Asia and the Middle East

May M, Rhatigan J. BRAC’s Tuberculosis Program: Pioneering DOTS Treatment for TB in Rural Bangladesh. Harvard Business Publishing. 2011.Abstract

This case examines the development of a tuberculosis (TB) treatment program in Bangladesh by the non-governmental organization, BRAC, from 1984 to 2006. After providing background about Bangladesh, the burden of TB there, and BRAC, the case examines how this program was piloted and grew to cover a population of 80 million people. It details how BRAC was able to create a TB control program that utilized community health workers to perform most of its essential functions including case finding, directly-observed therapy, identification of complications, and record keeping. The case concludes with a brief summary of BRAC’s expansion to Afghanistan and recently, Africa, and asks the reader to consider the feasibility of this TB care model in other contexts and in other conditions, such as HIV/AIDS.

Teaching Note available through Harvard Business Publishing.

Timeline of BRAC TB Program Expansions
Timeline of BRAC TB Program Expansions. Source: From One to Many: Scaling Up Health Programs in Low-Income Countries. Edited by Richard A Cash, A Mushtaque R. Chowdhury, George B. Smith, and Faruque Ahmed (2010). Ch 13. Islam A and May MA. Decentralized Management in the Expansion of BRAC's Rural Tuberculosis Program (DOTS). Pgs. 207-214. (Exhibit 3 in "BRAC’s Tuberculosis Program: Pioneering DOTS Treatment for TB in Rural Bangladesh" case.)

Learning Objectives: To understand effective strategies for effectively engaging community health workers to deliver complex medical and public health interventions to large populations in low resource settings.

Supporting Content: The sequel to this case is titled Tuberculosis in Dhaka: BRAC’s Urban TB Program.

Keywords: Community health workers, tuberculosis control, rural nongovernmental organizations, social enterprise

Charumilind S, Jain SH, Rhatigan J. HIV in Thailand: The 100% Condom Program. Harvard Business Publishing. 2011.Abstract

Thailand’s 100% Condom Program, which was implemented nationwide in 1991, is widely credited with averting a generalized HIV epidemic in that nation. This case traces the development and implementation of Thailand’s 100% Condom Program including its conception, the development of a pilot program in one province, and the program’s early regional expansion. It frames these events within the country’s general political, economic, and health situation; the epidemiology and public perception of HIV/AIDS; the government’s early HIV policy; and the economics of the commercial sex industry. The case explores how public health interventions are designed, refined, and spread. The case ends in early 1991 with the program’s founder trying to find ways to spread the successful regional program nationwide.

Teaching Note available through Harvard Business Publishing.

Sex establishments in Patpong Area, including go-go bars and members clubs
Sex establishments in Patpong Area, including go-go bars and members clubs. Source: "HIV in Thailand: The 100% Condom Program" case.

Learning Objectives: To understand the principles behind the design of disease prevention programs and to examine how successful programs align incentives among various stakeholders to achieve their objectives.

Supporting Content: This case has a supplementary summary of history and next steps, titled The 100% Condom Program: Part B.

Keywords: HIV prevention, stakeholder alignment, harm reduction

Cole C, Talbot JR, Rhatigan J, Weintraub R, Porter ME. HIV Prevention in Maharashtra, India. Harvard Business Publishing. 2011.Abstract

The case examines Avahan's delivery model for targeted HIV prevention in India within a value-based framework by describing an implementing nongovernmental organization's district level activities. After providing information about the epidemiological, organizational, and political context, the case shows how the nongovernmental organization, Muslim Samaj Prabodhan Va Shikshan Sanstha (MSPSS), is able to tailor a set of activities to match the needs of its target communities under the guidance of one of Avahan's six "state lead partners," Mukta, which is contracted to recruit and manage grantee NGOs. Through a detailed description of MSPSS' activities, the case examines how high-value, comprehensive HIV preventive services can be delivered to a high-risk population. The case ends with MSPSS's leaders challenged to preserve the value of the program as they prepare to transition the program to government ownership.

Teaching Note available through Harvard Business Publishing.

MSPSS Ceremony Honoring Female Police Officer
MSPSS Ceremony Honoring Female Police Officer. Source: MSPSS. (Exhibit 19 from "HIV Prevention in Maharashtra, India " case.)

Learning Objectives: To understand the role of strategy in health care delivery through an examination of how HIV prevention programs generate value for the populations they serve through their selection and configuration of program activities.

Keywords: Marginalized populations, targeted interventions, strategy, HIV prevention

Arnquist S, Weintraub R. HIV/AIDS in Indonesia: Building a Coordinated National Response. Harvard Business Publishing. 2011.Abstract

This case documents Indonesia’s progress in developing a coordinated national HIV/AIDS response. Within the context of a new democratic government, a weak civil society sector, a newly decentralized and underfunded public health system, and a religiously conservative environment, the case describes how international donors financed and directed HIV/AIDS-related efforts for the first 15 years of the epidemic. In 2006 the National AIDS Commission (NAC) was restructured and awarded funding from the United Kingdom’s Department for International Development (DFID). The case documents how DFID’s flexible financing enabled the NAC to develop a single national strategy, a national monitoring and evaluation framework, and a system of local AIDS commissions. The case ends in 2009 with the NAC preparing to assume a new role as one of three Principal Recipients of the Global Fund to Fight, AIDS, Tuberculosis and Malaria. The NAC leadership must contemplate how to sustain and further the progress made in scaling up HIV prevention services while taking on new responsibilities as a Global Fund Principal Recipient.

Teaching Note available through Harvard Business Publishing.

Map of Indonesia Showing HIV Program Implementers, 2005
Map of Indonesia Showing HIV Program Implementers, 2005. Source: Indonesia National AIDS Commission. (Exhibit 1 "HIV/AIDS in Indonesia: Building a Coordinated National Response" case.)

Learning Objectives: To understand the impact of external financing, donor-driven agendas, and a national champion in creating a multisectoral response to HIV in a religiously conservative, lower middle-income country.

Keywords: National strategy, sustainability, HIV prevention, flexible donor financing

Talbot JR, Bohrer M, Rhatigan J. Iran’s Triangular Clinic. Harvard Business Publishing. 2011.Abstract

This case traces the development and implementation of Iran’s Triangular Clinic, an innovative health care delivery program, from its beginning as a site for counseling HIV-infected individuals to an integrated facility offering comprehensive HIV, sexually transmitted disease (STD), and drug addiction treatment, care, and support. The case examines the need for such services among the marginalized population that the first clinic served within the historical, political, economic, and health context of Iran and, specifically, in Kermanshah province, where the project begins. The case raises the question of how the clinic model might be integrated into primary health care and replicated throughout the country as part of the Iranian Ministry of Health’s Integrated Health Program.

Teaching Note available through Harvard Business Publishing.

Triangular clinic model
Triangular clinic model. Source: World Health Organization and Regional Office for the Eastern Mediterranean, Best Practice in HIV/AIDS Prevention and Care for Drug Abusers: The Triangular Clinic in Kermanshah, Islamic Republic of Iran 2004, WHO: Cairo.

Learning Objectives: To examine how health care delivery organizations can configure their services to deliver high value health care to the populations they serve and to understand methods to engage marginalized populations in order to increase their access to and demand for health services.

Supporting Content: The sequel to this case is titled Scaling up Iran's Triangular Clinic.

Keywords: Marginalized populations, comprehensive HIV prevention, harm reduction

Blumenthal D, Ellner A, Jain S, Rhatigan J. Polio Elimination in Uttar Pradesh. Harvard Business Publishing. 2011.Abstract

This case describes key elements of the Global Polio Eradication Initiative’s (GPEI) campaign in India and explores the challenges faced in eliminating polio from the northern state of Uttar Pradesh. Throughout the 1990s, India began implementing coordinated national polio immunization days to supplement routine immunization in health clinics in an effort to eliminate polio from the nation. The case provides contextual information about India and Uttar Pradesh as well as polio and polio vaccines. It then examines the roles of key partners in the GPEI, including Rotary International, the World Health Organization (WHO), the US Centers for Disease Control (CDC) and UNICEF, and it describes the local operational challenges of the mass immunization campaign in Uttar Pradesh. The campaign has been unable to eliminate polio from this state, and the program leaders grapple with ways to improve the campaign’s performance there.

Teaching Note available through Harvard Business Publishing.

Comic Book, Crusade Against Polio, Front Cover
Comic Book, Crusade Against Polio, Front Cover. Source: Rotary International.

Learning Objectives: To understand the political and operational challenges of implementing a nation-wide disease elimination program and to appreciate how local, contextual factors influence the delivery of health interventions.

Keywords: Polio elimination and immunization campaigns, supply chain management, global collaboration

Wachter K, Rosenberg J, Singal R, Weintraub R. Reducing Child Malnutrition in Maharashtra, India. Harvard Business Publishing. 2015.Abstract

This case demonstrates what it takes to address a chronic, intergenerational public health issue. It explores the drivers behind the reduction of malnutrition in Maharashtra State, India, from 2001–2013. Specifically, the case examines the strategies and management decisions of leaders of the government-established Rajmata Jijau Mother-Child Health and Nutrition Mission as they worked to reduce the incidence of malnutrition in children and women through a multi-sectoral collaborative approach.

Teaching Note available through Harvard Business Publishing.

Stunting Syndrome from Conception through Adulthood
Stunting Syndrome from Conception through Adulthood. Dark blue denotes the period between conception and 2 years (‘the first 1000 days’) when interventions are most effective. Light blue denotes the time period between 2 years and mid-childhood and during the adolescent growth spurt when some catch-up in linear growth may occur. The light blue period before Conceptus reflects evidence that dietary interventions targeting stunted women pre-conception improve birth outcomes. Gray denotes periods when the stunting syndrome appears unresponsive to interventions. Dashed line–a stunted child whose environment becomes more affluent with abundant access to food, causing excessive weight gain; solid line–a stunted child whose environment remains resource-constrained/food insecure. Source: Adapted by case writers with assistance from Isabelle Celentano from Pendergast AJ, Humphrey JH. “The stunting syndrome in developing countries,” Paediatr Int Child Health. 2014;34(4):250-265; doi:10.1179/2046905514Y.0000000158.

Learning Objectives: A productive class discussion will allow students to appreciate how to configure specific interventions and indicators to ameliorate and measure malnutrition for a local setting; the complexity and importance of crafting policies and generating political will across sectors in support of nutrition programs; and the role of a strong community workforce in enabling nutrition programs to reach the target population.

Keywords: Maternal and child health, children, intergenerational disease, public-private partnership, nutrition, strategy, political leadership, scale-up, community health workers, health care delivery, malnutrition, cross-sector collaboration

Charumilind S, Jain SH, Rhatigan J. The 100% Condom Program: Part B. Harvard Business Publishing. 2011.Abstract

This document supplements HIV in Thailand: the 100% Condom Program and recounts the eventual nationwide adoption of that program and its impact on HIV in Thailand.

Teaching Note available through Harvard Business Publishing.

HIV and AIDS Projections, 1985-2020
HIV and AIDS Projections, 1985-2020. Source: Department of Disease Control, Ministry of Health (projections based on data up to 2003). (Exhibit 6 from the "HIV in Thailand: The 100% Condom Program" case.)

Learning Objectives: To examine the national spread of a regional disease prevention program and evaluate its impact.

Supporting Content: This document supplements HIV in Thailand: the 100% Condom Program.

Keywords: HIV prevention, stakeholder alignment, harm reduction

Cole C, May M, Talbot JR, Weintraub R, Porter ME. The Avahan India AIDS Initiative: Managing Targeted HIV Prevention at Scale. Harvard Business Publishing. 2011.Abstract

This case is the second in a two-part series describing the Avahan Indian AIDS Initiative (Avahan), a large-scale HIV prevention delivery program of the Bill & Melinda Gates Foundation (Gates Foundation). The case examines Avahan's choice of intervention strategies in the face of the HIV epidemic of India in 2002. It describes Avahan's structure, operations, and execution style, as well as how Avahan's management system for its seven "state lead partners" and 137 district-level nongovernmental organizations was applied initially to scale and later to sustain the delivery model. The case ends with Avahan's director planning to transfer program ownership to the Government of India.

Teaching Note available through Harvard Business Publishing.

Examples of Microplanning Tools Developed by Avahan SLPs
Examples of Microplanning Tools Developed by Avahan SLPs. Source: Created by case writers. (Exhibit 10 "The Avahan India AIDS Initiative: Managing Targeted HIV Prevention at Scale" case.)

Learning Objectives: To understand the strategies needed to deliver HIV prevention services at scale; how the configuration of management activities can enable rapid scale up of HIV prevention programming; and how these management activities must evolve to sustain delivery at scale.

Keywords: Management and operations, HIV prevention, transferring large-scale programs to government ownership, scaling up, sustainability, strategy

Arnquist S, Rosenberg J, Weintraub R. The Indus Hospital: Building Surgical Capacity in Pakistan (Condensed Version). The Lancet Commission on Global Surgery. 2015.Abstract

Set in Karachi, Pakistan, this case examines a private hospital's potential to impact health in a resource-constrained setting. Within Pakistan's health care system and its political, socioeconomic, and epidemiological context, the case focuses on the Indus Hospital, a charity hospital started in 2007. The case explores the effect of financing, leadership, and a mission-driven culture on health care delivery and the hospital's efforts to provide high-quality care for free to poor patients. It concludes with Indus' leaders planning how to expand their service delivery to include primary and preventative care. This is a condensed version of the case The Indus Hospital: Delivering Free Health Care in Pakistan

Teaching Note available through Harvard Business Publishing.

Indus Hospital Open-Air TB Clinic
Indus Hospital Open-Air TB Clinic. Pakistani architect Tariq Quaiser designed the Indus Hospital’s open-air TB clinic with a specialized design that optimized natural ventilation for increased airflow that effectively minimized the spread of disease. Source: Global Health Delivery Project case writers. (Exhibit 7 from "The Indus Hospital: Delivering Free Health Care in Pakistan" case.)

Learning Objectives: To understand a private hospital's potential to impact health in a resource-constrained setting, how private financing impacts health care delivery, and the impact of leadership on health care delivery.

Supporting Content: This is a condensed version of the case The Indus Hospital: Delivering Free Health Care in Pakistan.

Keywords: Human rights, workforce management, sustainability, role of civil society, information systems, organizational culture

Arnquist S, Weintraub R. The Indus Hospital: Delivering Free Health Care in Pakistan. Harvard Business Publishing. 2012.Abstract

Set in Karachi, Pakistan, this case examines a private hospital's potential to impact health in a resource-constrained setting. Within Pakistan's health care system and its political, socioeconomic, and epidemiological context, the case focuses on the Indus Hospital, a charity hospital started in 2007. The case explores the effect of financing, leadership, and a mission-driven culture on health care delivery and the hospital's efforts to provide high-quality care for free to poor patients. It concludes with Indus' leaders planning how to expand their service delivery to include primary and preventative care.

Teaching Note available through Harvard Business Publishing.

Indus Hospital Open-Air TB Clinic
Indus Hospital Open-Air TB Clinic. Pakistani architect Tariq Quaiser designed the Indus Hospital’s open-air TB clinic with a specialized design that optimized natural ventilation for increased airflow that effectively minimized the spread of disease. Source: Global Health Delivery Project case writers. (Exhibit 7 from "The Indus Hospital: Delivering Free Health Care in Pakistan" case.)

Learning Objectives: To understand a private hospital's potential to impact health in a resource-constrained setting, how private financing impacts health care delivery, and the impact of leadership on health care delivery.

Supporting Content: There is a shorter version of this case titled The Indus Hospital: Building Surgical Capacity in Pakistan (Condensed Version).

Keywords: Human rights, workforce management, sustainability, role of civil society, information systems, organizational culture

May M, Cash R, Rhatigan J. Tuberculosis in Dhaka: BRAC’s Urban TB Program. Harvard Business Publishing. 2011.Abstract

This case examines BRAC’s experience expanding its rural TB program to the urban environment of Dhaka between 2002 and 2008. The case provides background information about Dhaka and describes what TB services existed at the time. The case then describes the expansion of BRAC’s TB program into Dhaka and details innovations in the Urban program. Students should gain an understanding of how these program modifications were a response to the specific challenges the program faced in the urban setting. The case allows an exploration of how successful health care delivery program adapt to new environments.

Teaching Note available through Harvard Business Publishing.

Map of Dhaka
Map of Dhaka. Source: Available at http://www.urpnissues.com/webpage/maps/Districts/13.GIF. (Exhibit 1 in "Tuberculosis in Dhaka: BRAC’s Urban TB Program" case.)

Learning Objectives: To understand how a successful health care delivery program that is uniquely tailored to a particular setting can adapt its operations in a new environment.

Supporting Content: This case is a sequel to BRAC’s Tuberculosis Program: Pioneering DOTS Treatment for TB in Rural Bangladesh

Keywords: Service delivery innovation, tuberculosis control, urban nongovernmental organizations

Madore A, Rosenberg J, Weintraub R. “Sin Taxes” and Health Financing in the Philippines. Harvard Business Publishing. 2015.Abstract

This case traces the implementation of tobacco tax policy and health system reforms in the Philippines from 2009 to 2015 in the context of the global tobacco control movement, the economic and political influence of the Philippine tobacco industry, and the Philippine health system. After providing background on the prevalence and costs of smoking in the Philippines, the case follows the steps taken by a diverse group of actors to design, promote, and implement higher taxes on tobacco and alcohol products, the primary goals of which were to reduce smoking and raise funds to achieve universal health care. The case highlights the strategies used to counter opposition from the tobacco industry and allied politicians. It focuses on Health Secretary Enrique Ona’s efforts to support sin tax reform and how the country used the resulting revenues to try to improve health care and health insurance coverage. It ends with Ona contemplating the impact of his investments in national health insurance and public health infrastructure as a new health secretary takes his place.

Teaching Note available through Harvard Business Publishing.

From left to right: House of Representatives; Woman selling cigarettes
From left to right: House of Representatives; Woman selling cigarettes. Source: Global Health Delivery Project case writers.

Learning Objectives: A productive class discussion will allow students to appreciate the complexity and trade-offs governments may face in stimulating their economy, regulating industry, and improving public health; the importance of data in driving and sustaining policy reform; the role of financing policies and funding as tools for health system strengthening and value creation when leveraged strategically; and the potential for health to unify different actors and sectors to generate new policy and restructure fiscal and financial systems.

Keywords: Health insurance, health care financing, tobacco control, smoking, universal health care implementation, policy, cross sector collaboration, health system reform, political leadership, management