David Barash Program Director Developing Health Programs 12/9/2013 Dear Mr.

Barash: We are writing to request more information for submitting a grant application to the GE Foundation. Our organization is Obz Design, a non-profit team that is focused on using technology-based solutions to improve healthcare in underserved communities around the globe. Currently, we are working in Nicaragua, the second poorest country in Latin America, by collaborating with a local organization, AMOS Health and Hope, which provides healthcare services to 29 rural communities throughout the country. Our team is building a digital medical records database so that healthcare services can react to health emergencies, such as epidemics or problem pregnancies, with much greater speed and efficiency, and thereby save lives in disadvantaged communities. Living in poverty has terrible effects on the health and wellbeing of individuals. Poor living conditions can breed disease, and many people in developing countries live several hours away from any health services. Diseases like tuberculosis and malaria can spread quickly without proper treatment. Children, particularly young children and babies, are the most vulnerable to these sicknesses. The Better DataBetter Healthcare Project is our response to these serious problems. For the past year, Obz Design has partnered with AMOS Health and Hope, a non-profit health provider and a mainstay in these communities in Nicaragua. Together, we have been working to improve the healthcare services for 13,000 people living in rural areas. Obz Design provides tools, software, training, and logistical solutions so that AMOSs health promoters can focus on healthcare delivery not paperwork. Currently, our budget for Better DataBetter Healthcare is $69,950 over the next twelve months, of which $60,650 is required to continue working. We know that the GE Foundation does not encourage unsolicited proposals; however, your Developing Health Globally program shares our dedication to improving access to healthcare in the worlds poorest communities through infrastructure upgrades. Based on your commitment to improving healthcare in underserved communities around the world, we are asking for your help.

The Challenge: Providing access for quality healthcare to disadvantaged communities in developing countries In rural Nicaragua, high rates of poverty are combined with little to no access to healthcare. This fatal combination contributes to increased infant mortality rates, as well as deaths resulting from complications during childbirth. Diseases like malaria, tuberculosis, and intestinal parasites create fatal conditions for children in rural communities. Currently, AMOS Health and Hope provides healthcare services to approximately 13,000 individuals living in underserved communities throughout Nicaragua. However, AMOS desperately needs a digital database management system to consolidate healthcare information from around the country. Currently, health records are maintained only on paper, and converting this data into a digital format usually takes around six months. Data is collected on paper records in the community by health promoters, which must be approved by supervisors and go through post-processing before they are available to the leaders of the organization. This delay makes it much more difficult for AMOS to respond to immediate health concerns that are communicated in the data.

Figure 1. Paper records currently used by AMOS Health and Hope

Organization

manage

Obz Design is currently working on a digital Data post-processing database using the software FileMaker that would meet AMOSs needs and improve the quality of life for underserved communities throughout Nicaragua. With access to up-todate information, AMOS will be effectively Supervisor audit & equipped to provide neonatal care to expectant consolidation mothers or combat cases of malaria and tuberculosis before they spread. To address lifethreatening cases throughout Nicaragua, it is absolutely vital that information is available as Community data collection soon as possible. The new digital database management system, which Obz Design has Figure 2. Current information structure for already begun work on, will provide life-saving AMOS Health and Hope paper records support across Nicaragua.

The Project: Building and implementing a digital data management system across Nicaragua Obz Design has already begun work on this project. In July of 2013 James Fox, Paige Cowles, and David Zapata visited the community of San Onofre in Nicaragua, and met with an AMOS health promoter. This trip allowed Obz Design to identify the needs of AMOS, and begin constructing a plan of action. From these needs, we have divided the Better DataBetter Healthcare project into three phases: (1) Technology Development, (2) Field Trial, and (3) the Product Roll-Out. Phase One: Technology Development FileMaker: To construct the digital database, we are using the software FileMaker. After completing a feasibility analysis of our options, we determined this product is the most sustainable, productive, and cost-effective solution for digitizing AMOSs medical records. An Apple product, FileMaker allows users to easily create custom databases, conveniently view and edit them on iPads, and effortlessly produce and share reports. AMOS currently has a capable statistician on staff; FileMaker will allow her to focus on interpreting medical data rather than transcribing records. The software turns discrete data into consolidated data, connecting two or more data tables together by a common attribute to give you a complete picture of health trends in these communities. In order to meet our needs, we will need six licenses for FileMaker. iPads: We also chose FileMaker because it is customizable for iPads, which are an ideal hardware option because they are portable. Health promoters can easily carry them throughout the community as they collect census data and conduct home visits. With FileMaker on each iPad, AMOSs health workers will have a portable, easily maintainable way of collecting information. This flexible hardware works particularly well in an area where electricity is scarce and rain damage is common. Once we purchase the six software licenses, we will also need to purchase six iPads. We will then customize each software license for each of the six iPads. Labor: The work of building the digital database does take time. We have already purchased one software license and one iPad, and have begun using FileMaker to develop the database. Moving forward, we would benefit from contracting an IT expert who is familiar with FileMaker and could focus exclusively on constructing the digital database. With this flexible, efficient, and easy-to-use digital database, AMOSs trained staff will be able to record and respond to health information more quickly. Phase Two: Field Trial After purchasing and customizing the technology, Obz Design will conduct a three-month field trial in one to three communities in Nicaragua. Conducting a pilot project is essential to the success of the Better DataBetter Healthcare project. After training the health promoters in the technology and testing the project for three months, we will identify and correct any concerns with the database before commencing a full product roll-out.

Phase Three: Product Roll-Out After the three-month field trial and subsequent alterations, we will extend the Better Data Better Healthcare project to the rest of the communities that AMOS services (a total of 27 throughout the country). This will require a much more extensive effort, including more iPads, FileMaker licenses, and training for health promoters throughout the country. The full product roll-out is anticipated to last six months. During this project, Obz Design will be collaborating with AMOS Health and Hope to make sure that the program is meeting the needs of those who will be using it.

Outcomes: A digital medical database that saves lives The most immediate outcome for this project is a drastic reduction in the amount of time spent processing data. What used to take several months can be reduced to days, or even hours. With health promoters inputting data electronically, records will be updated automatically, with no additional time spent on manual data entry. With a digital medical database, the AMOS leadership will be able to see information as soon as health promoters input it into the system. Currently, paper records need to be entered into an electronic system by hand; this redundant data entry can create mistakes that will be eliminated with an updated system. With fewer errors and immediate access to information, AMOS can respond to health emergencies with much greater speed and Figure 3. Updated information structure for accuracy. By targeting healthcare services to AMOS Health and Hope with digital medical expectant mothers, deaths due to childbirth will database system decrease. By identifying new cases of contagious diseases (like malaria or cholera), care can be provided before the infections spread. Children are at a higher risk of death when contracting diseases like malaria, cholera, or other parasitic infections that occur in tropical environments. Obz Design can help AMOS respond faster to the most serious cases as soon as they arise. This will help reduce rates of death among the total population, but especially for children.

Who we are: The Obz Design team As GE employees and engineers, we strive to connect problems with strategically-designed solutions. Just as an engine requires careful design and collaboration between partscylinders, valves, pistons, and rodsin order to run effectively, so too does healthcare. We take that same level of care for design and optimization of machines into our nonprofit organization, Obz Design, by improving healthcare for those living in poverty through the development of technology-based solutions. James Fox, CEO of Obz Design, is a Mechanical Engineer with technical experience in Rwanda and South Africa. James currently works for GE Aviation in Cincinnati, OH as a design engineer focused on product development and advanced technology. In the U.S., James has worked with the Rehabilitation Institute of Chicago (RIC) and Northwestern University to design and test an orthotic device for stroke survivors. In South Africa, James worked with a small design firm to develop an infant apnea monitor, ApneAlert, meant for use in rural, technologylimited environments. In Rwanda, James led efforts to implement local, environmentallyfriendly cooking fuel production, through the use of biomass briquettes. Working with the Cincinnati professional chapter of Engineers Without Borders, James evaluated the feasibility of supporting local Rwandan residents in establishing briquette production businesses, serving their communities while generating income. Paige Cowles, Health Director for Obz Design, works as a registered nurse in the emergency department at Cincinnati Children's Hospital. Working in a clinical role has given her experience working firsthand with both cutting-edge healthcare technology and on evidence-based practice. Before becoming a nurse, Paige helped run a mobile pediatric screening clinic in the townships surrounding Cape Town, South Africa. Witnessing the effects of failed aid efforts made the need for appropriate and relevant healthcare technology in the developing world very clear. While living in Chicago, Paige was a leader in an organization called Health LEADS which recognizes the connection between poverty and poor health and attempts to empower clients by connecting them to the resources they need to live healthier lives. David Zapata, Director of Operations for Obz Design, is a Mechanical Engineer for General Electric. He was born in Colombia and moved to the United States in 2006. During his time in Colombia, he was involved with various organizations providing support to local communities in poverty. His involvement with the children of Fe y Alegria in Barranquilla, Colombia, helped him realize the responsibility we all have to help one another, especially those in need. When David moved to the United States, he had the opportunity to work for a fundraising company in New York City, where he represented organizations such as Children International and Save the Children. He is currently pursuing a Masters degree in Mechanical Engineering at the University of Cincinnati. As part of Davids experience in his career, he has had the opportunity to execute leadership roles in various areas such as mechanical design, project management and product supply chain. Most recently David has been involved with the product support team for one of GEs most successful engine product lines.
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Budget and Schedule: Total costs and timeline The total cost for the Better DataBetter Healthcare Project is estimated to be $69,650 for twelve months. We are requesting $60,650 to complete the remaining tasks. The $9,000 cost for the initial needs assessment has been met by Obz Design. A breakdown of the costs is provided in Table 1. The majority of costs are related to developing the software and implementing it on a large scale in Nicaragua. Hours/Units Initial needs assessment Labor Obz travel Technology development Labor (software developer) Licenses (FileMaker) Hardware (iPads) Field trial (Pilot) Labor Transportation (in Nicaragua) Obz travel Accessory materials Product roll out Labor - training, implementation Obz travel Transportation (in Nicaragua) Total cost Amount requested
Table 1. Obz Design Budget 100 500 6 6 150 2000 -

Rate/Cost
$40 $40 $300 $400 $25 $10 -

Cost
$4,000 (in kind) $5,000 (in kind) $20,000 $1,800 $2,400 $3,750 $500 $5,000 $200 $20,000 $5,000 $2,000 $69,650 $60,650

The estimated timeline for Better DataBetter Healthcare is twelve months. Figure 4 shows the estimated timeline over the course of 2014. Developing the digital medical database and beginning the field trials will take place in the first half of 2014, and the full product roll-out will occur in the second half of the year. Q1 2014 Phase I Technology Development Q2 2014 Phase II Field Trial 1-3 Communities Q3 2014 Q4 2014

Phase III Product Roll-Out 27 Communities

Figure 4. Better DataBetter Healthcare timeline 6

Moving Forward: Next steps for Obz Design and the GE Foundation Thank you, Mr. Barash, for considering a partnership with Obz Design. Like so many others, we believe you cannot end poverty without first improving healthcare. And as engineers, we approach this problem from a systematic level. We dont just provide technology. We provide a way to improve efficiency, so that like a well-designed machine, all the parts work effectively together to get the job done. We feel this approach directly aligns with the GE Foundation. Can you direct us on our next steps for submitting a full proposal to the GE Foundation? Please feel free to call or email us using the information below if you want to know more about Obz Design, our vision, and the project in Nicaragua. We look forward to discussing the next steps with you. Our phone number is (514) 123-4567, and we can be contacted via email at info@obzdesign.org. For more information, you can also visit our website at www.obzdesign.org. With your help, the Better DesignBetter Healthcare project can directly impact healthcare service in Nicaragua, and help save lives. Sincerely, The Obz Design Team James Fox Paige Cowles David Zapata