This case examines the potential for a non-governmental organization, Zanmi Lasante/Partners in Health (ZL/PIH), to aid in improving voluntary counseling and testing (VCT) services for HIV at a government hospital in Hinche, Haiti. The events of the case begin when the local government official who oversees the hospital invites ZL/PIH to work with the government to improve the hospital’s VCT services. After providing background information on the history of Haiti, on Hinche, and on the state of the current VCT program, the case describes ZL/PIH’s health care delivery model including its management systems, its use of community health workers, and its social programs. It explains how ZL/PIH adapted its mod
Rainy season on the roads, Central Plateau, Haiti; Credit: Evan Lyon
Learning Objectives: To understand how social, economic and political factors influence health care delivery and to examine effective strategies to address these factors in the design of health care programs.
Supporting Content: This case has a supplementary summary of history and next steps, titled Two Years in Hinche.
Keywords: Community-based organizations, HIV prevention, government-NGO partnerships
This case describes the Brazilian National AIDS Program's strategy in the late 2000s to prevent HIV infections. The case is set against the context of a heterogeneous, concentrated epidemic and decentralized public health system that guaranteed access to care and treatment. The case traces the nation's response to HIV from the late 1980s through 2009 via a human rights framework, highlighting the cooperation with civil society. Readers are challenged to understand the relationships between HIV/AIDS prevention and treatment, decentralization and sustainability.
Decentralization Policy M&E Indicators. Source: National Department of STD, AIDS and Viral Hepatitis. (Exhibit 14 from "HIV/AIDS in Brazil: Delivering Prevention in a Decentralized Health System" case.)
Learning Objectives: Students should understand the tradeoffs involved in a decentralized governance structure, the levers a central government department can pull to influence local health care delivery in a decentralized health system, and how civil society advocacy contributes to program sustainability.
Keywords: Human rights, HIV prevention, Sustainability, Role of civil society, Strategy
This case traces the development of a multidrug-resistant tuberculosis (MDR-TB) treatment program in Peru between 1994 and 1999 by Socios en Salud (SES), a community-based nonprofit organization, in a shantytown of Northern Lima called Carabayllo. After providing some background on existing TB treatment services and the organizational history of SES, it follows the organization up to 1999 and frames its work within the context of international MDR-TB policy. The case presents background information on the epidemiology of TB and MDR-TB in Peru as well as the shantytown of Carabayllo. It describes how SES implemented community-based treatment for cadre of patients with MDR-TB and achieved cure rates comparable with those obtained in the US. The case begins with a vignette that illuminates the problem of MDR-TB from a patient’s perspective and ends with the program needing to strategize about how to scale-up and expand its reach to more patients.
Outdoor sputum collection booth to prevent TB transmission in (MOH) national hospital in northern shantytown of Peru; Credit: Julie Rosenberg Talbot
Learning Objectives: To understand strategies that innovative programs use to improve access to health care and to explore ways that community health workers can deliver complex medical interventions within well-designed public health programs.
Keywords: Community health workers, multi-drug resistant tuberculosis treatment, policy change, advocacy
This case examines effective public health management strategies by examining the turnaround of National Tuberculosis (TB) Control Program (NTP) in Peru during the 1990s under Director Dr. Pedro Suarez. The case presents background information on the NTP before 1990 and situates its underperformance within the political and economic context of Peru at this time. It describes how Suarez transformed the NTP from an essentially bankrupt program in August 1990 to a model program, using effective management techniques. It concludes with the program struggling to improve outcomes among a group of patients failing its standardized protocols.
Health center in Peru; Credit: Julie Rosenberg Talbot
Learning Objectives: To understand the operations of a national tuberculosis control program and to learn how effective management techniques can be employed in public health programs to improve performance with an emphasis on basic principles of quality improvement.
Keywords: Program management, leadership, vertical programming, public health, tuberculosis control
This case describes the introduction of ready-to-use therapeutic foods (RUTFs) to treatment programs for severe acute malnutrition in children six months to five years old. It describes how RUTFs transformed malnutrition treatment in emergency and non-emergency contexts and how their use has evolved since they were introduced in 1999. The case examines RUTF policy in Haiti including the results of a pivotal pilot program and the introduction of RUTFs. The case explores the decision of the chief of Haiti’s Department of Nutrition to use RUTF for the treatment of moderately acute malnutrition in Haiti and leaves readers grappling with the question of how to implement a this policy.
Learning Objectives: To understand the global public health approaches to malnutrition and its prevention, and to examine the role of ready to use therapeutic foods in malnutrition treatment and prevention programs.
Keywords: Childhood malnutrition, health policy implementation
Two Years in Hinche is a brief supplement to HIV Voluntary Counseling and Testing in Hinche, Haiti. The first case describes an underperforming HIV Voluntary Counseling and Testing Program in government run hospital in Hinche, Haiti, and the decision by a government official to invite, Zanmi Lasante/Partners in Health (ZL/PIH), a non governmental organization, to help revamp the program. After a detailed examination of the program and of the ZL/PIH health care delivery model, the case ends with ZL/PIH agreeing to collaborate with the government to revamp the program. This case describes the subsequent steps ZL/PIH took to increase the amount of patients that received HIV counseling and testing by ten-fold, and to begin an HIV treatment program. It details ZL/PIH they were able to adapt their model for the public sector, improve supply chains, integrate staffs, and build community trust.