Publications

    Rosenberg J, Ahmad I, Weintraub R. Eradicating Smallpox: Delivery Strategies to Reach the Last Mile. 2022.Abstract

    In this teaching case, Dr. William Foege - the former director of the US Centers for Disease Control and Prevention who many credit with eradicating smallpox - helps readers understand what it took to eradicate it. The case gives background information on the disease, as well as earlier immunization efforts, and describes how the social, political, and economic complexities of India impacted public health initiatives. As international endeavors to fight smallpox expanded in the 1960s, India continued to account for a disproportionate percentage of new cases. Cases remained high until a more organized and targeted strategy in the 1970s increased staffing, improved reporting, boosted vaccination rates, and expanded national and international resources. Specific national and local strategies, a coordinated and centralized decision making structure, and an understanding of and clear communication with the population were crucial to the nation’s success. The state of Bihar was the most challenging state to address, with cases remaining stubbornly high. A final campaign intensified surveillance, containment, and vaccination efforts in Bihar, and the Global Commission for the Certification of Smallpox Eradication declared India smallpox-free in 1977. The case ends with Dr. Foege wondering what lessons from smallpox eradication in India can be applied to the COVID-19 pandemic, as well as future threats.

    Learning Objectives:

    This case documents the eradication of smallpox in India. A productive class discussion will allow students to appreciate the following:

    • The role of power dynamics in global health
    • The role of data and the importance of measuring the right outcome to inform program management 
    • Human resource management and its relationship to stakeholder management
    • The relationship between disease presentation and public health strategy and decision-making
    • How to build on what is known in confronting new contexts, diseases, and environments

    Exhibit 5a Decade in Which Smallpox Ceased to be Endemic by Country

    Keywords: India, public health, pandemic response, vaccine delivery, workforce management, collaboration, multilateral engagement

     

    Madore A, Rosenberg J, Weintraub R. Project ECHO: Expanding the Capacity of Primary Care Providers to Address Complex Conditions. Harvard Business Publishing. 2017.Abstract

    This case takes place in the United States (US) and traces the inception and growth of Project Extension for Community Healthcare Outcomes (Project ECHO)—a web-based "guided practice" model for primary care providers—from 2003 to 2016. After providing background on the US health system, including medical education, health care financing, and the supply and distribution of primary care and specialist providers, the case explores what motivated Project ECHO founder and liver specialist Sanjeev Arora, MD to train primary care providers in rural New Mexico in hepatitis C treatment and management. It describes early replication of the ECHO model in the US and across medical conditions and what the Project ECHO model entailed—including leveraging technology to expand access to specialty resources, best practices, case-based learning, and outcome monitoring, as well as good will among participants. A professional communications campaign, ongoing research, and persistence supported Project ECHO’s growth. The case displays three dimensions of Project ECHO’s early work: creating a new mode to redistribute the expertise of specialists to primary care practitioners, scaling this new care delivery model and measuring its impact, and identifying sustainable funding sources. The case concludes with the US Congress passing the ECHO Act to promote research on the model and Arora contemplating what else he might need to continue to scale to reach his goal of touching 1 billion lives.

    Teaching Note available through Harvard Business Publishing. 

    TeleECHO Clinic - hub and spoke
    TeleECHO Clinic. Source: Case writers.

    ECHO Institute
    ECHO Institute. Source: Case writers.

    Learning Objectives: To understand what is needed to design a service model; the potential for redistribution of expertise among practitioners to enhance value; the role of operational effectiveness in enabling scale up; and the importance of measuring impact for stakeholders.

    Keywords: Public health, health care delivery, scale-up, resource-limited settings, human resource, information technology, primary care, information management, data collection, mentorship

    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

    Madore A, Rosenberg J, 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

     

    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: Case writers.

    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

    Rosenberg J, 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
    (A) Group counseling on male circumcision; (B) mobile circumcision counseling site; and (C) circumcision being conducted in tented delivery site. Source: Nyanza Reproductive Health Society.

    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

    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

    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

    Rosenberg J, Rhatigan J, Kim JY. The Peruvian National Tuberculosis Control Program. Harvard Business Publishing. 2011.Abstract

    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.

    Teaching Note available through Harvard Business Publishing.

    Health Center in Peru
    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