application form - Global Health Delivery Project at Harvard University

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MIT SLOAN SCHOOL OF MANAGEMENT
GLOBAL HEALTH DELIVERY LAB
GHD Lab Initial application for hosts 2010-2011
Note: Projects will run from early February to late April 2011,
with student collaboration beginning in late 2010 or early 2011
Thank you for your interest in GHD Lab, an MIT class that pairs teams of students with
enterprises on the front lines of health care delivery in resource-limited settings to address
their pressing organizational and business needs. This application questionnaire will help us
understand your needs and assess if your project is a good fit for us. The application is
divided into an initial check and two parts: Part One is about the project and your
organization, and Part Two, which comes later, addresses resources and logistics for the
project.
Please make note of key milestones for this year’s projects:
 Initial check and Part One due by November 10, 2010. The earlier we get these, the
better.
 We’ll give you some quick feedback, and for projects that will fit well, Part Two is due
no later than December 1, 2010.
 Students will be matched with projects by December 10, 2010.
 Matched projects will be taken up in our GHD Lab course which runs at MIT from
February-April, 2011 (but we ask student teams to make initial contact with hosts in
December or January so they can get right to work in February).
 The two-week onsite intensive work takes place when the MIT students come to your
organization, around March 12-26, 2011.
The Initial Check and Part One are below. If your project looks to be a good fit for our class,
we will contact you with a request to submit Part Two, which you may access online at
http://globalhealth.mit.edu/home/apply/. We recommend you complete Part Two
after you hear our feedback. You may also find more information at the GHD Lab website,
http://globalhealth.mit.edu/home/ghd-lab-2011. To learn about last year’s projects,
please visit http://globalhealth.mit.edu/home/past-projects/. Our email is
ghd.projects.lab@mit.edu.
To start, please complete the initial check below. If you have any questions, it will be useful
to review our Note to Prospective Hosts (available from us or online at the “apply” address
above.) To complete the questionnaire, you’ll need to have a project in mind, even if tentative.
We understand that the project itself is likely to evolve. Please don’t hesitate to contact us
with questions.
GHD Lab 2010-2011 Host application Part One
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Initial check: Is the project a good fit with GHD Lab?
1. In which country is the site with which you would like us to work?
[ ] Kenya
[ ] Uganda
[ ] South Africa
[ ] Ghana
[ ] India
[ ] None of these
2. Do you deliver clinical care yourselves or work directly with doctors, nurses, or health workers
who deliver health care to patients in resource-constrained settings?
[ ] Yes
[ ] No
3. Which broad area or areas does the project you have in mind relate to? Select all that apply.
[ ] Improving internal processes and operations
[ ] Managing supplies and other logistics
[ ] Improving patient demand for or access to your services
[ ] Developing a new line of business or a new means of generating revenue
[ ] None of the above
[ ] Not sure
If your answer to questions 1 and 2 are “None of these” and “No”, we regret that your
project does not fit with GHD Lab, as it lies outside our focus this year. Please consider
us for next year! On question 3, we are looking for projects that fit in the categories we
identified: if your proposed focus is very different, it is likely not a good fit, either. If you
are not sure, please complete Part One and ask us for feedback.
GHD Lab 2010-2011 Host application Part One
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GHD Lab Project host application
Part One: The project and the organization
A. About your organization
1. What is the name of your organization?
2. Where would the project be located (city or area)?
3. If you have a website, what is the address?
4. Please describe in a few sentences your organization’s mission and its main services or areas
of operation and give us a sense of your size (e.g. number of programs, number of employees,
patients served, or similar).
5. How does your organization fund its operations (from operations/commercial finance, grants,
self-funding, etc.)? At your option, please include the names of any large donors.
B. Project contacts
1. Who is the primary contact person for this project? This would be the person whom the GHD
LAB team and MIT students can contact to discuss the project.
a. Name:
b. Title/role:
c. Work location(s):
d. E-mail:
e. Phone number(s):
f.
Skype id, Google Talk or any other contact information:
2. Please list a secondary contact person in case the person listed above is not available.
a. Name:
GHD Lab 2010-2011 Host application Part One
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b. Title/role:
c. Work location(s):
d. E-mail:
e. Phone number(s):
f.
Skype id, Google Talk or any other contact information:
3. Please confirm that contacts will be available to work with GHD Lab this fall and for frequent
student contact and collaboration for the duration of the project, with initial contact starting
from early December 2010 and intensive collaboration, February through April 2011.
4. If this form has been filled out by someone other than one of the above, please let us know
who you are.
C. Problem Focus
1. In a sentence or two, what is your core problem, opportunity, or situation that this project
addresses?
2. How does this project improve the delivery of health services? Does it relate to process
improvement and supply chains; reaching and serving patients, including via pricing, income
generation, and marketing; or developing new lines of business or organizational models to
increase sustainability?
D. Activities and Deliverables
A faculty-supervised team of four students would work with you from MIT, contacting you as early
as December 2010. The team will work intensively February-April and spend two weeks at your
organization from March 12-26 2011.
1. What you would like a team of MIT MBA and other graduate students to do for your
organization? Briefly describe the key activities, identifying the components to be completed
from MIT as well as the work on site.
2. What is the key deliverable that the team should provide to you at the conclusion of their work
in April 2011?
GHD Lab 2010-2011 Host application Part One
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E. Support and collaboration
1. Participation of senior leadership is crucial to project success. With which of your senior staff
do you expect the team will work closely?
2. How much time will each of them be able to spend in person with the team during their site
visit March 12-26?
3. What financial support can you offer for the students’ air travel, local travel, board, and
lodging? We’ll ask for more details later, but for now an estimate of the total amount you could
contribute would be helpful for our planning.
4. Tell us about any connections your organization has with MIT, Harvard, or other collaborators
in North America. Will any member of your organization be in the Boston area in the next few
months?
5. How did you hear about GHD Lab?
Thank you very much!
GHD Lab 2010-2011 Host application Part One
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