INTERPLASTBusiness Plan

2005-2007

To accompany the nomination to GlobalGiving’s Marketplace of Dr. Shankar Man Rai of Kathmandu, Nepal

This business plan outlines Interplast’s strategic goals for the three year period from 2005 to 2007. Interplast’s Nepal Surgical Outreach Center,

established and operated by Dr. Shankar Man Rai, is a key component of the implementation of these objectives.

Although the entire business plan is relevant to Dr. Rai’s project, the items in bold in the business plan below are related specifically to Dr. Rai’s

surgical outreach project for children with burns, clefts, and other disabilities in Nepal. He is currently working with Interplast’s President & CEO and Chief Medical Officer on a site-specific business plan for this particular

project, which we hope to share with you over the coming months.

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INTERPLAST

Business Plan2005-2007

Executive Summary

BackgroundInterplast is a nonprofit organization providing free reconstructive plastic surgery for children and adults in developing nations. Since 1969 Interplast has sent volunteer medical teams to over 20 developing nations and provided more than 57,000 reconstructive surgeries for the poor. Interplast is also building the capacity of surgeons and other medical colleagues in the developing world to care for needy people in their communities, twelve months a year, through providing medical education and through its Surgical Outreach Centers. The Interplast-affiliated outreach center in Kathmandu, Nepal is a complete success according to our current objectives, and will serve as a model for other similar sites around the world.

VisionInterplast’s vision is a world in which no human being must live with a congenital deformity or injury repairable by reconstructive plastic surgery. In all its medical programs, Interplast will strive to provide access to the greatest number of poor people in need of reconstructive plastic surgery, at the earliest possible point in their lives—now, and for generations to come.

ObjectivesOver the next three years, team trips will increase incrementally, while the bulk of the organization’s financial resources and program growth will be directed toward medical education of overseas colleagues and local empowerment.

Market AnalysisInterplast acknowledges that achieving its vision, and implementing its business plan over the next three years, requires fulfilling certain funding, personnel, and other resource needs to support the strategy.

Competitive AnalysisAmong its competitors, Interplast is benefited by the following strengths: itslongevity, reputation, partnering model, educational offerings, QI process, broad volunteer base, professional staff, and involved board of directors. The organization realizes it will need to address issues concerning its poor name, the lack of broad awareness of the organization’s purpose, lack of resources, and a limited host base.

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ServicesInterplast offers several medical program models including team trips, visiting educators, surgical outreach centers, the Webster Fellowship, telemedicine, and several supporting programs. The organization has tailored these programs to fit the needs of its different site models.

MarketingInterplast has developed a list of key message points so that the organization can present a unified message in all its communications. A comprehensive strategic communications plan is currently being developed.

Funding & Financial ProjectionsConsistent with this 3-year business plan, Interplast will grow incrementally during fiscal years 2005, 2006, and 2007. During that period, it will launch a $10 million comprehensive campaign (endowment, capital, and future program fund), thereby preparing the organization for a quantum growth in its services beginning no later than FY 2008.

13%14% 3% 1% -8%

18%9%

11%

-500,000

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

3,500,000

4,000,000

98/992,260

99/002,506

00/012,906

01/022,998

02/033,038

03/04 2,800

04/053,300

05/063,800

05/074,000

REVENUE PROJECTION THROUGH FY07 (in millions)

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TABLE OF CONTENTS

Summary 5Background 5Current Situation 5Organizational Structure 6Financial Summary 6

Vision 7Mission Statement 7Core Values 7Vision Statement 7Strategic Goals 7Gap Analysis 8Strategy Implementation 12Objectives 13

Market Analysis 16The Overall Market 16Customers 16Customer Characteristics & Buying Decisions 17

Competitive Analysis of the Industry 18Industry Overview 18SWOT Analysis 19Competitive Analysis with Key Competitors 21

Services 22Interplast Medical Program Models 22Positioning 24

Marketing 27Funding 28

Strategy 28Methodology 28Planning 28

Financial Projections 29Revenue Projection through FY 07 29Interplast “Gift Pyramid” 30Program Objectives with Direct Program Costs 31

Appendices 32Appendix I: Surgical Outreach Center Burn Pilot Program 32Appendix II: Interplast Grand Rounds 33Appendix III: Board and Staff Credentials: A Note 34

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SUMMARYBackgroundInterplast is a nonprofit organization providing free reconstructive plastic surgery for children and adults in developing nations. For more than three decades, Interplast has made it possible for children and adults, in some of the poorest regions of the world, to live full lives as members of society. Without Interplast, individuals born with disfiguring birth defects or suffering disabling injuries are often denied such opportunities and the quality of their lives, the lives of their families, and the economies of their communities all suffer as a result.

Since 1969 Interplast has sent volunteer medical teams to over 30 developing countries and provided more than 57,000 reconstructive surgeries for the poor. The organization has also delivered hands-on training to hundreds of overseas surgeons, anesthesiologists, nurses, and adjunct therapists, in their own hospitals, leaving them with the immediate ability to provide skilled medical care to the poor.

Interplast is also building the capacity of surgeons and other medical colleagues in the developing world to care for needy people in their communities, twelve months a year, through its Surgical Outreach Centers. With direct funding, ongoing medical quality assurance, and technology, Interplast makes it possible for 1,500 needy children per year to receive the free surgeries, follow-up therapy and care they require from local medical professionals, such as Dr. Shankar Man Rai in Nepal. Approximately 1,500 more poor patients receive treatment through Interplast team trips to developing countries.

Interplast is the most established organization of its type and is renowned for the highest quality of medical care, its lean organizational structure, and its close partnership with overseas medical colleagues that is always directed toward developing medical independence. Interplast is a collaborative effort of medical volunteers, overseas medical partners, donors, community volunteers, and staff, all working together to reach the poorest people of the world who wait for their help.

Current situationReconstructive plastic surgery is provided in the following ways:Trips: Direct care in which the organization sends volunteer medical teams to select sites to perform surgeries for needy patients.Education & Empowerment: Partnering with medical professionals in the developing world to help them advance their skills and manage their own outreach programs to treat their countries’ underserved populations.

Direct Surgical TripsMore than 200 volunteers participate in Interplast surgical trips each year. The medical teams include plastic surgeons, anesthesiologists, pediatricians, nurses, and trip secretaries/translators.

17 trips were sent in fiscal year ‘04

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The typical trip lasts two weeks 60-80 surgeries are performed on each trip Medical supplies and equipment are provided with the team

Medical Education and Empowerment Programs Visiting Educator program: Medical specialists provide lectures, consultation,

and hands on instruction in specialized medical skills tailored to the needs of the host colleagues.

Empowerment program: Interplast provides funding, medical consultation, equipment, and other guidance and support needed by select surgeons in the developing world to manage their own outreach programs. At this time, six surgeons from Nepal, Zambia, Bangladesh, Peru, and Ecuador are involved in this program.

Sub-components of Programs Web-based medicine : The outreach surgeons are able to document their

cases using a digital camera, laptop computer, and access to the Internet. These resources also allows them and other international physician partners to log on to the organization’s Interplast Grand Rounds to post patient photographs and case overviews and ask other participating surgeons from all over the world for guidance in approaching treatment.

Education materials : These tools detailing basic cleft lip and palate repair techniques are distributed to Interplast’s international partners to help them further develop their surgical and patient care skills.

Medical Scholar Program : This program provides opportunities for healthcare providers from developing nations to study in the U.S. or other countries. Interplast selects candidates who demonstrate the motivation and capability to provide care for the poor in their own countries.

Organizational Structure 18 employees Departments include Development, Medical Programs, International Services,

Volunteer Staffing & Recruitment, Marketing & Communications, Supplies & Equipment, and G&A.

Volunteer medical professionals make up the specialty committees that dictate medical policy

Active 30 member Board of Directors Over 700 medical volunteers

Financial SummaryInterplast currently provides its services in 12 developing nations, serving 3,500 patients per year, with a $10 million total budget, $3.3 million cash. Total assets are $2-3 million.

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VISIONMission StatementInterplast’s mission is to provide free reconstructive surgery for people in developing nations, and to help improve health care worldwide. The organization’s goals are to establish, develop, and maintain host-country, domestic-patient, and educational programs with the following objectives:

Provide direct patient care—reconstructive surgery and ancillary services to those with no other resources.

Provide educational training and medical interchange. Assist host-country medical colleagues toward medical independence. Enable recipients of care to become providers of care to new sites.

Interplast maintains no political or religious affiliations. Sensitivity to, and respect for, other cultures as equals pervades the Interplast philosophy and deeply influences the manner in which we conduct ourselves as ambassadors.

Core Values Care for those with no other resources. Highest standards of medical ethics and quality of medical care. Sensitivity to, and respect for, other cultures as equals. Volunteerism and philanthropy. No religious, political, or economic motivations. Education and empowerment. Our work is guided by community need and humanitarian instincts.

Vision StatementInterplast’s vision is a world in which no human being must live with a congenital deformity or injury repairable by reconstructive plastic surgery.

Strategic Goals In all its medical programs, Interplast will strive to provide access to poor people

in need of reconstructive plastic surgery, at the earliest possible point in their lives

Interplast will develop permanent reconstructive plastic surgical outreach centers wherever possible within the developing nations Interplast serves, affording free access to reconstructive care by poor people in those nations

Interplast will provide medical education and training in reconstructive plastic surgery to medical colleagues within underdeveloped nations in order that those skills be used to give poor people free access to reconstructive care

Interplast will develop ancillary care programs associated with restoring and sustaining function following reconstructive surgery in developing nations, in order that it be used to give poor people free access to such care

Interplast will provide free direct surgical care to poor patients in developing nations, while working with local medical colleagues to provide medical education and skills transfer at those sites

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Interplast will customize its medical education and service programs in developing nations to meet the needs of the site

Interplast will actively recruit medical volunteers qualified to fulfill the direct surgical, educational and empowerment needs of each site, and build and sustain that corps

Interplast will work to develop economic models which will permit permanent surgical outreach centers to become self-sustaining

Gap Analysis: This is an analysis of the gap between current reality and the strategic goals; in other words, it describes where Interplast is as an organization and where it wants to be.

People

International PartnersAs Interplast pursues its strategy of education and empowerment, international colleagues will need to be identified to fill the necessary medical specialties involved in reconstructive surgery. These specialties include reconstructive surgery, anesthesia, operating room and recovery room nursing, as well as post-operative care. Although some of the international colleagues fit into one of these specialties, this is not true at all sites. These medical partners, therefore, will have to be trained or new colleagues will have to be identified at the various sites to fulfill these functions.

Medical VolunteersOur core group of volunteers, currently a strong organizational asset, will need to be further enhanced to meet our strategic requirements. Not only must the organization find more specialized volunteers in surgical techniques, all our medical volunteers must be comfortable with the notion of passing on their skills and have the ability to teach. Most importantly, Interplast will need volunteers who embrace and champion the new strategy. Recruiting for pure service trips in which teaching is very informal and on a one-to-one basis is much broader and, therefore, easier. Interplast has among its current corps of volunteers some excellent resources; the organization needs to annually reassess the specific skills of its volunteers to make the best use of their talents.

Medical StaffOne of the duties of the CMO at Interplast is to recruit and assure the expertise and effectiveness of the surgeons who volunteer with Interplast both on teams and as educators. He is also responsible for the educational curriculum in the surgical arena. With the growing need for skills transfer of anesthesia techniques at our sites, Interplast will need to bring an anesthesiologist on staff to meet the challenges that it will face over the next few years as it follows its educational and empowerment strategy.

Non-medical VolunteersOne of the greatest barriers to transfer of knowledge on our team trips is the language obstacles that exist at many of our sites. In order to bridge this gap, Interplast will have to supply more translators at sites that are underserved in this regard.

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Board of Directors There are two clear components that make up Interplast’s board—those members from the medical community and those members from the business community. Interplast will continue to search for ethnic and national diversity in its membership. The potential for overseas members to join the board will be researched. As Interplast looks ahead to strengthening its education and empowerment commitments, medical members of the academic community will have to be actively sought out to join the board. The organization will continue to bring highly capable and skilled business people to the board to help evaluate and guide strategy. Equally important will be the selection of individuals to the board who have a strong capacity to give and help raise money for major gifts.

DonorsIndividual donors, foundations, and corporations will continue to be vital to the organization. Emphasis will be placed on strategically growing the numbers of donors from all areas, with gifts at all levels. A particular emphasis will be placed on obtaining larger grants from foundations that look for programs which are scalable, with long-term, measurable results, as well as organizations that work toward site independence. In addition, Interplast will approach individuals for larger gifts to advance Interplast’s organizational capacity over a period of years so that the organization can set multi-year goals. The proposed strategic changes will permit Interplast to establish the metrics that allow the organization to seek such larger, directed grants.

ProgramsAt many of our established sites, the need to move towards more specialized instruction has become apparent. To meet this challenge, the number of Visiting Educators will need to increase incrementally. Although team trips will still play an important role, the annual increase in trips will be on a much smaller scale.

The need for burn care in developing countries is well known to international organizations. The World Health Organization reports that ninety-six percent of burn-related deaths occur in developing nations. Burn reconstruction plays a larger and larger role on Interplast’s team trips. The effort to reach out to this underserved population clearly falls within the organization’s strategy of reaching poor patients in need of reconstructive plastic surgery. At this time, our Outreach Centers are primarily concerned with the repair of cleft lip and palate. Interplast has committed itself to bringing about the availability of reconstructive plastic surgery for burn deformities in our Outreach Centers, beginning this year with Nepal and Zambia.

Program ManagementWith the new strategy, Interplast will need to continue to grow the education and empowerment component. The menu of programs that Interplast can now offer means that the service program will be tailored to fit the needs of each site. Included in the assessment of new sites will be information pertaining to the needs of the local

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population, the number of physicians willing to participate in the program, their level of training, the level of service already provided for the poor, and important logistical matters.

BrandInterplast’s brand equity will continue to hold all its present value, but with the strategic change, the equity will increase. The brand will become reflective of Interplast’s position as the preeminent organization providing permanent solutions on a local basis in reconstructive plastic surgery. Over the next three years, Interplast will need to market itself by taking full advantage of this increasing equity.

Customer BaseDonors Interplast’s donor base is currently major gift-oriented with a few very large gifts on which the organization has come to rely. The organization has an unusually long history with many donors, maintaining a good reputation and relationship with them. Interplast will need to diversify its funding and seek enough donors at the $100,000 or more level to provide the multi-year funding necessary to fulfill strategic directions and lessen the reliance on just two or three large grants. Interplast will also seek to increase gifts at all levels and to dramatically grow the numbers of donors to the organization. A comprehensive fundraising campaign will be instituted to achieve these goals.

International PartnersIn order to move towards its strategic goals, Interplast will need to find additional surgeons in the developing world who are capable of managing, developing and directing Outreach Centers. These individuals will have both management and technical surgical skills. Along with a close relationship with Interplast, these individuals will need to demonstrate a humanitarian desire to help the poor of their country.

PatientsAlthough Interplast started as mainly a cleft lip/palate repair organization, the present situation on the ground is changing. Teams are finding fewer cleft repair patients at sites and a larger percentage of patients needing surgery for other deformities. Continuing a trend that the organization has already embraced, Interplast will offer the services that the patient population at its sites requests by offering a wide range of reconstructive plastic surgery repair.

TechnologyInterplast has planned and instituted a number of exciting technological tools to advance its efforts. The organization recently changed its in-house computer systems from a Macintosh platform to a PC platform, thanks to the generous donation of computers from Saratoga Systems. This change included the purchase of two servers and Microsoft Small Business operating system that will provide the basis of improving Interplast’s surgical record keeping.

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Interplast also recently re-launched Interplast Grand Rounds directly under the planning and direction of the organization and hosted on the Interplast website. Interplast Grand Rounds enables Outreach surgeons and those participating in Interplast’s Visiting Educator Workshops to interact with experts from the U.S. and Canada regarding complicated reconstructive surgery cases. This program allows our partners to have the same medical interchange that occurs daily in hospitals throughout the U.S. Interplast Grand Rounds is an essential educational tool but can only be offered to physicians who have access to a laptop computer and a digital camera to be able to post cases for consultation. Over the next three years, Interplast will need to grow the number of surgeons who have access to this program.

Interplast has also instituted its Patient Care Improvement Project using handheld PDA’s to gather chart information from Interplast’s surgical trips. The PCIP was made possible by the generous donation of Handspring Neo’s from Handspring, and the tireless work of anesthesiologist Richard Gillerman who is building the program. Interplast is currently working with volunteers from Cisco Systems to launch the next steps in building a database to house the PCIP data as well as data from Outreach surgeries. The PCIP will soon require the purchase of newer, more durable PDA’s for the program.

The burn surgery system is currently being built by L2 Consulting to be accessed through the Interplast website. The system is designed to track burn surgery data from the two pilot programs in Nepal and Zambia, and to provide ongoing quality assurance for the burn program. The Cisco volunteers also assisted Interplast in envisioning the system and developing its components. The burn surgery system is being developed to allow data to eventually co-mingle with surgical data from the PCIP as well as Smile Train Express.

Interplast is also reviewing the state of the computers, cameras, and Internet access capabilities of its Outreach surgeons to plan for updates and improvements, also seeking new technology to continually improve communications with the sites.

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Strategy Implementation

Program Goals 2005 2006 2007General Strategic

PathContinue transition to

agenda-based programs in all sites

Explore existing sites where medical

education is highly successful, for conversion to

empowerment sites

Continue development of medical education programs

at all sites, targeting specific medical skills

needs

Tactic for Pursing this Strategic Path

Conclude comprehensive needs assessment of each site and write a business

plan for each site

Work the business plans for each site written in

2004

Continue to work the business plans for each site,

written in 2004, with appropriate modifications

Strategic Choice-Making & Integration

In historical direct service with no medical education

component, work on creative ways to develop

education and empowerment/i.e., regional synergies

Leave sites where other organizations are

providing direct service adequately and where there is no possibility

for education and empowerment

By this point, Interplast should have a highly-developed portfolio of

medical education models, with evidence as to their

effectiveness

Expansion of Service

Conduct new site visits to seek out education and empowerment-capable

sites

Begin replication of Surgical Outreach

Centers, as candidates permit

Evaluate all existing Surgical Outreach Centers

for continuation and viability

Building Partnerships for

Sustained Growth and Development

Pursue partnerships with indigenous NGOs,

especially at Surgical Outreach Centers

Begin using indigenous NGO partnerships to

explore sustainability at Surgical Outreach

Centers

Seriously consider establishing Interplast

foundations in overseas sites

Measuring Ourselves/ Evidence of

Effectiveness

Perfect measurement tools for education

Produce multi-yr. report on medical education

outcomes

Interplast metrics look different, measuring direct

service, and education/empowerment

Positioning Interplast in the

global community

Research global development

and join InterAction

Position Interplast visibly within this

community at every opportunity

Reassess Interplast’s positioning within the global development

communityGlobal

Environmental Data-Gathering

Begin gathering data on all sites, including economic, medical, social and other

factors

Use new data on sites to draw conclusions for future strategy and

tactics

Reassess business plans for each site based on past 3

years’ experience and new data

Achieving Sustainability for Surgical Outreach

Begin researching sustainability models for

Surgical Outreach Centers

Frame the models of sustainability for Surgical Outreach Centers, including funding sources

Where possible, begin implementing sustainability

models at Surgical Outreach Centers

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Objectives

Objectives for 2005 Team trips will increase from 17 to 18. Interplast will expand the number of translators to two staffed on teams on all

trips to support our educational component. This means an increase of 12 translators for those trips with currently only one translator.

Interplast will bring an anesthesiologist on staff to establish an anesthesia education program and help in anesthesia volunteer recruitment (see appendix).

Visiting Educator trips will increase from 12 to 17 (see appendix) Site visits will not increase in number but will focus on sites with an educational

component. Interplast will increase its investment in cleft surgical outreach centers by

27%. The organization will invest $66,000 in the surgical outreach center burn

pilot program at 2 sites to do 175 test cases (see appendix). The ancillary services budget will more than double to include 2 additional

speech camps in Nepal, increasing the number from 6 to 8 for its speech therapy model program.

The Medical Scholar Program will partner in training 4 scholars to build surgical capacity.

Interplast will increase the user base by two partner surgeons on Interplast Grand Rounds.

The organization will increase delivery of educational materials to partner physicians by growing investment in the educational materials budget by 63%.

Objectives for 2006 Team trips will increase to 19. Visiting Educator trips will increase to 21. There will be a 20% increase in the number of site visits. The number of burn cases at the 2 surgical outreach centers involved in the

initial pilot program will increase to 265 cases. An additional speech camp will be budgeted for Nepal, increasing the

number from 8 to 9, and 2 speech camps will be piloted at another surgical outreach center.

5 scholars in the Medical Scholar Program. Interplast will increase the user base by an additional two partner surgeons on

Interplast Grand Rounds. The educational materials budget will increase by 25%.

Objectives for 2007 Team trips will increase to 20. VE trips will increase to 24. There will be a 20% increase in the number of site visits.

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Two additional outreach centers will start a pilot burn program. Including the two established burn programs, the total number of burn surgeries will increase to 330.

Two additional speech camps will be added at the surgical outreach center that piloted the program in 2006 for a total of 4 camps. Nepal will remain at 9 speech camps.

6 scholars in the Medical Scholar Program. Interplast will increase the user base by an additional two partner surgeons on

Interplast Grand Rounds by supplying essential hardware. The educational materials budget will increase by 25%.

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SUMMARY OF PROGRAM OBJECTIVES

YEAR TeamTrips

Anesthesia Staff Member

VETrips

SiteVisits

Cleft SurgicalOutreachCenters

BurnProgramOutreachCenters

SpeechCamp Outreach Centers

MedicalScholarProgram

GrandRounds

EducationMaterials

2005 Increase of 1 trip to 18 trips ¼ time

Increase of 6 from 12 to 17

NoIncrease from ‘04

27% increase in investment

Pilot program 2 sites 175 cases

Increase of 2 camps in Nepal (6 to 8)

4 scholars

2 new users

Increase of 50%

2006 Increase of 1 trip to 19 trips ½ time

Increase of 3 from 17 to 21

20% increase in budget

Remains steady

Burn program2 sites265 cases

Increase of 1 camp in Nepal (9) and 2 camps at pilot site

5 scholars

2 new users

Increase of 25%

2007 Increase of 1 trip to 20 trips ½ time

Increase of 3 from 21 to 24

20% increasein budget

Remains steady

Burn program 4 sites330 cases

Increase of 2 camps at pilot site (4)Nepal (9)

6 scholars

2 new users

Increase of 25%

3-yearOver-view

From 17 to 20 trips

½ time anesthesia staff

From 12 to 24 VE trips

Total of 44% increase in site visit budget

Remains at ’05 level of funding

New program with 4 burn sites

Increase number of sites in Nepal and start program in second site

15 scholars

6 new partner users

increase in distribution of educational materials

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MARKET ANALYSIS

The Overall MarketMillions of children are living with unrepaired cleft lips and palates, a congenital defect that can occur in as many as one in 600 children born in the developing world. Children born with cleft lips suffer mercilessly at the hands of others who do not understand the etiology behind the child’s alarming appearance. These children are often born with cleft palates that will profoundly affect their speech if not corrected at an early age, further cementing a life of misery. The loss of such children to society exacerbates the downward spiral for families already living in extreme poverty.

Burn injuries are growing at alarming rates among the neediest families of the world. The World Health Organization (WHO) reports that fire-related burns represent a significant global burden, ranking ninth among the leading causes of disease among children 5-14 years of age. Living in flammable structures and cooking and washing over open fires are among the most common reasons children incur such burns. In Bangladesh, acid attacks on teenage girls represent an even more insidious cause of injury.

According to the WHO, 96 percent of burn-related deaths occur in developing nations. There are no documented numbers for children who are seriously burned and survive to live with the devastating consequences, but anecdotal evidence indicates that the number is staggering. Because these children typically do not have immediate access to sophisticated burn care, their injuries are often left to heal by themselves, creating scar tissue that can destroy function and disfigure a child in unimaginable ways.

The bulk of the people in the world make their living or provide for their existence by manual labor. Injuries to the hand or congenital deformities of the hand can make providing for oneself and family difficult or even impossible. Since the hand is the part of the extremity most exposed, hand injuries are very common. The proper care of these hand deformities can restore function and provide a future.

The number of plastic surgeons worldwide is increasing as the years pass. But in many countries the training can be limited, or in some cases inferior. There is a tremendous need for more fully trained plastic and reconstructive surgeons the world over. In the U.S. there is one plastic surgeon for every 45,000 inhabitants. By way of comparison, Bangladesh, a country of 135 million inhabitants, only has 15 plastic surgeons. Nepal has 6 plastic surgeons for a population that surpasses 25 million. And Zambia has only one plastic surgeon to serve the whole population of 10 million.

Customers

Host physician colleagues Patients Donors

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Customer Characteristics & Buying Decisions

Host colleaguesInterplast’ host colleagues are typically surgeons with a humanitarian motivation. They are interested in improving delivery of care to the most needy in their countries. These individuals are looking for tailored programs that meet their needs, a long-term relationship, and high quality partnerships.

PatientsThe patients interested in Interplast’s services are poor people in underserved developing nations in need of reconstructive plastic surgery. These patients have little or no other access or choice for medical care. These patients and their families are motivated to find care because they want to better their lot in life.

DonorsThe donors who give to Interplast are interested in international philanthropy. Specifically, they want to change the lives of children in developing nations. There are three types of donor groups: individuals, foundations, and corporations. Foundations are especially interested in supporting capacity building for the long term. Both foundations and corporations are looking for an organization with an established reputation and a strong emphasis on quality. Corporations are often interested in a marketing or publicity advantage.

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COMPETITIVE ANALYSIS OF THE INDUSTRY

Industry OverviewInterplast’s competitiveness is evaluated below on the basis of the Degree of Rivalry, the Threat of Entry, the Threat of Substitutes, Buyer Power, Supplier Power, and Complementors.

Degree of RivalryInterplast’s competitors include over 105 organizations in the U.S. of varying sizes that travel overseas and perform reconstructive plastic surgery in developing countries. This count does not even include the many organizations that exist in the rest of the world that perform the same services. Most of these organizations are performing standard surgery procedures that include cleft lips and palates, burn reconstruction, and congenital abnormalities. The field is becoming increasingly more crowded as teams from different organizations bump up against each other at certain sites. The threat of rivalry to Interplast’s standard service trip model is high. However, the education and empowerment component of Interplast appears to have a very low threat of rivalry, as there are very few organizations that have established programs in this area.

Threat of EntryThe nonprofit reconstructive surgery sector is one in which entry into the market is moderately difficult. A successful organization such as Interplast needs healthy relationships with the host country medical community and its governmental institutions, experienced medical volunteers, an inventory of supplies and equipment, financial backers, and name recognition. In general, reputation is the biggest barrier to entry for nonprofits. Interplast has established its reputation through its long experience, association with the American Society for Plastic Surgery, word of mouth, and medical contacts in the developing world. Interplast has relationships with highly regarded plastic surgeons in the developing world that are able to help the organization find suitable sites in which to work. Interplast also strives to keep its excellent reputation by implementing quality control systems.

Threat of SubstitutesThe threat of substitutes in the nonprofit reconstructive surgery sector is quite high. There are other groups such as ENT and orthopedic surgery organizations performing reconstructive surgery in the developing world.

Buyer PowerThe buyers in the nonprofit reconstructive plastic surgery sector can be varied. The buyers for Interplast include host colleagues, patients, and donors. The main buyers are actually those who are able to arrange for the teams to work in hospitals and have access to the underserved populations. In the case of Interplast, these representatives are usually host medical colleagues. However, many other organizations rely on government officials or other non-medical individuals with strong connections to act as liaison with their

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groups. Depending on the circumstances, the buyer can have great power in deciding where, when, and on whom the team will operate.

Interplast has a policy of working directly with medical professionals at the site. Rather than have a team of medical professionals forced upon a hospital by some high-ranking government official, the organization prefers to work with the hospital director and other medical colleagues to integrate with the hospital personnel. The buyer for Interplast is, therefore, the host medical colleague.

Individuals, foundations, and corporations giving to international causes make up one of the smallest percentages of overall philanthropic dollars, so buyer power is very high. Interplast’s individual donors are attracted to the immediate change they are able to make in the lives of poor people, primarily children, and the fact that they can see and understand the results. Foundations are looking for scalable projects with long-term measurable results and are attracted to funding capacity building as well as the use of technology. Corporations comprise the smallest number of donors and dollars. Corporations are interested in joining forces with an organization whose work will complement their corporate strategy and help fulfill their marketing goals. All donors are attracted to an organization with an established reputation, a strong emphasis on quality, and a strict adherence to fiscal responsibility.

The patients as buyers have the least amount of power as the access to reconstructive plastic surgery is so limited in the developing world.

Supplier PowerInterplast’s supplier pool is composed of medical volunteers and donors. Medical volunteers are actually donors, as their operating time on trips is calculated as in-kind donations. Additionally, they pay a participation fee as a member of a team. Suppliers have low or high power depending on the organization. Interplast is very careful not to let volunteers and donors influence its business decisions; other organizations within the industry make some business decisions based on the desire of donors and volunteers. (For example, volunteers in those organizations may have a strong influence on who joins a team and donors may influence the choice of sites where the team might work.) Because of the large number of competitors, supplier power can be quite high within the industry.

SWOT Analysis (Strengths, Weaknesses, Opportunities, Threats)

Internal Strengths Longevity Reputation Good model of partnering Educational offerings QI process Broad volunteer base Professional staff Involved Board of Directors

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Upgraded equipment

Internal Weaknesses Poor name Lack of broad awareness of organization’s purpose Lack of resources (money, person power, supplies and equipment) Limited host base

External Opportunities Distance learning Self-sufficiency movement in international nonprofits Untapped clinical areas (burns, hand, micro, etc.) Undiscovered sites More partnerships Foundations & corporations interested in looking for more permanent solutions to

problems Ability to tell our story Research Small gifts

External Threats Political instability abroad Competition for fundraising Number of similar organizations Shrinking market for cleft lip/palate surgery Logistical problems for transporting equipment

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SERVICES

Description

Interplast Medical Program Models

General Reconstructive TeamsInterplast teams include plastic surgeons, anesthesiologists, pediatricians, operating room nurses, recovery room nurses, and secretaries/translators. The teams typically spend two weeks at each site, and perform approximately 75 surgeries per trip. Interplast’s volunteers work side-by-side with local medical professionals to screen patients, perform surgery, and provide related care. Interplast ships approximately 15 to 20 boxes of medical equipment and supplies—weighing in at a total of about one-half ton—with every team in an effort to ensure that the volunteers have everything necessary to perform surgery safely, and to avoid utilizing the precious and limited resources of host country medical facilities. During every surgical trip, Interplast teams provide not only direct patient care, but also education and training for local medical professionals.

Specialty Reconstructive TeamsInterplast specialty teams perform only one type of reconstructive plastic surgery. For example, currently the organization sends several specialty teams to perform hand surgery exclusively. Surgical Outreach CentersInterplast coordinates six locally-managed Surgical Outreach Centers in Bangladesh, Ecuador, Nepal, Peru, and Zambia that provide year-round access to free reconstructive plastic surgery for impoverished patients. Each program is coordinated by local plastic surgeons who have been Interplast’s partners for many years. They manage teams of local surgeons, anesthesiologists, nurses, speech therapists, and other medical specialists who are committed to providing surgery and follow-up care for the needy citizens of their countries. Since the launch of the first Surgical Outreach Center in Nepal in 1999, the program has provided more than 6,000 life-changing surgeries for children born with cleft lip and/or cleft palate.

Visiting EducatorsEvery year, Interplast coordinates several Visiting Educator Workshops in our program sites around the world to provide advanced training in specialized surgical, anesthesia, and other patient care skills. Upon invitation, Interplast arranges for Visiting Educators to spend approximately one week at a site to provide hands-on, individualized instruction for local medical professionals. The topics addressed by each workshop are based on specific needs expressed by our international medical partners. Workshops typically include academic lectures, patient consultation, surgery, and follow-up care review. Past workshops have involved techniques in pediatric plastic surgery, hand surgery, microsurgery, burn contracture surgery, and pediatric anesthesia.

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Webster FellowshipThe Webster Fellowship (WF) is a one-year staff appointment given to a recently trained Board Eligible or recently Board Certified Plastic Surgeon. The WF travels on Interplast trips as a second or third surgeon, performs site visits, accompanies visiting educator trips where appropriate, develops educational tools for distribution, and serves as an ambassador for Interplast to the world. Selection is made by the CMO and discussed with the Webster Fellowship Selection Advisory Committee.

Telemedicine

Interplast Grand RoundsMany of the reconstructive plastic surgeons in developing countries who partner with Interplast work in relative isolation, with few (if any) other plastic surgeons in their region available for consultation and information exchange. Interplast now manages a web-based program that makes it possible for these surgeons to communicate easily with expert physicians from around the world. Interplast Grand Rounds allows Interplast’s partner surgeons to present cases complete with patient photographs and ask other participating physicians for guidance in approaching treatment.

CD ROM/Millard Video/SRPRSInterplast has developed a variety of educational tools and resources to help our medical colleagues further their surgical and patient care skills. In collaboration with the Stanford-NASA-National Biocomputation Center at Stanford University Medical Center, Interplast volunteers developed an instructional CD-ROM incorporating video, still photography, and text to detail cleft lip and palate repair techniques. The CD-ROM has been translated into several languages and distributed to Interplast medical colleagues around the world. In addition, Interplast is now able to share with our overseas colleagues a video recently completed by plastic surgeon Dr. Ralph Millard providing instruction in cleft lip and palate repair techniques that he developed. These tools are valuable resources for Interplast's colleagues, who are often the only professionals in their areas of specialty working in their individual hospitals, and have few opportunities to work with and learn from peers. In addition, they may not have easy access to current journals and textbooks that can help them further develop their skills.

Hand Flap CD (under development)

Patient Care Improvement Project (PCIP)The PCIP is a data collection project on palm-based handhelds (the Handspring Visor). This project was initiated because information gathered by our current data collection method, paper, did not lend itself to easy analysis or interpretation. Data collected via the new route, to include case demographic, brief history and physical, procedure, host country personnel involvement, and quality assurance information, will be entered in real

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time at the point of care. Data from the handhelds will be downloaded into a case database at the office and used by Interplast in the following ways:

Track numbers and types of procedures that are done to give a better picture of case mix, trip productivity, costs per surgery, and value of service.

Track utilization of host country personnel, their involvement, and the quality of care they provide.

Analyze Quality Assurance data including examination of potential confounding factors (e.g. Upper Respiratory Infection) so that the medical staff can receive timely feedback on QA occurrences, trends, and other pertinent medical information that comes from database analysis.

Speech Therapy ProgramThe repair of a cleft palate is really only the first step in the process of making someone capable of functioning in society. Virtually all children require speech therapy after palate repair. There is a huge need to implement speech therapy programs in our Outreach Centers. The program in Nepal is a model of how this might work. Speech camps are held in outlying cities where families bring their children and spend a week in intensive speech therapy. All the costs of travel are included to ensure poor families’ ability to travel. The families are also taught methods of providing the therapy for their children at home.

Special Education FellowshipsThis Fund will sponsor training opportunities for promising healthcare providers from developing nations. Interplast selects candidates who have worked with our medical teams and demonstrated the motivation and capability to provide care for the poor in their own countries, and the ability and desire to train other medical professionals.

Seminars and ConferencesThe International Partners Conference held in October 2003 was an opportunity for all of our international hosts to exchange ideas, learn more about Interplast, and begin to form the nucleus of regional working groups for education. Some form of regional conferences or seminars may be a useful tool for education in the future.

Site Development and EvaluationsAny potential new sites require in-person evaluation prior to providing any of the services Interplast supplies. It is necessary to evaluate the existing infrastructure as well as determine the level of capability of the local physicians. Periodically, all sites need to be re-evaluated to be certain that our services and education are both meeting the needs of our partners as well as being certain that our goals of improving reconstructive plastic surgery for the poor are being met.

Positioning

Site ModelsFactors considered:

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1. Host status2. Educational potential3. Outreach potential4. Need for teams

Model 11. Non-plastic surgeon hosts2. Excellent educational potential3. Outreach Center not possible4. Team needed

(Examples: all Vietnam sites)

Products available: General Reconstructive Teams, Visiting Educators, Webster Fellowship, PCIP, Site Development and Evaluations.

Model 21. Excellent plastic surgeon hosts2. Excellent educational potential3. Outreach Center not possible4. Teams needed

(Examples: all Myanmar sites)

Products available: General Reconstructive Teams, Specialty Reconstructive Teams, Visiting Educators, Webster Fellowship, Telemedicine, PCIP, Special Education Fellowships, Site Development and Evaluations.

Model 31. Excellent surgeon hosts, not all plastic surgeons2. Excellent educational potential3. Outreach Center possible4. Teams needed

(Examples: Iquitos, Azogues, Cusco, La Paz, Nicaragua)

Products available: General Reconstructive Teams, Specialty Reconstructive Teams, Surgical Outreach Centers, Visiting Educators, Webster Fellowship, Telemedicine, PCIP, Speech Therapy Program, Special Education Fellowships, Site Development and Evaluations.

Model 41. Excellent plastic surgeons2. Excellent educational potential3. Now are Outreach Centers4. Need for teams varies

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(Examples: Portoviejo (Guayaquil), Bangladesh, Nepal, Zambia, Piura, Lima*)

Products available: General Reconstructive Teams, Specialty Reconstructive Teams, Visiting Educators, Webster Fellowship, Telemedicine, PCIP, Special Education Fellowships, Site Development and Evaluations

Model 51. Excellent plastic surgeons2. Excellent educational potential3. Outreach Center not needed4. No need for teams

(Examples: Sri Lanka, Brazil)

Products available: Visiting Educators, Telemedicine, Special Education Fellowships, Site Development and Evaluations.

Model 61. No physician host2. Educational opportunities limited3. Outreach Center not possible4. Teams needed

(Examples: La Ceiba, Puno*)

*Affiliated with Outreach Director and his work

Products available: General Reconstructive Teams, Webster Fellowship, PCIP, Site Development and Evaluations.

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MARKETING

At this time, Interplast is developing a comprehensive strategic communications plan in line with Interplast’s new strategy. The organization is in the process of hiring a new Director of Communications and one of his or her first duties will be to continue working with Edelman and the Board Communications Committee to complete the plan.

The big issues the communications plan will address are how the organization can “sell” the strategy to donors and medical volunteers and how Interplast can get the word out about the new strategy to potential partners in the developing world.

Interplast will continue to communicate its mission and strategy in the conventional ways. The organization’s greatest mouthpieces are still the medical volunteers, board members, and donors. Conventional methods for communicating with these groups (e.g., the newsletter, E-bulletins, presence at national conferences) will continue.

Interplast realizes the importance of presenting a unified message in all its communications along with more focused approaches to broadcast, print and other media. To this end, the organization with the help of Edelman has composed a list of key message points: ** Every donation to Interplast makes a direct and profound difference in the lives of

children in developing countries who suffer physically and emotionally simply because they have little or no access to reconstructive surgical care.

 **  The first nonprofit devoted to providing free reconstructive plastic surgery for needy

patients around the world, Interplast has built long-term relationships with best-in-class doctors who donate their time and expert volunteers who have helped develop best practices to ensure safety, quality, and accountability.

 ** Since 1969, Interplast has provided 54,000 surgeries, and currently provides

approximately 3,500 surgeries a year.  To reach the most impoverished patients long-term, Interplast is committed to medical education and empowerment programs that are tailored to the changing needs of individual communities and provide regular access to life-changing surgery and related care.

 ** Specifically for corporate/foundation audience:       Interplast is an efficiently run organization managed by a professional staff and

governed by a board of directors consisting of leaders from the business and medical sectors who appreciate and recognize the contributions of our volunteers, medical partners and donors.

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FUNDINGStrategy

Interplast will shift its funding strategy from one of meeting its annual budget on a year-by-year basis to a two-pronged approach designed for growth and sustainability by:

Continuing annual fundraising to support programs and infrastructure and, Soliciting extraordinary gifts to launch and support programs such as the Surgical

Outreach Centers, including the addition of different types of surgeries to the caseload of the centers. Such initiatives require a secure source of funding that is not jeopardized by swings in the economy and other factors affecting annual fundraising.

Methodology

Interplast will launch a comprehensive campaign to raise $10 million or more to ensure the future direction of the organization. Interplast has already begun the earliest stage of planning for the campaign and will proceed slowly over the next year to institute such an initiative. The campaign could last 24 months or longer once it is officially underway.

Included in the planning will be consultation with outside fundraising counsel to assess the readiness of Interplast’s fundraising infrastructure, including staff and resources, and to assess the readiness of the board and Interplast’s current donor pool. Ongoing consultation will determine if Interplast must add or change staff to achieve the goals of the campaign, as well as to continue ongoing fundraising at the level being raised at the conclusion of the campaign.

Planning

Interplast’s strategic planning over the past year has successfully developed a program structure that can be developed into significant and achievable solicitations. Interplast staff has also developed funding templates and systems that can reliably create accurate budgets to solicit for programs, and to track funding to the satisfaction of all levels of donors and auditors.

The campaign is currently envisioned to highlight three components.

1. The Future Program Fund – designed to give Interplast a “leg up” over a number of years to develop fully some programs that currently suffer from annual budget cuts to meet revenue projections.

2. The Endowment Fund – to create a rock solid and growth-oriented investment fund that can be devoted to the work of the Surgical Outreach Centers.

3. The Capital Fund – to invest in medical equipment, technology, and possibly structural changes to the Interplast’s office.

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FINANCIAL PROJECTIONS

Consistent with this 3-year business plan, Interplast will grow incrementally during fiscal years 2005, 2006, and 2007. During that period, it will launch a $10 million comprehensive campaign (endowment, capital, and future program fund), thereby preparing the organization for a quantum growth in its services beginning no later than FY 2008.

13%14% 3% 1% -8%

18%9%

11%

-500,000

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

3,500,000

4,000,000

98/992,260

99/002,506

00/012,906

01/022,998

02/033,038

03/04 2,800

04/053,300

05/063,800

05/074,000

REVENUE PROJECTION THROUGH FY07 (in millions)

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INTERPLAST “GIFT PYRAMID”

FISCAL YEAR 2007 - GOAL FISCAL YEAR 2006 - GOAL

100,000 7 1,550,000 100,000 7 1,350,000

30,000 - 99,999 25 900,00030,000 -

99,999 22 839,000

10,000 - 29,999 37 550,00010,000 -

29,999 33 486,0001000 - 9999 270 580,000 1000 - 9999 250 550,000

1 - 999 2,800 420,000 1 - 999 2500 375,000  3,139 4,000,000   2,812 3,600,000           

FISCAL YEAR 2005 - GOALFISCAL YEAR 2004 - TO-DATE

4/8/04

100,000 6 1,250,000 100,000 2 367,138

30,000 - 99,999 19 770,00030,000 -

99,999 13 626,016

10,000 - 29,999 30 430,00010,000 -

29,999 22 363,1771000 - 9999 230 500,000 1000 - 9999 154 370,428

1 - 999 2300 350,000 1 - 999 1,345 243,022  2,585 3,300,000   1,536 1,969,781           

FISCAL YEAR 2004 - GOAL FISCAL YEAR 2003 - ACTUAL

100,000 6 1,070,000 100,000 3 1,083,590

30,000 - 99,999 19 760,00030,000 -

99,999 17 702,469

10,000 - 29,999 50 550,00010,000 -

29,999 27 405,7201000 - 9999 250 550,000 1000 - 9999 220 517,195

1 - 999 2400 370,000 1 - 999 2150 333,000  2,725 3,300,000   2,417 3,041,974           

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PROGRAM OBJECTIVESWith Direct Program Costs

YEAR TeamTrips

AnesthesiaStaffMember

VETrips

SiteVisits

Cleft SurgicalOutreachCenters

BurnProgramOutreachCenters

SpeechCamp Outreach Centers

MedicalScholarProgram

GrandRounds

EducationMaterials

2005 Increase of 1 trip to 18 trips (1 trip=$25,225)

¼ time

$35,000

Increase of 5 from 12 to 17$53,000

$15,450NoIncrease from ‘04

27% increase in investment from ‘04$300,000

Pilot program 2 sites 175 cases$66,000

Increase of 2 camps in Nepal (6 to 8)$11,200

$12,2504 scholars

2 new users$2000

Increase of 63%$3,850

2006 Increase of 1 trip to 19 trips (1 trip=$26,170)

½ time

$70,000

Increase of 4 from 17 to 21$65,478

$18,54020% increase Remains

steadyNo increase

Burn program2 sites265 cases$99,500

Increase of 1 camp in Nepal (9) and 2 camps at pilot site$17,000

$15,3155 scholars

2 new users$2000

Increase of 25%$5,332

2007 Increase of 1 trip to 20 trips (1 trip=$27,150)

½ time

$71,400

Increase of 3 from 21 to 24$74,832

$22,24820% increase

Remains steadyNo increase

Burn program 4 sites330 cases$145,250

Increase of 2 camps at pilot site (4)Nepal (9)$19,800

$19,1456 scholars

2 new users$2000

Increase of 25% $6,665

3-yearOver-view

From 17 to 20 trips

½ time anesthesia staff

From 12 to 24 trips

44% budget increase

No increase from ’05

Establish burn program at 4 sites

Increase number of sites in Nepal and start program in second site

15 scholars

6 new partner users

$15,847additionalinvestment

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APPENDICES

Appendix I: Surgical Outreach Center Burn Pilot Program 32

Appendix II: Interplast Grand Rounds 33

Appendix III: Board and Staff Credentials: A Note 34

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Burn Care at Outreach Centers

The need for burn care in developing countries is well known to Interplast (see above). The addition of the capability to help the large number of severely deformed children by making free access to burn care available would be a significant contribution to health care in these countries.

From an organizational standpoint, we are developing a QI process and data recording system to assure quality in such a program devoted to locally-based burn surgeries. This will be web-based. We have solicited and received some funding for such a program, both for reimbursement and administration, but are in need of additional funding on an ongoing basis.

Interplast has undertaken a trial program this fiscal year in the two most appropriate countries, Nepal and Zambia. There are several possibilities for payment methods. Paying by case is not as applicable as with clefts, as the case difficulty and length in the arena of burn reconstruction can vary greatly. An hourly rate appears to work best, with local surgeons adjusting the costs and funding requests as appropriate (see Dr. Shankar Rai’s budgetary information).

Interplast as an organization commits itself to bringing about the availability of reconstructive plastic surgery for burn deformities in our Surgical Outreach Centers.

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INTERPLAST GRAND ROUNDS

Interplast Grand Rounds is a web-based venue for doctors from all over the world to “make rounds” together in a virtual hospital. This program allows physicians from the poorest regions of the world to interact with experts from the U.S. and Canada regarding complicated reconstructive surgery cases to help poor children, including severe burns, facial deformities, animal attacks, and hand trauma. Interplast Grand Rounds defies international boundaries and time zones to allow physicians from the poorest regions of the world to have the same medical interchange that occurs daily in hospitals throughout our country. This dialogue requires that the international partner have a laptop computer and a digital camera to be able to post cases for consultation

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INTERPLAST BOARD AND STAFF CREDENTIALS: A NOTE

Interplast is fortunate to have a highly talented and active Board of Directors who govern the organization. The Board is composed of two groups: skilled medical personnel consisting of plastic reconstructive surgeons, anesthesiologists, pediatricians, and nurses—currently active in the medical program of the organization—and successful business men and women, philanthropists, and active community leaders. These exceptional board members represent the very best of medical practitioners and administrators, of community activists, and of corporate America, including venture capitalists, investment specialists, organizational consultants, and attorneys, among others. The Interplast Board is a beneficiary of the pro bono services of a prominent San Francisco attorney and an executive with the world’s fifth largest public relations firm, Edelman.

Interplast is staffed and managed by 18 full-time equivalent staff members, led by a President & CEO with 18 years of nonprofit administrative experience and 23 years of nonprofit fundraising experience; a Chief Medical Officer who is a prominent retired plastic reconstructive surgeon with 30+ years of experience; and a Vice-President for Development with 20+ years of successful major gift fundraising experience at two of the nation’s most prestigious institutions of higher education, in addition to 5 years’ experience in major gift fundraising at Interplast.

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