“As I am handing over my role as CEO, I feel many emotions, but the biggest is gratitude”

Erica Layer began her journey with D-tree nearly 9 years ago, starting as Project Manager in Tanzania and now finishing as CEO and leading our organization for 4 years. In this blog, she reflects on her journey and the future of D-tree.

In mid-September, Riccardo Lampariello joined D-tree and took the reigns as D-tree’s new leader (get to know him better in this blog) and I have shifted my role to a supporting one for the next few months – supporting Riccardo and ensuring the transition is a smooth one.

Over the last few weeks, I have been reflecting on my journey at D-tree which began nearly 9 years ago. I remember meeting D-tree’s founder, Marc Mitchell, in our office in Dar es Salaam, when I was applying for the position of Project Manager. Marc asked me many difficult and provocative questions; he was challenging the development sector and making clear that D-tree did things “differently”. I left the interview fully convinced that I would not get the job. But Marc later shared that he was being difficult during the interview because he saw something in me: as a lifelong professor, he challenged people who he believed in to push them to do more. This remained true for the next several years, where I worked closely with Marc and the rest of the D-tree team to deliver on projects, define our strategy and support our growth.

During my first year with D-tree, in 2014, I was the project manager for a collaboration with Pathfinder where we developed a mobile app for Community Health Workers (CHWs) to support community-based family planning service delivery. I learned so much from this work – how to design a digital tool, how to build an app, and how to work with various stakeholders who all have different priorities and still create a tool that ultimately works for the end users. I’ll never forget a trip to Shinyanga, a very rural area in Northwest Tanzania, where we were deploying the family planning system. Network coverage was very poor in most communities, and we were unsure about whether the app could sync with the server. Two colleagues, Mariam and Melania, were expertly leading a training session one day so I drove around for 6 hours on dusty, bumpy dirt roads with 4 phones on my lap, each with a different SIM card from various mobile network providers, assessing the network strength and attempting to synchronize the mobile app. Our partner who developed Mangologic (now Logiak), was sitting in Germany waiting for the server to sync, and finally enthusiastically messaging me to let me know it was successful.

“I drove around for 6 hours on dusty, bumpy dirt roads with 4 phones on my lap, each with a different SIM card from various mobile network providers, assessing the network strength and attempting to synchronize the mobile app.”

I also remember the countless flights between Dar es Salaam and Zanzibar when I served as the Program Director for our Safer Deliveries program (which has now evolved into Jamii ni Afya). In 2015, we were tasked to find the most cost-effective model to support women to deliver in health facilities. We developed an evaluation to assess three different service delivery models – one in which women received a cash transfer to offset transport costs if she delivered in a health facility, one in which we supported women to enroll in village savings groups to receive a loan for transport, and one control group with intensive birth planning and preparation by the Community Health Volunteer (CHV). We conducted the evaluation in North B district, and used old maps with shehias (wards) drawn on by hand, overlaid with the most recent census data, to determine which areas would receive which intervention. It was a lot of work and a lot of fun working with our team to test this out: I remember our colleague Bi Jalia leading the training sessions with CHVs and being completely surprised when such a (seemingly) quiet and mild-tempered woman could command the full respect and attention of a room full of participants. The findings of our evaluation showed that providing women and their families with intensive birth planning during pregnancy was just as effective as providing cash incentives; an excellent and surprising finding that enabled us to deploy a much more cost-effective program as it grew to national scale.

“The findings of our evaluation showed that providing women and their families with intensive birth planning during pregnancy was just as effective as providing cash incentives; an excellent and surprising finding that enabled us to deploy a much more cost-effective program as it grew to national scale.”

In 2016, I remember traveling with Marc to Kathmandu, Nepal, to participate in an accelerator program through our Saving Lives at Birth award. We joined innovators from dozens of other global health startups, and instead of focusing on our product or service, we focused on our business models, pathway to scale and sustainability strategies. This was one of the first times I was exposed to the importance of thinking of D-tree’s work – and organization – as a business, and contemplating how we needed to “market” our work in order to scale it and have real and sustained impact. This workshop helped to shape my perspective and look more holistically at what we do – both the quality of the on-the-ground implementation, as well as the way we show up to and engage with the rest of the field.

Now, as I am handing over my role as CEO, I feel many emotions, but the biggest is gratitude. I am incredibly grateful for the experiences I’ve had and the growth I have undergone. I am grateful for the mentorship I have received from colleagues and Board Members and for the opportunity to have played a role in an organization that is truly making the world a better place. I feel confident that D-tree will continue to thrive because of the excellent people on our team.

I also look forward to the ways in which digital health will continue to grow and become increasingly critical for health systems globally. When I started with D-tree, the field was talking about whether digital health was effective in small-scale pilots. Today, the discussion has shifted to government-owned, national programs that are integrated into broader public health systems. There is still much work to be done, but we, as a field, have achieved great progress in the last decade and we will start to see real, sustained impact in the years to come.

I will be staying with D-tree as a member of the Board, and I look forward to continuing following D-tree’s successes and working through our challenges as we continue to do the hard and rewarding work of transforming health systems so that everyone, everywhere has access to high-quality healthcare. Thank you to everyone who has been part of my journey.