . . . 24 Giving Sight to Children with Visual Impairments . . . . . . . . . . . . . . . . . . . . . . . . 26 Repairing the Trauma of Burn Related Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Improving the Mobility of Children with Clubfoot . . . . . . . . . . . . . . . . . . . . . . . . 30 Thinking Lean: Improving the Quality and Efficiency of Services at CBRT . . . . . . . . . 33 Kevin Meyer: Gemba Gives Back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Supporting Creative Solutions for Long-Term Change . . . . . . . . . . . . . . . . . . . . . 36 Haika Mawalla: Nurturing Leaders and Creative Problem Solvers . . . . . . . . . . . 38 Kupona Foundation: Expanding for Success . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Governance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Financials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Looking Ahead to 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Special Thanks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

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Celebrating Kupona’s Inaugural Annual Report Kupona Foundation supporters have been changing lives in Tanzania since 2009. Our inaugural Annual Report shines a spotlight on your impact and highlights the life changing programs that your generosity has made possible. Your support ensures that our sister organization, CCBRT, can continue to empower people and communities in Tanzania. It’s been a fantastic year for fundraising at Kupona, with over $600,000 contributed through institutional partnerships, individual donations, in-kind support and fundraising events, including our Annual Golf Outing and Spring Cocktail Reception. Our long-term partnerships with Johnson & Johnson, Fistula Foundation and Smile Train continued to unlock brighter futures for hundreds of fistula and cleft lip/ palate patients; an amazing community turned tragedy into hope following the loss of a loved one, enabling us to launch a new family planning program; we continued to support efforts to improve the quality of maternal and newborn healthcare in Tanzania; and an exciting new partnership with WonderWork allowed us to increase the mobility and independence of children with burn scars, clubfoot and pediatric cataract. This year, for the first time, Kupona’s efforts to connect CCBRT with technical support were formalized. New partnerships with Executive MBA programs at MIT Sloan and UCLA Anderson focus on the development of sustainable enterprise models to safeguard the future of CCBRT services; volunteer experts from the U.S. Lean community spent time at CCBRT to help develop their continuous improvement initiatives; and our newest colleague, Dr. Sierra Washington, a Harvard-trained OB/GYN, was seconded to CCBRT as a Senior Technical Advisor to the maternal and newborn healthcare program. We look forward to seeing the fruits of their labor, as their efforts continue into 2015.

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In the second half of 2014, Kupona established a team in the U.S. for the first time, welcoming two full time members to the Kupona family. This growth has already drastically increased the number of opportunities we are able to pursue. We continued to strengthen our Board of Directors and Advisory Board to expand Kupona’s network and create a foundation for growth. We also strengthened our relationship with CCBRT, with three trips to Tanzania focused on monitoring and evaluation, improved collaboration and communication, partner relations and strategic planning. Our colleagues at CCBRT constantly inspire us. Their professionalism, commitment and passion know no bounds. We were delighted to join them in Tanzania in October to celebrate 20 years of exemplary, life changing service to the Tanzanian community. Their programs are powerful examples of how innovation, expertise and enthusiasm can combine to produce lasting results. Their work is not just life changing: it’s game changing. We’re glad that you have chosen to be a part of it. This report provides a snapshot of some of the work happening at CCBRT, and introduces you to some of the people who are now able to reach their full potential thanks to your support.

Abbey Kocan

Dr. Yoni Barnhard

Executive Director President, Board of Directors

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Unlocking Potential Through a Shared Vision Kupona Foundation works across sectors, geographies and disciplines as part of a collective impact partnership with CCBRT (Comprehensive Community Based Rehabilitation in Tanzania), a stalwart provider of high quality healthcare services for poor and marginalized populations in Tanzania. We unlock access to the U.S. market, mobilizing the support required to make CCBRT’s inspiring and effective models possible. Working side-by-side with total transparency, Kupona Foundation and CCBRT facilitate the context-driven allocation of resources to those people, places and programs with the greatest potential for impact. Through strategic coordination, direct financial support, and creative solutions for sustainable growth, Kupona Foundation helps CCBRT unlock the potential of people and communities living in poverty in Tanzania by improving access to comprehensive high quality healthcare.

“I would call Kupona a little sister. It is very important to have a sister. You never have that feeling of being alone.” -Erwin Telemans, CEO, CCBRT 6


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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 to support the development of Tanzania has the potential to make a significant long term impact.

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Capital City Dodoma

Region East Africa

Population 47.6 million

Area 364,000 sq. miles

Currency Tanzanian Shilling

Official Language Kiswahili


CCBRT: A Leader in Local Care Starting as a small Community Based Rehabilitation unit 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, CCBRT works in partnership with the Government of Tanzania to improve the quality of care provided to mothers and newborns in public healthcare facilities, and conducts 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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Partnerships for Progress Kupona Foundation convenes an ecosystem of like-minded individuals and organizations, all committed to changing the face of healthcare in Tanzania.

Fundraising

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

Technical Support

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

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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.


Impact by the Numbers OVER

$600,000 life changing programs 2 Partnerships

with top tier business schools

respectful care during delivery

mobility returned to

130 children with burn scars

41 people gained access to family planning methods

dignity restored to

846 women living with obsetric fistula

people able to see

received higher quality,

repaired

the world around them

105,000 mothers

437

smiles

7,823

provided in support of

3,987 children with clubfoot who will be able to walk to school 11


Changing the status quo for mothers and their newborns With nearly one woman dying every hour from childbirth or pregnancy related complications, Tanzania has one of the highest maternal mortality rates in the world. For every woman that dies, 20 more will develop an injury, infection or life changing disability. As the primary caregiver in a Tanzanian family unit, saving the life of the mother is the key to improved education, nutrition and socio-economic prospects for the whole family. In 2014, CCBRT continued to work in close partnership with the Government of Tanzania in existing public healthcare facilities to train and mentor frontline healthcare workers, distribute life saving equipment, and develop existing infrastructure. Launched in 2009, the comprehensive program is designed to improve the quality of care available to expectant mothers and their newborns, and strengthen the wider healthcare system in one of the fastest growing urban centers on the continent. In parallel, CCBRT is building a new 200-bed maternity and newborn hospital, which will be a referral facility for emergency and high-risk cases. This hospital will become a beacon of best practices and will improve the management of emergency cases, ultimately increasing the chances of survival for up to 15,500 women and newborns every year. In 2014, the construction of the CCBRT Maternity and Newborn Hospital continued, as did extensive planning for opening, staffing and operating the new facility. CCBRT began supporting six additional government healthcare facilities through its maternal and newborn healthcare capacity building program. This year, the team saw a measurable improvement in the quality of care across supported facilities.

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Dr. Sierra Washington: Advance Planning, Advocacy and Action In 2014, Dr. Sierra Washington became the first physician to be seconded by Kupona Foundation on a long-term contract at CCBRT. A Harvard-educated OB/GYN with extensive experience in maternal and newborn healthcare in East Africa, Dr. Washington is serving as a Senior Technical Advisor to the comprehensive maternal and newborn healthcare program at CCBRT.

“I focus on three areas: Advance planning, Advocacy and Action.” “We are busy with advance planning for the hospital. We are planning what services we will provide and how we will deliver the best care possible. We are writing hospital policies and protocols in accordance with international ‘gold-standards’ of care and adapting them to the local setting. We anticipate that the hospital will offer the highest standards of maternal and newborn care. One-third of maternal deaths are due to excessive blood loss. In order to achieve safe deliveries in Dar es Salaam we must ensure a safe and secure supply of blood is available to our patients. We have been working to support the government’s plans to ensure a safe and adequate supply of blood. CCBRT will dedicate space in the new hospital for a satellite blood bank and support efforts to increase blood donations. CCBRT supports 22 government facilities to improve the quality of emergency obstetric and newborn care. So, in addition to advance planning for the hospital and supporting blood supply and safety at the national level, I also serve as trainer in comprehensive obstetrics in existing government facilities. I provide bedside teaching to local providers in labor and delivery, and I teach safe surgery. We are currently focusing on updating the C-Section skills of local providers and implementing the WHO safe surgery checklist. We are training 21 young professionals to become trainers in safe surgery. It’s very exciting. We are well on our way to providing state of the art care for mothers and their newborns in Tanzania. “ Through her work, Dr. Washington is ensuring the sustainability of high quality care through knowledge transfer to future generations of physicians in the Dar es Salaam region.

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In 2014, the Capacity Building team: Alongside colleagues at the supported facilities, 105,000 quality care during delivery.

mothers with higher

Trained 1,693 frontline healthcare workers to provide quality obstetric and newborn care. Increased the average quality of care scores at partner facilities from in 2010, to 78% in 2014.*

9%

Recorded notable decreases in collective stillbirth rates (26.8 per 1,000 total births in 2014 down from 29.3 per 1,000 total births in 2013) across supported facilities. Recorded significant decreases in collective maternal mortality rates (123.79 in 2014 down from 149.5 in 2013) across supported facilities.

Let’s put the size of the CCBRT Maternity and Newborn Hospital into perspective:

Approximate number of deliveries per year: NYU Langone Medical Center: 4,700

Columbia Memorial Hospital: 8,000

CCBRT Maternity and Newborn Hospital: 15,500 when operating at full capacity

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*Measured by Standards-Based Management and Recognition (SBMR) assessments, developed by Jhpiego, an affiliate of Johns Hopkins University.


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Building a legacy: Family Planning at CCBRT Family planning is one of the most cost effective ways to reduce maternal mortality, enabling families to make safe, informed choices about their sexual and reproductive health and to plan and space their pregnancies to safeguard the life and health of both mother and baby. In 2014, the first formal family planning services at CCBRT Disability Hospital were launched, in memory of Tim Manchester, an ardent supporter of CCBRT and advocate of family planning. Since Tim’s untimely death in 2013, his family and friends have raised nearly $60,000 for Kupona Foundation. Funds raised were directed to the family planning program at CCBRT, enabling the Tim’s Corner family planning kiosk and clinic to become a reality. CCBRT has provided family planning methods to 41 patients and general reproductive health counseling to another 31 patients since Tim’s Corner opened in 2014. Plans to integrate family planning into existing services at CCBRT Disability Hospital also continued. In anticipation of this integration, the Tim’s Corner team has started to train CCBRT staff, parents of children with disabilities enrolled in CCBRT’s rehabilitation program, and women receiving treatment for fistula on the importance of family planning. In addition, preparations continue to integrate family planning into all services in the new CCBRT Maternity and Newborn Hospital. Kupona Foundation and CCBRT remain in frequent contact with the Manchester family and other family planning partners as we develop strategies to address the unmet need for family planning services in Dar es Salaam, and we provide regular updates to everyone who generously contributed to the fund established in Tim Manchester’s memory.

Did you know?

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It would cost $6.7 billion a year to meet current unmet Family Planning needs globally – that is the equivalent to the cost of one presidential election in the U.S


“We choose to work with Kupona Foundation because, through their collaborative partnership with CCBRT, they consistently deliver lasting change and demonstrate how the power of partnerships can create a healthier world, one community at a time.” – Conrad Person, Executive Director, Corporate Contributions, Johnson & Johnson

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Nurse Stella: Empowering her patients through education Stella is the lead nurse at CCBRT’s family planning clinic, Tim’s Corner. Offering quality, confidential family planning counseling, Tim’s Corner makes family planning information and methods universally available to CCBRT’s patients and staff, empowering them to make informed decisions about their sexual and reproductive health. For women who have never had family planning counseling before, dispelling the myths surrounding contraception is often the first hurdle. “I met a man of 25 years. He had a 22-year-old wife with two children…He thought his wife should get family planning, but his wife didn’t want to use it…She didn’t know anything about family planning before we spoke. After I talked to her, she decided that family planning was a good choice for their family. I was feeling very proud about that. I was happy that I could share this information with her so that she could feel knowledgeable about options for her health and her family.” Stella works hard to share her understanding of the comprehensive benefits of family planning with her clients. “When a woman uses family planning, it helps to improve her health status and care for her family. If a mother gives birth to many children, sometimes the family cannot afford to send all of the children to school or buy them clothes or food. Those are things that could be difficult. If we can talk about family planning, women will only have the number of children that they can manage.” Stella will keep the conversation going at Tim’s Corner, keeping in mind that the first beneficiaries of family planning are often young women. By postponing their pregnancies, girls and young women can finish their education, pursue job opportunities, and be empowered to take control of their own future.

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Restoring dignity to women with obstetric fistula In Tanzania, up to 3,000 women each year develop incontinence during childbirth because of a lack of access to skilled medical care. This condition is known as obstetric fistula. Women with fistula are some of the poorest and most marginalized members of the community, forced to deal with the debilitating physical and psychological effects of fistula. The stigma associated with fistula means that women are often abandoned by their families, isolated from their communities and are unable to work. In most cases, their babies do not survive the traumatic delivery. CCBRT’s holistic care program is designed to break down barriers to treatment and restore dignity to women with fistula. Kupona’s long-term partnerships with Johnson & Johnson and Fistula Foundation support comprehensive care for fistula patients at CCBRT, which includes treatment costs, salaries for medical staff, and CCBRT’s life changing socioeconomic reintegration program. This support enables the team to provide high quality, comprehensive restorative treatment free of charge, and support women as they rebuild their lives and reintegrate into their communities. In 2014, CCBRT restored dignity to 846 women with fistula. Over the last six years, CCBRT has grown to become one of the largest fistula treatment centers in the world, and in 2014 was accredited by the International Federation of Gynecology and Obstetrics (FIGO) as an international training center for fistula surgeons.

Did you know? The last fistula hospital in the U.S closed in 1895, and is now the site of the Waldof-Astoria Hotel in New York City. 22


Nangi’s Story Born in a rural Tanzanian village, Nangi was a young girl when she married. She had two pregnancies, and delivered both children at home with only a female village elder to attend to her. Both times there were complications, and neither baby survived delivery. After a very traumatic obstructed labor with her second child, Nangi developed an obstetric fistula, an injury that causes chronic incontinence. When she first began leaking urine, Nangi didn’t understand what was happening to her. She consulted many traditional healers and witch doctors for help, but Nangi and her family lost hope as one remedy after another failed. “I said, ‘I will die like this.’ I was tired, and lost hope to get treated.” Nangi lived with this condition for over 60 years. CCBRT sends ambassadors to rural Tanzanian communities to search for women with fistula. When they met Nangi they convinced her to seek treatment. After decades of living with incontinence, she is currently recovering from a simple surgery that repaired her fistula, restored her dignity and renewed her hope for the future.

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Repairing the smiles of young people with cleft lip and palate Cleft lip and palate are facial impairments developed during early pregnancy. Children with cleft lip and palate often struggle to eat and have difficulty speaking. Due to social stigma, many aren’t able to attend school or earn a living. Cleft lip and palate can be repaired through reconstructive surgery, and will have no long-term detrimental effects on the health or development of a child if identified and treated at an early age. Thanks to Kupona Foundation’s partnership with Smile Train, CCBRT is able to provide surgical treatment, transportation to the hospital, food and accommodation during treatment for all cleft lip and palate patients free of charge. A simple surgery empowers children to realize their potential, both at school and at home, removing the barriers that limit their access to education, and reducing the stigma they face within their community. In 2014, CCBRT repaired the smiles of 437 patients. The team was delighted to perform Smile Train’s one-millionth cleft lip and palate surgery since their inception, and to celebrate this incredible milestone at the Power of a Smile Gala in Brooklyn, New York.

Did you know?

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Treating a child with a cleft lip and palate in Tanzania is relatively inexpensive. It costs CCBRT just $450 to restore a smile and change a life. In the U.S. the same procedure would cost a patient between $5,000 and $10,000.


Benjamin’s Story Twenty-year-old Benjamin has lived with cleft lip for all of his life, facing the stigma associated with his condition on a daily basis. “It was so annoying living with the condition. I missed a lot of opportunities in life, including my education. My parents delayed my start at school, and I didn’t start my first classes until I was 12. People bullied me all the time, especially when they met me for the first time. They always stared at my face, and I felt very shy. I decided to drop out of school when I was in my third year, and I started to sell fish. But sometimes, people didn’t want to buy from me because of my condition.” Benjamin is confident that, with the life changing surgery he has received, many opportunities will be coming his way. Once he has fully recovered, he plans to return home to strengthen his business. “Now I will have a consistent income, which isn’t the case for all of the young people in my village.”

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Giving sight to children with visual impairments Cataract is the world’s leading cause of blindness. If children born with cataract do not receive treatment, they face serious obstacles to their development – struggling to complete schoolwork, interact with their peers, and secure employment later in life. One of only three organizations in Tanzania to perform pediatric eye surgery, CCBRT’s eye department has a strong reputation for high quality care in the Tanzanian community. In 2014, CCBRT restored sight to 7,823 people, 619 of whom were children. This year, Kupona Foundation was delighted to embark upon a new partnership with WonderWork, contributing to eye surgeries for hundreds of children, unlocking their access to education and empowering them to reach their full potential.

Did you know? Pediatric cataract is not just a problem in developing countries. The U.S. National Eye Institute estimates that 1,200-1,600 infants are diagnosed with pediatric cataract each year in the United States. The difference between the U.S. and Tanzania is the time it takes for patients to receive treatment. While Boston Children’s Hosptial reports conducting pediatric cataract surgery on newborn babies, studies in Tanzania report significant delays in treatment for children with cataract. 26


Goodwin’s story Now seven years old, Goodwin was born with cataracts on both eyes, seriously restricting his vision. It was not until his teacher noticed that he was struggling to read the blackboard in class that his parents realized there was a problem. “At first we thought he was pretending but as time went on he started to bump into things around him. That is when we realized he had a problem with his vision.“ Goodwin was eventually referred to CCBRT’s Disability Hospital for surgery. After the procedure, Goodwin was anxious. His eyes were covered with bandages and he was worried that he would never be able to see again. Everything changed the next day, after nurses removed Goodwin’s bandages. He was finally able to see things around him more clearly. Goodwin’s parents now have hope for his future, and he is excited to return home, and to continue his studies.

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Repairing the trauma of burn related injuries Children are the most common victims of burn related injuries in Tanzania. On top of the severe pain of the physical injury, burn scars can have significant social and economic implications for the child and his or her family and community. When left untreated, burn scars can fuse muscle and bone, leading to loss of mobility and preventing a child from participating fully in school, limiting their education and opportunities to socialize with their peers. Treatment for burns can span several months and is very expensive, meaning that many families are unable to seek medical attention. CCBRT does not treat acute emergency burn cases, but their highly skilled team provides heavily subsidized reconstructive surgery and physiotherapy for children with burn scars, helping to restore their mobility and increase their independence. Kupona Foundation’s new partnership with WonderWork provides funding to support this comprehensive treatment process. In 2014, CCBRT provided life changing reconstructive surgery for 130 people – primarily children - with burn -related injuries.

Did you know? In Tanzania, it is common to cook on charcoal or kerosene stoves or over open fires. Children often suffer severe burn injuries when fire breaks out, or when they play near an open flame. 28


Fatuma’s Story When Fatuma was six, her grandmother was using a candle to guide her at night when petrol inside the house caught fire. Fatuma was born with a hearing impairment, so she could not hear the commotion that followed and suffered extensive burns. Fatuma received treatment in a government hospital for two months, but doctors told her family that they could not provide the level of treatment that she needed. Fatuma was advised to go to CCBRT. The scarring from Fatuma’s burns prevents her from extending her arms or bending her fingers. Fatuma underwent two rounds of surgeries at CCBRT in order to restore her mobility. Mama Fatuma shared that “before the first surgery, I was very nervous. When she was first burned, we stayed at the hospital for a long time, but they weren’t able to give her the care she needed. After Fatuma’s first surgery [at CCBRT], when I saw that she could bend her elbow again, I knew that CCBRT would be able to help her.” Fatuma is still healing from her surgeries, but she can now fully extend both arms and has more mobility in her fingers. Mama Fatuma is now much less worried about Fatuma’s future. “When she is healed, I am hoping that Fatuma will be able to wash herself, feed herself and be more independent. I would like to send her to a school that can support deaf children. Because she cannot speak, it will be important for her to write so I am happy that she will be able to do this now.”

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Improving the mobility of children with clubfoot Clubfoot is a deformity of the bones and joints in the feet, causing feet to turn inward and point down. Developed during pregnancy, clubfoot affects about 1 out of 1,000 newborns worldwide. If left untreated, the deformity will worsen as the feet develop, and the child will struggle to walk properly. There is, however, a high chance of full correction if the impairment is identified and treated from birth. CCBRT advocates for conservative treatment from an early age, using the Ponseti method: a course of treatment involving casting, braces and manipulation of the foot, without invasive surgery. In severe cases, CCBRT also performs corrective surgeries at its Disability Hospital in Dar es Salaam. Treatment for clubfoot requires a long-term rehabilitation program over the course of four years. It is vital that patients attend all scheduled appointments to ensure a good outcome. In order to improve attendance rates over the course of treatment, CCBRT introduced a text message-based reminder system. In the poorest rural communities of Moshi in Northern Tanzania, where travel to the clinic is difficult, CCBRT also covers transportation costs in order to reduce the financial burden associated with long-term treatment. Treatment for clubfoot restores full mobility, enabling a child to live an active and independent life, free from the stigma and discrimination associated with disability. In 2014, CCBRT treated 3,987 children with clubfoot; 397 new patients, and 3,590 continuing with their long-term treatment programs. Kupona Foundation’s multi-faceted partnership with WonderWork supports the treatment of children with clubfoot at CCBRT’s Disability Hospital in Dar es Salaam.

Did you know? The Ponseti method is also the preferred method of treatment for children with clubfoot in the U.S. 30


Donald’s Story When Donald was born, his mother was deeply concerned when she noticed that his feet were turned inward. Donald has a twin brother who was born just minutes before him and when comparing his feet to his brother’s, it was clear that Donald’s were severely misshapen. Medical staff at the hospital where Donald was born diagnosed him with clubfoot. Donald’s mother, Joyce, was very upset to receive this diagnosis from Donald’s medical providers. “I didn’t feel well knowing that his feet were abnormal. I was determined to find him treatment for this condition. I have seen many people in my home region with this condition and I want my son to avoid the hardship that those adults now have to live with.” Joyce saw an advertisement for CCBRT, and with both sons, left the home that she shares with her mother-in-law to travel to Dar es Salaam. During Donald’s first visit to CCBRT, Joyce shared that she felt very confident that her son’s condition could be corrected. “I believe that CCBRT can help to fix Donald’s clubfoot. I will be very excited to see his feet become normal over time.” Joyce hopes that with appropriate care, Donald can be strong, active and be able to reach his full potential.

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“Kupona Foundation gives us a direct line of communication with a U.S. team that we know and trust, simplifying coordination of our grants and planning for our visits to Tanzania. When we combine that with the fact that CCBRT is one of the best run hospitals we’ve seen in Africa, we get a high-impact partnership that is enabling real change for children living in poverty.” – Brian Mullaney, Co-Founder and CEO, WonderWork

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Thinking lean: improving the quality and efficiency of services at CCBRT The principles of lean management and continuous improvement, popular in manufacturing and production lines, emphasize the increased efficiency of systems and reduction of waste in order to improve the cost effectiveness of operations and increase quality for the end user. Following a visit from two volunteers from the U.S. in 2012, CCBRT saw the applicability of these principles in the realm of healthcare and has since been implementing the principles of lean management throughout the organization. Lean management is a popular practice in the United States. In 2014, Kupona Foundation connected with several experts keen to share their skills and experience with the team in Tanzania. This year, experts in different areas of lean management, traveled to Tanzania to train the team at CCBRT and to advise on the development of a comprehensive staff training program and support senior leadership development. One of the most promising new connections in 2014 was with Dr. John Toussaint and the Thedacare Center for Healthcare Value, the global pioneers of Lean Healthcare Management. Following Dr. Toussaint’s visit to CCBRT to facilitate a strategic leadership session, members of the CCBRT team traveled to Wisconsin to visit their facility, and learn from their experience in applying lean principles in the healthcare context. This marked the beginning of a longterm collaboration, which we look forward to building in 2015.

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Kevin Meyer: Gemba Gives Back In 2014, Kevin Meyer, one of the founders of Gemba Academy, visited CCBRT to learn more about how the ‘Gemba Gives Back’ program could help to guide CCBRT through its lean journey. “Gemba Academy was founded five years ago to deliver high quality, cost-effective, and on-demand lean and six sigma continuous improvement training on a global scale. The continuous improvement space has created success for Gemba Academy and its founders. We actively seek out ways to leverage those methods and technologies to help those in need.” CCBRT’s lean and continuous improvement journey is centered on a desire to improve the quality and efficiency of services for patients by eliminating waste. “The impact on charitable and/or non-profit organizations can be monumental as they are often on a shoestring budget. Every bit of waste removed directly increases customer value. This is in contrast to for-profit organizations, where the benefits of waste reduction are often split between customer value and shareholder value.” “Although still at the beginning of its lean journey, during my visit I was impressed to see that the team and patients at CCBRT are already benefiting from the new approach. Significant improvements have been made in reducing the risk to staff as they process hospital wastes. In procurement and finance, by mapping processes and challenging previous assumptions, lead times were reduced by 70% and documentation quality increased by 40%. Perhaps the most significant changes have occurred in the thought process of senior managers. The senior management team is continuously practicing the principles of lean management. The ‘Go See Mindset’, A3 Thinking, and regular team huddles in front of Visual Management tools allow the team to better understand operational realities and improve decision making for the organization. Lean is truly revolutionizing how CCBRT thinks and acts.” “My visit to CCBRT cemented my belief that lean and continuous improvement practices can make a real difference to both non-profit organizations in low resource settings and their beneficiaries. I would encourage experienced lean practitioners to get in touch with the team, and find out more about volunteering as a lean coach or consultant. It’s a rare opportunity to make a tangible change to frontline healthcare in Tanzania.”

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Supporting creative solutions for long-term change High quality, comprehensive healthcare for expectant mothers, newborns and people with disabilities will be a constant need within the Tanzanian community for years to come. Kupona strives to support and drive creative solutions that will safeguard CCBRT’s services, and ensure the sustainability and longevity of their operations. Kupona works closely with CCBRT to support its evolution into a social enterprise in order to increase CCBRT’s financial sustainability. The CCBRT Private Clinic, designed to generate revenue from patients able and willing to pay more for their services, is the cornerstone of this evolution. Revenue from the Private Clinic is reinvested to finance subsidized and free services for poor patients. This year, Kupona Foundation and CCBRT participated in the first General Electric (GE)-sponsored Leadership, Innovation and Strategy (LIS) training in Africa. Kupona’s Executive Director, Abbey Kocan, joined members of CCBRT’s Senior Management Team in Addis Ababa, Ethiopia, as they discussed how to effectively manage organizational growth and the evolution into a social enterprise. Kupona Foundation also played a critical role in identifying opportunities to generate revenue and help CCBRT move toward a sustainable business model in 2014, connecting CCBRT with individuals and organizations in the United States willing to share their expertise and advice as CCBRT grows. In 2014, Kupona launched two new partnerships with top tier business schools in the U.S.: MIT Sloan, and UCLA Anderson. Executive MBA teams embarked on two projects, exploring variations on revenue generating options to build upon CCBRT’s existing private clinic model, and plans to launch a financially sustainable training center for medical and non-medical professionals. Kupona also developed a partnership with Princeton in Africa, helping to facilitate the placement of a Princeton in Africa Fellow to support CCBRT with communications and fundraising. Kupona Foundation will continue to coordinate these partnerships in 2015.

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Haika Mawalla: Nurturing leaders and creative problem solvers Deputy CEO of CCBRT, Haika Mawalla, participated in the first General Electric (GE)-sponsored Leadership, Innovation and Strategy (LIS) training in Africa in 2014. “The Leadership, Innovation and Strategy (LIS) training was such a valuable opportunity for CCBRT, giving us a chance to learn from one of the leading giants in the global healthcare industry.” “As we look to build a sustainable legacy at CCBRT, one of the most important things to focus on is the empowerment and training of our staff. They have the most innovative and brilliant ideas for solving the problems we face, we just have to create the environment to nurture and collect these ideas. Since the training, I have started to build my team’s confidence in problem solving. One of my managers, who oversees the use of around $100,000 of commodities a year, had never questioned existing processes for procurement and consumption before. Empowering her to take the lead in meetings, and bring her ideas to the table, has allowed her to develop and implement ways to manage her resources more effectively and reduce waste. When I saw this start to work, it made my day. The training also taught me that a leader is not born, but nurtured into their role. Every organization has so many untapped leaders within their team – we just need to invest the time and energy in coaching and mentoring. Our focus upon financial and organizational sustainability is all part of building a long-term future for CCBRT. Financial sustainability will give CCBRT the stability and independence we need to direct resources to respond to changing circumstances without worrying about finding the financing to support it. If, for example, a generator breaks down, putting surgical procedures for the day at risk, we need to be able to afford the repairs immediately. With reliable income streams we can also focus our attention on other priorities – including building future leaders and establishing a supportive infrastructure for future generations at CCBRT. I think this is the best legacy you can leave to any organization: the structures that enable and support the growth of that organization beyond your time there. Kupona’s role as a bridge between the U.S and Tanzania is invaluable. CCBRT does not have the means to set up leadership trainings of the same scale and calibre as the GE LIS training, but they are such fantastic opportunities for us to grow and learn. Kupona’s ability to connect a local NGO like CCBRT with such worldly and experienced trainers gives us access to resources and perspectives that we would otherwise be unable to unlock.”

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Kupona Foundation: Expanding for Success Since the launch of Kupona Foundation in 2009, our Executive Director worked alone, with the support of the Board of Directors and Advisory Board. Over the last 5 years Kupona has grown to become a reliable source of income for CCBRT. The potential for Kupona to do more and to scale its activities was apparent, but capacity was limited. In 2014, the Board of Directors approved the recruitment of new team members to support our Executive Director, increasing the number of opportunities we are able to pursue, reducing Kupona’s reliance upon one individual, and protecting the longevity of our activities. Now with three full-time employees (one seconded full-time to work with CCBRT as a Technical Advisor), and one contractor, the Kupona team is building a strong foundation for improved donor communications, strategic messaging, and efficient operations to enable long-term growth and more targeted support for CCBRT.

“With an established team we are in a much better place to explore new opportunities to help CCBRT expand its impact in Tanzania, and share learnings and best practices for the benefit of healthcare across the region of East Africa.” - Abbey Kocan, Executive Director, Kupona Foundation

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Governance In 2014, Kupona Foundation was pleased to welcome Steve Hatfield as the newest member of the Board of Directors. A senior partner at Deloitte Consulting, Steve brings over 18 years of experience in operational excellence and management consulting, and has already provided invaluable advice as Kupona grows and mobilizes its dedicated team. The Board of Directors met seven times in 2014, in fulfillment of their roles in governance and financial oversight, with three additional sessions for strategic planning. The Board continued to support fundraising and the expansion of Kupona’s network of supporters, through cocktail receptions to raise money in support of CCBRT’s maternal and newborn healthcare program, and Kupona’s 4th Annual Golf Outing to raise funds for the construction of CCBRT Maternity and Newborn Hospital. Dr. Jaymie Henry formally stepped down from the Board of Directors in 2014 due to personal commitments and her focus on activating the G4 Alliance, advocating globally for the neglected surgical patient. We are delighted that she agreed to take a place on the Advisory Board, where she continues to share her vast experience in public health and advocacy as we work to raise the profile of our partnership with CCBRT within the development sector.

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Board of Directors 2014 Dr. Yoni Barnhard (President) Mrs. Katie Flanagan (Founding Executive Director) Mr. Steven Hatfield Mr. James Mann (Vice Chair) 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 as we grow. The Advisory Board brings a rich combination of experience and expertise to Kupona. Members include finance, legal, and public health experts, an OB/GYN and global advocate for essential surgery, an investor, an entrepreneur, a technology consultant and a marketing specialist.

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Kristy Bohling

Jaymie Henry, MD

Nick Smoot

Alison Carlman

Rohan Mehta

Tyler Woebkenberg

Alexandra Esparza

Mary Mei

Jameel Farruk

Elena Rubinov


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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 upon request.

Statement of Financial Position as of December 31, 2014

Operating Results for the Year Ended December 31, 2014

ASSETS

SUPPORT & REVENUE

Current Assets

Contributions

Cash Pledges receivable Total Current Assets

$180,946 $87,500 $268,446

Temporarily Restricted

$398,150

Unrestricted

$209,605

Interest Income Total Support and Revenue

$211 $607,966

LIABILITIES AND NET ASSETS EXPENSES

Liabilities Accounts payable

$8,700

Total Current Liabilities

$8,700

Temporarily restricted

Total Program Services

$222,246 $37,500

Total Net Assets

$259,746

Total Liabilities and Net Assets

$268,446

Management & General Operating

$39,643

Fundraising

$62,087

Total Supporting Services

$101,730

Total Expenses

$569,195

Revenue in Excess of Expenses

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$467,465

Supporting Services

Net Assets Unrestricted

Program Services

$38,771


Summary of Expenses

Program Spending Allocation Program Spending

82%

Fistula & Mabinti Centre

Cleft Lip & Palate

46%

Fundraising

11%

Management & General Operating

7%

30%

Family Planning

2% CCBRT Core Program

6%

Eye, Burns, & Clubfoot Maternal & Newborn Healthcare Program

9%

7% 47


Looking Ahead to 2015 Next year, Kupona will look to maintain its trajectory of growth, and use the added capacity of an established team to create a strong, efficient and sustainable source of support for CCBRT. We will scale our efforts to connect CCBRT with funding and technical resources, all with the ultimate aim of empowering people and communities in Tanzania, and changing the face of healthcare across the country. We will actively seek to expand and strengthen our Board of Directors, and will focus on enhancing operational systems and processes to support long-term operational excellence, efficiency, and increased fundraising capacity. We plan to expand our outreach to individuals and establish a presence on new channels for strategic stortyelling, so that the impact of CCBRT’s life changing work can reach a broader audience. We will continue to strengthen existing relationships with institutions and build new partnerships to mobilize financial support for critical programs at CCBRT. We will also maintain our focus on capacity building at CCBRT, engaging with individuals and organizations willing to share their experience and expertise to fill critical resourcing gaps on the ground in Tanzania.

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With special thanks to: Johnson & Johnson Fistula Foundation Princeton in Africa Smile Train WonderWork All Island Equipment, Inc Allen & Overy LLP Allenhaus Creative Christina Avino Dr. Bob and Rhoda Barnhard Bill and Kim Block Bloomberg LP Jeri Cohen Fine Jewelry Tara Cohen-Stewart Contractors Sales Co. Tomas M and Carmela Cordero DA Collins Construction Co. Inc Edward J Davis Douglas Elliman Real Estate Roxanne Elings Tom Elings

Michael Falcon Paige Fleming Anthony Fuller Marty Galasso Jr General Electric Paul Glist Claude Goetz Valerie Greer Ken, Suzzane and Armand Heise Thompson Hine Hogan Lovells US LLP Jane Johnson Peter Knitzer Lacy and Lance Koonce Victor Kovner Sheila Wofsy and Reggie Lenoir Lynn Loacker Colin MacFarlane Akira Maeda The Manchester Family Mary Queen of Peace Church

Mayer Brown LLP Rachel Nelson Allie Nicholson Todd Plitt Patricia H Potts Quidoo Consulting Real Bark Mulch LLP Ramon Sandoval Bob Schwed Steven W Seaboyer Molly O’Meara and Joe Sheehan Simpson Thacher & Bartlett LLP TD Advisors Jennifer and Scot Tucker Kathleen Vieira Diane and Michael Werner WilmerHale Sue and John Wyand Melanie Zhang Young Zhang

Kupona would also like to thank the photographers whose work is featured in this report: CCBRT/Benjamin Eagle: Cover, pgs 4, 5, 7, 9, 13, 15, 17, 39, 41, 43 & 49 CCBRT/Dieter Telemans: pg 3 Kupona/Young Zhang: pg 45

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

KuponaFoundation

Kupona Foundation is a U.S. 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.

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Kupona Foundation Annual Report 2014