Africa

Sue K, Rosenberg J, Weintraub R. Addressing Tanzania’s Health Workforce Crisis Through a Public-Private Partnership: The Case of TTCIH. Harvard Business Publishing. 2016.Abstract

Set in rural Tanzania, this case traces the founding and development of the Tanzanian Training Centre for International Health (TTCIH) from the early 2000s through 2015. It begins with an overview of the political, socioeconomic, and epidemiological context of Tanzania, followed by a detailed description of the human resource for health crisis in Tanzania and the landscape of available health care training programs. The case then explores the origins and evolution of TTCIH, launched through a unique collaboration between private industry, a public health institute, local stakeholders and educators, and the Tanzanian Ministry of Health and Social Welfare. It describes the evolution of TTCIH as leaders strive to make it self-sustaining and responsive to Tanzania’s health workforce crisis. The case highlights the challenges of successfully integrating corporate management practices and values into a global health program and the role of strategic leadership to sustain TTCIH.

Teaching Note available through Harvard Business Publishing.

TTCIH Income and Number of Students, 2005–2013
TTCIH Income and Number of Students, 2005–2013

Learning Objectives: A productive class discussion will allow students to appreciate the challenges of designing sustainable, high-quality health training institutions in low-resource settings; the training and resources needed to support task shifting and to address health workforce shortages in health care delivery; and, the importance of maintaining a sound strategy for medical education programs in the midst of changing national health needs and the evolving medical education landscape.

Keywords: Global health, public health, health care delivery, education, government, value creation, Human Resources for Health, health care, nongovernmental organizations, Public-Private partnerships, learning, revenue growth, organizational effectiveness

Sullivan E, Drobac P, Thompson K, Rodriguez W. Botswana’s Program in Preventing Mother-to-Child HIV Transmission. Harvard Business Publishing. 2011.Abstract

This case traces the development of Botswana’s prevention of mother-to-child HIV transmission (PMTCT) program, from its inception as a pilot program in 1999 through its national expansion in 2002 and its struggle to improve outcomes and integrate with broader maternal and child care services through 2008. After providing some background on Botswana, its demographics and health situation, including HIV/AIDS and that national response, the case provides an overview of PMTCT—a critical challenge in global health—and describes the inception of the PMTCT program in Botswana. Readers see the challenges the program faced upon the initial scale-up and explore the key efforts and advances in process and policy that help the country overcome them and become a well known PMTCT success story. The case ends with the program wrestling with a relatively small group of women and their infants who fell through the cracks in the program and several holes in the health system that are preventing the program from eradicating infant HIV completely and tracking its progress.

Teaching Note available through Harvard Business Publishing.

PMTCT Programme vehicle. Credit: Erin Sullivan
PMTCT Programme vehicle. Credit: Erin Sullivan.

Learning Objectives: To understand the role of a robust strategy, including experimentation, adoption, process improvement, and policy in global health implementation and national scale-up strategies.

Keywords: Health care policy, Horizontal programming, HIV prevention, Translation of research into practice

ole‐MoiYoi K, Rodriguez W. Building Local Capacity for Health Commodity Manufacturing: A to Z Textile Mills Ltd. Harvard Business Publishing. 2011.Abstract

This case focuses on the establishment of the Olyset® Consortium—a public-private partnership that was created to facilitate the manufacture of long-lasting insecticidal bed nets to prevent malaria infection in sub-Saharan Africa—and A to Z Textile Mills (“A to Z”), the manufacturer of the nets in Arusha, Tanzania. The case examines how the public-private partnership was developed, its use of an incentive-based supply chain, A to Z’s business model and impact, and the sustainability of the venture. The case reveals that despite significant success in attaining objectives, the misaligned incentives of the many partners presented major obstacles to the overall sustainability of A to Z’s Olyset® production line.

Teaching Note available through Harvard Business Publishing.

Long Lasting Insecticide Nets and Olyset Production Process
Long Lasting Insecticide Nets and Olyset Production Process. Source: A to Z Textile Mills Ltd., Arusha, Tanzania (Case Exhibit 9).

Learning Objectives: To understand the potential for public-private partnerships to leverage innovation and scalability from the private sector and quality and equitable access from the public sector and to examine the costs and benefits of local manufacturing of technologically complex global health commodities in resource-limited settings.

Keywords: Public-private partnerships, incentive-based supply chain, global health commodity manufacturing, malaria prevention

Madore A, Talbot JR, Weintraub R. Electronic Medical Records at ISS Clinic Mbarara, Uganda. Harvard Business Publishing. 2012.Abstract

This case traces the evolution of the medical records system at the Immune Suppression Syndrome (ISS) Clinic in Mbarara, Uganda. After providing some background on Uganda, its HIV epidemic, and the general rise of electronic medical records and software, it explains the history of the ISS Clinic and its service delivery model. ISS Clinic had used paper records to manage care, treatment, and reporting needs until it partnered with the University of California, San Francisco on research initiatives. In 2004 ISS Clinic became a global health initiative beneficiary and the outpatient antiretroviral therapy center of Mbarara Regional Hospital. Offering free treatment, patient enrollment jumped dramatically. The clinic's electronic Access database was unable to keep up. The clinic secured a grant to implement a new medical record system, and leaders struggled to convince the physicians and other stakeholders of its value. The most clinically-relevant pieces were slow to be put in place, and new Ministry of Health regulations posed minor setbacks. At the end of 2010, the clinic had seen nearly 21,000 patients. Clinic research had contributed to more than 20 peer-reviewed articles, but the long-term prospects for the database were unknown.

Teaching Note available through Harvard Business Publishing.

Screenshot of an Electronic Form in OpenMRS, ISS Clinic
Screenshot of an Electronic Form in OpenMRS, ISS Clinic. Source: ISS Clinic. (Exhibit 12 from "Electronic Medical Records at ISS Clinic Mbarara, Uganda" case.)

Learning Objectives: This case documents the evolution of medical records at an HIV/AIDS clinic in a resource-limited setting. A productive class discussion will allow students to appreciate what it takes to collect and systemize accurate health data for patient care and research, what it takes to implement an electronic medical system in a resource-limited setting, and the relationship between a health record system, clinical care, and public health.

Keywords: Management and operations, HIV treatment, health research, health information systems

ole-MoiYoi K, Rodriguez W. Investing in Global Health: Botanical Extracts Ltd. Harvard Business Publishing. 2011.Abstract

This case traces the establishment of Botanical Extracts (BE) as a manufacturer of artemisinin, the active pharmaceutical ingredient in artemisinin-based combination therapies (ACTs) for malaria in East Africa. After providing background on the disease and its epidemiology and history, the case delves into the malaria eradication and control efforts of the past 50 years, with emphasis on treatment with anti-malarials. It describes how artemisinin made the transition from a traditional Chinese medicine to Novartis’ largest pharmaceutical product by volume. The case presents background information on the artemisinin industry, with emphasis on the WHO, Novartis, artemisinin extractors, and Artemisia farmers. The case details the founding of BE, its role in the ACT industry, and the complex supply chain for ACTs from the cultivation of the raw material to the delivery of ACTs as well as the public private partnership that was driving the manufacturing and delivery of ACTs. The case ends by describing the challenges faced by BE in June 2008, asking how best the company should move forward.

Teaching Note available through Harvard Business Publishing.

The Artemisia Plant and Cultivation
The Artemisia Plant and Cultivation. Image A Source: Advanced Bio-Extracts. Image B Source: Farmer in Central Kenya, June 2008. (Exhibit 7 from "Investing in Global Health: Botanical Extracts Ltd." case.)

Learning Objectives: To understand 1) the challenges of manufacturing necessary healthcare commodities for a populace that is unable to afford them, 2) how risk is distributed among actors in public-private partnerships, and 3) how investment in health commodities in developing countries can promote sustainable economic development.

Keywords: Public-private partnerships, pharmaceutical supply chains, malaria eradication and control, health commodity manufacturing

Arnquist S, Weintraub R. loveLife: Preventing HIV Among South African Youth. Harvard Business Publishing. 2011.Abstract

This case describes the strategy of the nongovernmental organization (NGO), loveLife, to prevent HIV among South African youth in the face of the world’s largest HIV epidemic, youth culture in post-apartheid South African, and a national government hostile to HIV/AIDS programs. The case traces loveLife from its inception and rapid scale up in 1999 to 2005, when loveLife lost one-third of its operating budget after the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) chose not to renew its second phase of funding. This case documents loveLife’s strategy in scaling up and sustaining delivery of HIV prevention services at scale. A short, optional case coda describes loveLife’s restructuring and positioning after the Global Fund crisis up to 2009.

Teaching Note available through Harvard Business Publishing.

Examples of loveLife media. Source: loveLife.
Examples of loveLife media. Source: loveLife. (Exhibit 10 from "loveLife: Preventing HIV Among South African Youth" case.)

Learning Objectives: To learn the application of strategic thinking in HIV prevention using Michael Porter’s “Five Tests of a Good Strategy” and to understand the organizational changes required in transitioning from scaling up to operating at scale.

Supporting Content: This case has a supplementary summary of history and next steps titled loveLife: preventing HIV among South African youth (Part B). There is also an additional sequel, loveLife: Transitions After 2005.

Keywords: Demand generation, scale up, sustaining delivery at scale, HIV prevention among youth, strategy, stigma

Arnquist S, Weintraub R. loveLife: preventing HIV among South African youth (Part B). Harvard Business Publishing. 2011.Abstract

This case describes the strategy of the nongovernmental organization (NGO), loveLife, to prevent HIV among South African youth in the face of the world’s largest HIV epidemic, youth culture in post-apartheid South African, and a national government hostile to HIV/AIDS programs. The case traces loveLife from its inception and rapid scale up in 1999 to 2005, when loveLife lost one-third of its operating budget after the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) chose not to renew its second phase of funding. This case documents loveLife’s strategy in scaling up and sustaining delivery of HIV prevention services at scale. A short, optional case coda describes loveLife’s restructuring and positioning after the Global Fund crisis up to 2009. 

Teaching Note available through Harvard Business Publishing.

HIV Incidence among 15-20-year-old South Africans, 2002-2008. Source: Rehle T, Hallett T, Shisana O, et al. A Decline in New HIV Infections in South Africa: Estimating HIV Incidence from Three National HIV Surveys in 2002, 2005 and 2008. PloS one. 2010;5(6):e11094. (Exhibit 2 from "loveLife: preventing HIV among South African youth" case.)

Learning Objectives: To learn the application of strategic thinking in HIV prevention using Michael Porter’s “Five Tests of a Good Strategy” and to understand the organizational changes required in transitioning from scaling up to operating at scale.

Supporting Content: This case is the supplement to loveLife: Preventing HIV Among South African Youth.

Keywords: Demand generation, scale up, sustaining delivery at scale, HIV prevention among youth, strategy, stigma

Arnquist S, Talbot JR, Weintraub R. loveLife: Transitions After 2005. Harvard Business Publishing. 2012.Abstract

This case focuses on how loveLife, South Africa's largest youth-focused nongovernmental organization, recovered from losing one-third of its operating revenues in 2006 when the Global Fund to Fight AIDS, Tuberculosis and Malaria chose not to renew funding to South Africa. The case describes managers' decisions to downsize and secure additional government funding to save the organization and the ways in which the original strategy guided these changes. The case ends in 2009 with loveLife's new chief executive officer contemplating how to secure the organization's future amid national political changes and funding challenges.

Teaching Note available through Harvard Business Publishing.

loveLife Program Coverage, 2007. Source: loveLife
loveLife Program Coverage, 2007. Source: loveLife. (Exhibit 6 from "loveLife: Transitions After 2005" case.)

Learning Objectives: To appreciate how crises can impact program management and activities, the role of leadership in responding to crises, the benefits of second generation leadership for an organization, and the implications of transitioning from international funding sources to domestic government funding sources.

Supporting Content: This case is a sequel to loveLife: Preventing HIV Among South African Youth.

Keywords: National strategy, impact of financing, HIV prevention, leadership, sustainability

Redditt V, ole-MoiYoi K, Rodriguez W, Talbot JR, Weintraub R. Malaria Control in Zambia. Harvard Business Publishing. 2012.Abstract

This case reviews the changes in national policy and the subsequent interventions used to reduce the incidence of malaria in Zambia from 2005 to 2010. After providing contextual information on Zambia-including historical, demographic, social, and health information-the case delves into the history of malaria control efforts worldwide and in Zambia. Though Zambia was at the forefront of malaria control-changing policy, adopting new treatment, and aggressively pursuing comprehensive malaria control efforts-in the early 2000s, by 2005 the Zambian government was still falling short of its targets. The National Malaria Control Center (NMCC) resolved to intensify its efforts by developing one national plan to improve coordination, data collection, and partner involvement, and ultimately, to scale up interventions rapidly in order to meet the national malaria targets. The new NMCC director, Dr. Elizabeth Chizema, guided the program toward success through several key interventions described in the case. With basic improvements in monitoring and evaluation, Chizema could demonstrate progress in malaria control. Nonetheless, she worried that partners might lose interest in helping Zambia given the decreasing burden even though the program still had many challenges to overcome.

Teaching Note available through Harvard Business Publishing.

Malaria Program Scale-up: Coverage and Burden Reduction
Malaria Program Scale-up: Coverage and Burden Reduction. Source: Malaria Control and Evaluation Partnership in Africa. Scaling Up for Impact through Comprehensive Program Improvement. Seattle; 2007. (Exhibit 4a from "Malaria Control in Zambia" case.)

Learning Objectives: To understand the development of a successful malaria control program over time and the components that led to its success, including the value of setting bold national goals, the merits of a health system with centralized governance and decentralized implementation, the importance of multiple coordinated interventions as opposed to a "silver bullet" approach for malaria control, and the use of data as an outcome measure, planning tool, and fundraising tool.

Supporting Content: There is a shorter version of this case titled Malaria Control in Zambia (Condensed Version).

Keywords: National strategy, supply chain management, malaria eradication and control, leadership

Redditt V, ole-MoiYoi K, Rodriguez W, Talbot JR, Weintraub R. Malaria Control in Zambia (Condensed Version). Harvard Business Publishing. 2012.Abstract

The case delves into the history of malaria control efforts in Zambia, including control and treatment policy changes in the in the early 2000s that set Zambia apart from other countries. Because by 2005 Zambia was still falling short of its targets, the National Malaria Control Center (NMCC) resolved to intensify its efforts by developing one national plan to improve coordination, data collection, partner involvement, and ultimately, rapidly scale-up interventions to meet the national malaria targets. The new NMCC director, Dr. Elizabeth Chizema, helped the program achieve success through several key interventions described in the case. With improved monitoring and evaluation, Chizema could demonstrate progress in malaria control, but she worried that partners might lose interest in helping Zambia given the low burden, and the program still had many challenges to overcome. This is a condensed version of the case Malaria Control in Zambia

Teaching Note available through Harvard Business Publishing.

Malaria Program Scale-up: Coverage and Burden Reduction
Malaria Program Scale-up: Coverage and Burden Reduction. Source: Malaria Control and Evaluation Partnership in Africa. Scaling Up for Impact through Comprehensive Program Improvement. Seattle; 2007. (Exhibit 4a from "Malaria Control in Zambia" case.)

Learning Objectives: To understand the development of a successful malaria control program over time and the components that led to its success including the value of setting bold national goals, the merits of a health system with centralized governance and decentralized implementation, the importance of multiple coordinated interventions as opposed to a "silver bullet" approach for malaria control, and the use of data as an outcome measure, planning tool, and fundraising tool.

Supporting Content: This is a condensed version of the case Malaria Control in Zambia.

Keywords: National strategy, supply chain management, malaria eradication and control, leadership

Wachter K, Talbot JR, Weintraub R. Partners In Health in Neno District, Malawi. Harvard Business Publishing. 2013.Abstract

Set in Neno District, Malawi from 2007–2012, the case focuses on the economic impact of investing in health care infrastructure. It examines management decisions that leaders of Abwenzi Pa Za Umoyo (APZU) and its founding organization—Partners In Health (PIH)—made as they supported the Government of Malawi in building a hospital and scaling up the delivery of APZU clinical and social programs across Neno district. The case highlights how a non-governmental organization can navigate the politics and local culture to improve Malawi’s health care system in close partnership with a strong, protocol-driven government. The case begins with Ophelia Dahl, co-founder and executive director of Partners In Health, reflecting on her December 2011 trip to Neno, nearly four years after her first visit. She observed signs of progress unrelated to health—bank branches had opened in town, a new road had been built, and the market had expanded dramatically. Ultimately, the case explores what this demonstrates about the value of her organization’s investments in health.

Teaching Note available through Harvard Business Publishing.

Neno rural hospital
In the foreground: One-story original structures of Neno Rural Hospital used for outpatient and maternity services. In back: Two-story building constructed by APZU and partners used for inpatient wards, meetings, computer use, laboratory work, and government offices. Source: Keri Wachter, 2012.

Learning Objectives: To understand the challenges of hiring and retaining local and expat staff, the complexity of an international NGO partnering with the government to improve health care, how leadership acumen and approaches impact scaling up and sustaining health care delivery, the relationship between the district hospital and the local economy, and how to assess impact beyond health measures.

Keywords: Global health, social equality, project management, business and government relations, partnerships, strategy, economic development, health care policy, health care delivery, public health, human resource management, developing countries, innovation

Madore A, Yousif H, Rosenberg J, Desmond C, Weintraub R. Political Leadership in South Africa: HIV. Harvard Business Publishing. 2015.Abstract

This case describes the rapid scale-up of South Africa’s national HIV/AIDS response from 2009 until 2015. After providing background on apartheid, the impact of HIV/AIDS denialism, and an overview of the health system in South Africa, the case follows Minster of Health Aaron Motsoaledi’s leadership of the national department of health’s HIV/AIDS program. The response included four key components: a countrywide counseling and testing campaign, capacity building to increase access to treatment, an overhaul of the ARV bidding and procurement processes, and promotion of voluntary male medical circumcision. The case highlights how Motsoaledi and his team leveraged expertise and resources from domestic and international organizations to support ambitious testing and treatment goals. It focuses on Motsoaledi’s communication strategies and the factors that influenced his planning and implementation decisions. The case ends with Motsoaledi considering how to advance the national HIV/AIDS program amid larger health system issues, including overcrowding and limited monitoring capacity.

Teaching Note available through Harvard Business Publishing.

Promotion of prevention of mother-to-child transmission (PMTCT) of HIV
Promotion of prevention of mother-to-child transmission (PMTCT) of HIV (source: Global Health Delivery Project case writers)

Learning Objectives: A productive class discussion will allow students to appreciate how politics can shape the trajectory of an epidemic; the importance of leveraging existing resources to scale services in a public health system; the challenges of transitioning from an emergency response to a sustainable public program; and the competing interests of a vertical intervention program and the complex health system within which it operates.

Keywords: Political leadership, data and health policy, counseling and testing, adherence, advocacy, HIV treatment, health care delivery, cross-sector collaboration, vertical programs, value creation, drug procurement, civil society, strategy

Madore A, Yousif H, Rosenberg J, Desmond C, Weintraub R. Political Leadership in South Africa: National Health Insurance. Harvard Business Publishing. 2015.Abstract

This case traces the development of national health insurance (NHI) in South Africa under Minister of Health Aaron Motsoaledi. After providing background on health financing and health insurance policy in South Africa, the case explores Motsoaledi’s approach to realizing universal health coverage by establishing a government-administered NHI system and overhauling primary health care in the public sector. The case highlights the importance of strategic communication and stakeholder engagement in the highly political process of health system reform. It focuses on the complexity of the NHI policy process and the steps Motsoaledi and his team took to increase standards and accountability for public primary health care facilities. It concludes with the national health department rolling out new tools for monitoring facility progress and Motsoaledi awaiting approval of his team’s 19th draft plan for NHI, wondering what to do in the meantime to improve health care.

Teaching Note available through Harvard Business Publishing.

National Department of Health, South Africa
National Department of Health, South Africa (Source: Global Health Delivery case writers)

Learning Objectives: A productive class discussion will allow students to appreciate the relationship between policy development, financing, and implementation of public health care delivery; the complexity of implementing standards and accountability for primary care infrastructure; and the work and negotiation needed to build consensus among private and public payers and providers with competing financial interests to generate greater value in health care delivery.

Keywords: Political leadership, health system strengthening, stakeholder engagement, primary health care reform, policy development, politics and health care, health care financing, health insurance, strategy

 

ole-MoiYoi K, Talbot JR, Weintraub R. Roll-Out of Rapid Diagnostic Tests for Malaria in Swaziland. Harvard Business Publishing. 2012.Abstract

After outlining the history of malaria in Swaziland, this focused case study examines the implementation of rapid diagnostic tests (RDTs) for malaria in Swaziland to improve case management and to strengthen the national malaria surveillance system as the National Malaria Control Program (NMCP) aims to implement a national elimination strategy. In addition to information on RDT selection, the case details Swaziland's quality assurance program-the first of its kind in the region, the public health benefits of the immediate disease notification system for active case detection, and Simon Kunene's leadership qualities as the manager of the NMCP for 24 years. The case addresses the necessary increases in financing and human resources to support the strategy and evaluates the impact of RDTs on the strategy. Challenges the NMCP faces in achieving malaria elimination include sustaining political will, interest, and financial commitments from donors and strengthening health workforce training and RDT procurement and distribution.

Teaching Note available through Harvard Business Publishing.

Milestones toward Malaria Elimination
Milestones toward Malaria Elimination. Source: The Global Malaria Action Plan: For a malaria-free world. Roll Back Malaria Partnership, 2008. (Exhibit 4 from "Roll-Out of Rapid Diagnostic Tests for Malaria in Swaziland" case.

Learning Objectives: To understand the role of diagnostics in a malaria elimination strategy, what it takes to effectively integrate a new diagnostic into care delivery, how leaders generate social and political capital over time, and the intricacies of managing a national disease program.

Keywords: National strategy, supply chain management, diagnostic testing strategies, malaria eradication and control

Chao T, Patel P, Rosenberg J, Riviello R. Surgery at AIC Kijabe Hospital in Rural Kenya. Harvard Business Publishing. 2015.Abstract

This case traces the development of surgical and anesthesia services at a rural mission hospital in Kijabe, Kenya. After providing some background of the health system in Kenya, it follows the history of AIC Kijabe Hospital from its founding in 1915 to 2013. The hospital provided high quality surgical services that were supported by many long-term missionary staff members, updated operating theaters, an intensive care unit, and a robust surgical training program. The case describes how the mission of the hospital affects its culture of care provision. It follows the executive director, Mary Muchendu, and her process in turning a mission-focused hospital into a business-focused hospital. The case ends with Muchendu weighing the tradeoffs of providing sustainable growth versus caring for the poor.

Teaching Note available through Harvard Business Publishing.

Surgical Facilities at AIC Kijabe Hospital
Surgical Facilities at AIC Kijabe Hospital: postoperative recovery area with wall oxygen, suction, and vital sign monitoring. Source: Global Health Delivery Case Writers.

Learning Objectives: This case documents the development of a robust surgical program at a mission hospital in rural Kenya, including human resource training and infrastructure improvement. A productive class discussion will allow students to appreciate the factors that allow high-quality surgical care to be delivered in a resource-limited setting; how a mission-driven culture affects a hospital, its sustainability, and the care it provides; what is required to provide high-quality surgical training; and the tensions and tradeoffs between sustainable growth and care for the poor.

Supporting Content: There is a shorter version of this case titled Surgery at AIC Kijabe Hospital in Rural Kenya (Condensed Version).

Keywords: Surgical disease, mission-based hospitals, rural surgery services, management, speciality training, global health care delivery, faith based organizations, human resources for health, anesthesia

Chao T, Patel P, Rosenberg J, Riviello R. Surgery at AIC Kijabe Hospital in Rural Kenya (Condensed Version). The Lancet Commission on Global Surgery. 2015.Abstract

This case traces the development of surgical and anesthesia services at a rural mission hospital in Kijabe, Kenya. After providing some background of the health system in Kenya, it follows the history of AIC Kijabe Hospital from its founding in 1915 to 2013. The hospital provided high quality surgical services that were supported by many long-term missionary staff members, updated operating theaters, an intensive care unit, and a robust surgical training program. The case describes how the mission of the hospital affects its culture of care provision. It follows the executive director, Mary Muchendu, and her process in turning a mission-focused hospital into a business-focused hospital. The case ends with Muchendu weighing the tradeoffs of providing sustainable growth versus caring for the poor. This is a condensed version of the case Surgery at AIC Kijabe Hospital in Rural Kenya

Teaching Note available through Harvard Business Publishing.

Surgical Facilities at AIC Kijabe Hospital
Surgical Facilities at AIC Kijabe Hospital: postoperative recovery area with wall oxygen, suction, and vital sign monitoring. Source: Global Health Delivery Case Writers.

Learning Objectives: This case documents the development of a robust surgical program at a mission hospital in rural Kenya, including human resource training and infrastructure improvement. A productive class discussion will allow students to appreciate the factors that allow high-quality surgical care to be delivered in a resource-limited setting; how a mission-driven culture affects a hospital, its sustainability, and the care it provides; what is required to provide high-quality surgical training; and the tensions and tradeoffs between sustainable growth and care for the poor.

Supporting Content: This is a condensed version of the case Surgery at AIC Kijabe Hospital in Rural Kenya

Keywords: Surgical disease, mission-based hospitals, rural surgery services, management, speciality training, global health care delivery, faith based organizations, human resources for health, anesthesia

Park P, Bhatt A, Rhatigan J. The Academic Model for the Prevention and Treatment of HIV/AIDS. Harvard Business Publishing. 2011.Abstract

This case traces the development of the Academic Model for the Prevention and Treatment of HIV/AIDS (AMPATH), and its founding organization, the Indiana University – Moi University (IU-MU) Partnership in Eldoret, Kenya. The case opens with a discussion of AMPATH’s new Home-Based Counseling and Testing Program (HCT) and its prospects for improving HIV care in Western Kenya. After providing some background on the general political, economic, and health situation in Kenya, it follows the development of the IU-MU Partnership from 1990 to 2000, its subsequent entry into HIV care services through AMPATH in 2001, and AMPATH’s rapid growth to become the largest provider of HIV services in Kenya. It then describes the organizational and operational characteristics of AMPATH and concludes with the organization wrestling with the opportunities and operational challenges that HCT presents.

Teaching Note available through Harvard Business Publishing.

AMPATH Center in Eldoret, Kenya
AMPATH Center in Eldoret, Kenya. Source: Case writer. (Exhibit 12 in "The Academic Model for the Prevention and Treatment of HIV/AIDS " case.)

Learning Objectives: To understand the development and design of a large scale HIV care program in a resource-limited setting and to examine how HIV treatment programs can effectively configure their services to provide maximum value to the populations they serve.

Keywords: Service expansion, the role of academic medical centers, HIV treatment and prevention, home-based counseling and treatment

Kleinman S, Talbot JR, Harris J, Ellner A. The AIDS Support Organization (TASO) of Uganda. Harvard Business Publishing. 2011.Abstract

This case traces the development of The AIDS Support Organization (TASO), a Ugandan non-governmental organization, from 2001 to 2006. One of the first organizations to become involved in HIV/AIDS in the late 1980s, TASO began as a meeting place for people infected and affected by HIV/AIDS, helping people to live positively. The organization provided free counselling, social support, limited medical care, community mobilizing, advocacy and networking. TASO worked alongside government facilities and trained government medical personnel in HIV counselling. After many years, TASO got a new director who brought management skills, a commitment to professionalizing the organization, and a drive to expand services. TASO began incorporating antiretroviral therapy (ART) into its offerings. The ART delivery model combined home and clinic-based care in order to maximize patient adherence. The case follows the development of the organization and scale up of services and raises the question of how to deliver care most cost effectively while maintaining its values and meeting the changing needs of the population and clients.

Teaching Note available through Harvard Business Publishing.

Training health workers to care for HIV/AIDS patients in Uganda. Credit: Sarah Kleinman; TASO
Training health workers to care for HIV/AIDS patients in Uganda. Credit: Sarah Kleinman; TASO

Learning Objectives: Students should learn how a healthcare delivery organization can expand and evolve over time in response to changes in external context and the needs of its clients; how public and private organizations can coordinate to meet the varied needs of a population; and the importance of leadership, management, and strategic vision in creating successful global health programs.

Keywords: Service expansion, Home- and clinic-based care, HIV prevention and treatment.

Bitton A, Talbot JR, Clarke L. Tobacco Control in South Africa. Harvard Business Publishing. 2011.Abstract

This case reviews the policy changes in tobacco control in post-apartheid South Africa from 1994 to 1996 under the leadership of Minister of Health Dr. Nkosazana Zuma. After providing contextual information on South Africa, including historical, demographic, social, and health information, the case delves into the history of tobacco and of global tobacco control efforts. The case then details the history of tobacco in South Africa, including data collection, epidemiology, early control efforts, and the policy efforts of the mid-1990s. The case describes the African National Congress (ANC)’s policy victories under Zuma’s leadership. Knowing that tobacco disproportionately affected certain racial and minority groups, Zuma made tobacco control a top priority. With the support of the President, local tobacco experts, and anti-tobacco advocates, Zuma worked hard to break previous connections between the government and the tobacco industry and to reduce smoking. The case ends in 1996 when smoking prevalence had declined to 32% from 34% in 1995, but South Africa still had one of the highest levels in the developing world. As the ANC was preparing to enact the new Constitution that reinforced health promotion, Zuma had to determine what her next move would be for tobacco control and how she would prioritize it with the other health needs of the country.

Teaching Note available through Harvard Business Publishing.

Tobacco Control as Health Promotion
Tobacco Control as Health Promotion. Source: Reddy, SP and Swart D. Unraveling Health Promotion: A Framework for Action: Tobacco Control. MRC: 1998. (Exhibit 8 in "Tobacco Control in South Africa" case.)

Learning Objectives: To understand the political and economic forces that impact tobacco control legislation in a country undergoing an epidemiological shift, the role of research and data, and the value of health communication, chronic disease prevention, and advocacy in health care delivery.

Supporting Content: This case has a supplementary summary of history and next steps, titled Tobacco Control in South Africa: Next Steps.

Keywords: Chronic disease prevention, advocacy, health policy, tobacco control

Bitton A, Taranto L, Talbot JR, Kadar E. Tobacco Control in South Africa: Next Steps. Harvard Business Publishing. 2011.Abstract

This case is a supplement to Tobacco Control in South Africa, which reviews the policy changes in tobacco control in post-apartheid South Africa from 1994 to 1996 under the leadership of Minister of Health Dr. Nkosazana Zuma. This case explains what happened after 1996, the steps Zuma took to continue her fight against tobacco (including expanding research capacity, getting increases in excise taxes passed, and pushing national legislation through) and what happened after her departure in 1999.

Teaching Note available through Harvard Business Publishing.

Relationship between Excise Tax Rate and Cigarette Consumption in South Africa
Relationship between Excise Tax Rate and Cigarette Consumption in South Africa. Source: van Walbeek C, WHO. Tobacco Excise Taxation in South Africa. (Exhibit 2 in "Tobacco Control in South Africa: Next Steps" case.)

Learning Objectives: To understand the political and economic forces and the role of research and data in implementing tobacco control legislation in a country undergoing an epidemiological shift, and the value of health communication, chronic disease prevention, and advocacy in health care delivery.

Supporting Content: This case is the supplement to Tobacco Control in South Africa.

Keywords: Chronic disease prevention, advocacy, health policy, tobacco control

Talbot JR, Cole C, May M, Weintraub R. Voluntary Medical Male Circumcision in Nyanza Province, Kenya. Harvard Business Publishing. 2012.Abstract

This case traces the development of the voluntary medical male circumcision (VMMC) campaign in Nyanza Province, Kenya as it transformed from the subject of a randomized clinical trial into national policy. After providing some background on the cultural, political, and scientific context surrounding male circumcision, the case traces the PEPFAR-funded implementers' advances in delivering male circumcision in Nyanza. It examines the various delivery models used in Nyanza and the evolution of the relationship between implementers as well as on the development of the national strategic plan for VMMC released in 2009. The case ends with the implementers having come together successfully for two rapid, aggressive, 30-day implementation campaigns and the head of Kenya's National AIDS and Sexually Transmitted Infections Control Programme wrestling with how to make such campaigns sustainable and what lessons from the campaign to pass on to the national program.

Teaching Note available through Harvard Business Publishing.

Mobile Service Delivery Model Images
Mobile Service Delivery Model Images. Source: Nyanza Reproductive Health Society. (Exhibit 13 from "Voluntary Medical Male Circumcision in Nyanza Province, Kenya" case.)

Learning Objectives: To understand how a randomized controlled trial may be translated into a large-scale public health program; how a surgical campaign was designed and implemented for rapid impact; the role of national and international collaboration in large-scale health delivery; and the ethical tradeoffs that arise in large-scale public health programs.

Supporting Content: There is a shorter version of this case titled Voluntary Medical Male Circumcision in Nyanza Province, Kenya (Condensed Version).

Keywords: Project management, AIDS, policy, supply and demand, partnerships, strategy, innovation

Talbot JR, Cole C, May M, Weintraub R. Voluntary Medical Male Circumcision in Nyanza Province, Kenya (Condensed Version). The Lancet Commission on Global Surgery. 2015.Abstract

This case traces the development of the voluntary medical male circumcision (VMMC) campaign in Nyanza Province, Kenya as it transformed from the subject of a randomized clinical trial into national policy. After providing some background on the cultural, political, and scientific context surrounding male circumcision, the case traces the PEPFAR-funded implementers' advances in delivering male circumcision in Nyanza. It examines the various delivery models used in Nyanza and the evolution of the relationship between implementers as well as on the development of the national strategic plan for VMMC released in 2009. The case ends with the implementers having come together successfully for two rapid, aggressive, 30-day implementation campaigns and the head of Kenya's National AIDS and Sexually Transmitted Infections Control Programme wrestling with how to make such campaigns sustainable and what lessons from the campaign to pass on to the national program. This is a condensed version of the case Voluntary Medical Male Circumcision in Nyanza Province, Kenya.

Teaching Note available through Harvard Business Publishing.

Mobile Service Delivery Model Images
Mobile Service Delivery Model Images. Source: Nyanza Reproductive Health Society. (Exhibit 13 from "Voluntary Medical Male Circumcision in Nyanza Province, Kenya" case.)

Learning Objectives: To understand how a randomized controlled trial may be translated into a large-scale public health program; how a surgical campaign was designed and implemented for rapid impact; the role of national and international collaboration in large-scale health delivery; and the ethical tradeoffs that arise in large-scale public health programs.

Supporting Content: This is a condensed version of the case Voluntary Medical Male Circumcision in Nyanza Province, Kenya.

Keywords: Project management, AIDS, policy, supply and demand, partnerships, strategy, innovation