Rosenberg J, Dreisbach T, Donovan C, Weintraub R. Positive Outlier: Sri Lanka’s Health Outcomes over Time. Harvard Business Publishing. 2018.Abstract

    This case describes the development and structure of Sri Lanka’s health system, which has yielded health outcomes far superior to any of its South Asian neighbors. The case highlights factors supporting the health outcomes, including the availability of free health services to all citizens, government investment in the health workforce, and the care-seeking behavior of Sri Lankan citizens. After providing an overview of Sri Lanka’s history, geography, demographics, and economy, the case traces the evolution of the public sector health system from the precolonial era through the period of heavy investment in health from the 1930s through 1950s and on into the 21st century. The case describes the management of the system and the relationship between the national health ministry and provincial and local governments. It examines how health professionals are trained and deployed throughout the system, the supply chain, and financing. The case then examines the growing private health sector, its relationship with the public sector, and the role of innovation. After a summary of the country’s health outcomes, readers are pushed to think about what it will take to address the changing epidemiological burden to continue to boast exemplary health outcomes and provide quality health care to those who need it.

    ​​​​​​Teaching Note available to registered faculty through Harvard Business Publishing or the Case Centre.

    A productive class discussion will allow readers to appreciate the capabilities of a public payer system to improve the health of the population; the influence of the private sector in a “single payer system” and the downstream effects on demand and supply of services; the return on investment for a country offering free public medical and nursing education; and the relationship between literacy, demand generation, and health outcomes.

    Keywords: Universal health care, health care delivery, health system, health outcomes, social determinants of health.

    Cuneo CN, Rosenberg J, Madore A, Weintraub R. Improving Mental Health Services for Survivors of Sexual Violence in the DRC. Harvard Business Publishing. 2017.Abstract

    This case explores the implementation and evaluation of mental health treatment for victims of conflict-related gender-based violence (GBV) in the Democratic Republic of the Congo (DRC) by the International Rescue Committee (IRC), a humanitarian organization based in New York City. Following the contextual background, the case traces the IRC’s work developing a psychosocial support program for GBV survivors starting in 2002. When the Applied Mental Health Research Group (AMHR) at Johns Hopkins University Bloomberg School of Public Health evaluates the program in 2008, the IRC begins to consider the potential for its work to inform similar interventions. In 2011, the IRC team collaborated with AMHR to implement two concurrent randomized control trials (RCTs): one on the mental health effects of Cognitive Processing Therapy (CPT) and the other on the mental health and financial impact of a social and economic empowerment intervention called the Village Savings and Loans Association (VSLA). While the time and resources that went into completing the trials expanded the monitoring and evaluation capacity within the IRC and added important evidence to the lean body of global mental health literature, conducting the studies stretched the IRC’s local staff thin and required clarification of priorities and purpose. Had the RCTs had been worth it, and for whom? How could the study findings contribute to improving services for vulnerable populations in the region and beyond? 

    Teaching Note available through Harvard Business Publishing.

    Theory of Change
    Source: Study of Effectiveness of a Social-Economic Intervention for Sexual Violence Survivors in Eastern DRC, November 2014.

    Theory of Change 2
    Source: Group Cognitive Processing Therapy: A Specialized Mental Health Intervention that Supports Improvements in Well-being for Sexual Violence Survivors. Johns Hopkins Bloomberg School of Public Health, International Rescue Committee.

    Learning Objectives: A productive class discussion will allow students to appreciate the challenge of meeting human resource needs to provide mental health care, the complexity of implementation and empirical study of mental health services, and the ethics and challenges of conducting randomized controlled trials in conflict settings.

    Keywords: public health, human resources, health care delivery, information management, mental health, scale-up, resource-limited settings, health care policy, data collection, public administration

    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

    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

    Talbot JR, 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