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Nonprofit harnesses digital health tools to re-imagine healthcare systems of low-income countries


D-tree International is a global nonprofit that works in the space between the world of health and the world of technology, helping governments and non-governmental organizations realize the potential of tech in health programs. Grounded in the system it is working in and not just focused on flashy technology, D-tree facilitates compromise to enable healthcare technology to have a meaningful impact on individual lives.

In the last few years there has been broad consensus around the world that the way to address severe shortages of skilled healthcare workers in low- and middle-income countries is through digital health, says D-tree CEO Erica Layer. “Really, the way we see it is not just the ability to replace paper systems, but re-imagining healthcare systems,” says Layer. “In 10 years these health systems will look completely different.”


One example of D-tree’s work was to establish a 911-like emergency transport system in rural Tanzania where none had previously existed. D-tree worked with partners to develop a digital system organizing existing community resources whereby anyone in the community could reach a dispatcher 24 hours a day, and the digital tools support the dispatcher to triage the emergency and coordinate transport. The system has supported more than 8,000 women and children and reduced maternal mortality by 27%, and is currently being scaled up to serve 5 million people in Tanzania.


The system has supported more than 8,000 women and children and reduced maternal mortality by 27%

D-Tree has also been working with the government of Zanzibar to develop and scale up a national digital community health worker program to help pregnant women have safer deliveries. The program links pregnant women with community health workers, community drivers, village savings groups, and health facilities. The result has been a 50% increase in deliveries taking place in health facilities, and pregnant women are four times more likely to go to a health facility for a check-up after delivery. The government is now formalizing this initiative as part of a national program, and D-tree is working with them to expand and integrate the digital tools into the national system.

“D-tree” refers to “decision tree,” as the original focus of the startup health organization was on a clinical algorithm used to diagnose patients. The company has recently rebranded as it broadens its scope. Layer joined the organization four years ago and took on the role of CEO last spring as the organization is passed on to a much younger generation. She is motivated by how social good and innovation can come together to address truly pressing problems in human development.


“We firmly believe that tech has a role to play in the quality, efficiency, and accountability of health systems,” she says. At the heart of D-tree’s work is developing technology that empowers health workers with limited training so that they can provide high-quality health services to people who have no access to doctors. This problem is only expected to grow; the World Health Organization estimates that by 2030, there will be a global shortage of 18 million healthcare workers. By equipping unskilled workers with digital tools, empowering supervisors with real-time feedback, and supporting governments to use data for decision-making, tasks can be shifted to a lower cadre of workers.

Layer, who was previously a Peace Corps volunteer in South Africa and an HIV prevention researcher at Johns Hopkins University, from which she received her masters in public health, sees her role as continually shifting as the healthcare landscape changes. Ten years ago she never thought she would be working with a digital health organization, but has since discovered that it is “exactly my passion.” She’s learned the value in being open to trying new things, “because it might just be your dream job.”


[1] Limb, M. (2016). World will lack 18 million health workers by 2030 without adequate investment, warns UN. BMJ, 354, i5169. DOI: 10.1136/bmj.i5169
Body Photo Credit | Top: Adam Jan Figel /
Body Photo Credit | Bottom: Adriana Mahdalova /
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