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

     

    Rosenberg J, Ahmad I, Sharara N, Weintraub R. Improving Maternal Health by Addressing Stockouts: Integrating the Private Sector into the Public Health Supply Chain in Senegal. Harvard Business Publishing. 2021.Abstract

    This case traces the development of a series of initiatives to intended to reduce stockouts of family planning commodities in Senegal’s public health system and the eventual scale up of the redesigned supply chain to include additional commodities and its transfer of management to the government. After providing some background on the history of Senegal, including its governance and health system, the case explores early efforts to overhaul the supply chain in the country and reproductive health efforts. It then describes the Gates Foundation’s involvement and how the relationship between family planning and supply chain management came to light. The Gates Foundation, along with others, supported the launch of the Informed Push Model with Third Party Logisticians (IPM-3PL), which proved to reduce stockouts dramatically. Despite significant initial support from both government ministries and international donor agencies, as the program scaled IPM-3PL did not survive the transition to a fully government-run model, and the program was eventually discontinued in 2019 after two attempts to hand over the program to Senegal’s National Supply Pharmacy (Pharmacie Nationale d'Approvisionnement; PNA), the government agency in charge of distribution of medicines. The case ends with the director of the PNA contemplating what was next for Senegal and what she could tell others who had been so closely watching the country as an example.

    Learning Objectives:

    This case documents the need for and process to overhaul Senegal’s public health supply chain. A productive class discussion will allow students to appreciate the following:

    1. The benefits and challenges of transitioning aspects of a public health supply chain between push and pull models
    2. The trade-offs of private sector integration in public health supply chains
    3. How the management and financing structure of a public health supply chain impacts its efficacy and scalability
    4. The need for cross-sector and intragovernmental collaboration for effective supply chain management and the relationship between policy and last mile delivery

    Supply Chain Scenarios

    Keywords: supply chain management, private-public partnership, maternal health, third party logisticians, informed push model, scale up, distribution

    Hashimoto K, Rhatigan J. Chagas Disease Vector Control in Honduras. Harvard Business Publishing. 2017.Abstract

    This case describes how the Honduran Ministry of Health developed and implemented a Chagas disease control program with the assistance of the Japan International Cooperation Agency (JICA) and others from 2003 to 2012. After providing background information about Honduras and Chagas disease, the case examines the work of the Guatemalan Ministry of Health and JICA to implement a Chagas disease control program that provided the template for the program in Honduras. The case then describes the adaptation of this model for the Honduran context, including details of the surveillance model and vector control interventions. The case concludes with the program considering how it would maintain its success in spite of decreased funding and changes in leadership.

    Teaching Note available through Harvard Business Publishing.

    Chagas vector chart
    Main vector species of Chagas disease in Central America. Source: Biblioteca Virtual en Salud de Honduras.

    Indoor residual spraying
    Training community members for indoor residual spraying in the first trial in Intibucá 2004. Source: Case writers.

    Learning Objectives: A productive class discussion will allow students to appreciate strategies in control of neglected tropical diseases; Chagas disease vector control and surveillance; the role of bilateral cooperation to strengthen health systems management; and how regional disease control initiatives are implemented locally.

    Keywords: Information management, scale-up, health care policy, public administration, government policy, resource-limited settings, data-collection

    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

    Brooks P, Rosenberg J, Weintraub R. The Global Trachoma Mapping Project. Harvard Business Publishing. 2016.Abstract

    This case explores what it took to map the prevalence of trachoma infection in 1,531 districts across 26 countries by directly examining 2.39 million individuals in just three years. Dozens of organizations worked together on the largest standardized mapping project in the world as part of an effort to eliminate blinding trachoma globally by the year 2020. After providing some background on trachoma, early control efforts, and the formation of a global coalition, the case explores the events, strategies, technology, and stakeholders that enabled the mapping project. It describes how the stakeholders worked together, the coordination and management mechanisms used, and the investments required. Given that disease elimination had been achieved only once before, in the case of smallpox, the case asks students to consider how the project’s leaders, Tom Millar and Anthony Solomon, could help maximize returns from trachoma mapping so that the campaign could achieve its ultimate goal of global trachoma elimination within the next five years. Were there ways in which they could leverage efforts to map this neglected tropical disease to inform other disease control programs?

    Teaching Note available through Harvard Business Publishing.

    Life cycle of Trachoma
    Life Cycle of Trachoma. Source: The Carter Center/Al Granberg, International Trachoma Initiative. Available at http://www.neglecteddiseases.gov/target_diseases/trachoma/.

    Learning Objectives: A productive class discussion will allow students to appreciate what contributes to the development of a productive coalition; what it takes to collect quality data at scale; the challenges and benefits of identifying your target population for public health programming; and the tradeoffs between a targeted campaign addressing one disease and bundling efforts for multiple diseases.

    Keywords: Disease mapping, disease elimination, multi-sectoral collaboration, electronic data capture

     

    Rosenberg J, 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
    (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: 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

    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

     

    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

    ole-MoiYoi K, Rosenberg J, 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

    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

    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

    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

     

    Phillips E, Rhatigan J. Treating Malnutrition in Haiti with Ready-to-Use Therapeutic Foods. Harvard Business Publishing. 2011.Abstract

    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.

    Teaching Note available through Harvard Business Publishing.

    Model Plumpy’nut Sachet
    Model Plumpy’nut Sachet. Source: http://www.lle.rcs.k12.tn.us/Teachers/guidance_page/Images/plumpybag.jpg. Accessed June 17, 2009. (Exhibit 7 from "Treating Malnutrition in Haiti with Ready-to-Use Therapeutic Foods" case.)

    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

     

    Dhillon R, Rhatigan J. The Measles Initiative. Harvard Business Publishing. 2011.Abstract

    This case examines the work of the Measles Initiative (MI), a consortium of multiple international organizations, in helping catalyze a global effort to reduce worldwide measles-related mortality by expanding delivery of measles vaccinations. After providing background information on the biology of the measles virus and the epidemiology of measles, it recounts the formation of the MI, its partnership structure, its goals, its program design, and its financing. The case focuses on how multilateral global health initiatives coordinate with national governments to improve health care delivery. By 2009, the MI had made significant gains in reducing measles mortality, but was facing decreased funding and was questioning its strategy going forward.

    Teaching Note available through Harvard Business Publishing.

    Clinical Presentations of Measles
    Clinical Presentations of Measles. Image A Source: CDC: Image 132. Public Health Image Library. Available at: http://phil.cdc.gov/phil/details.asp?pid=132. Image B Source: CDC: Image 6887. Public Health Image Library. Available at http://phil.cdc.gov/phil/details.asp?pid=6887. (Exhibit 1 from “The Measles Initiative” case.)

    Learning Objectives: To understand how multi-lateral, international disease-control initiatives are designed, coordinated, and financed and to examine how these initiatives interact with national health systems to achieve their objectives.

    Keywords: Coordination of multilateral global health initiatives and national governments, international partnerships, measles vaccination campaigns, strategy