Publications

    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

    Sue K, Rosenberg J, Weintraub R. Addressing Tanzania’s Health Workforce Crisis Through a Public-Private Partnership: The Case of TTCIH. Harvard Business Publishing. 2016.Abstract

    Set in rural Tanzania, this case traces the founding and development of the Tanzanian Training Centre for International Health (TTCIH) from the early 2000s through 2015. It begins with an overview of the political, socioeconomic, and epidemiological context of Tanzania, followed by a detailed description of the human resource for health crisis in Tanzania and the landscape of available health care training programs. The case then explores the origins and evolution of TTCIH, launched through a unique collaboration between private industry, a public health institute, local stakeholders and educators, and the Tanzanian Ministry of Health and Social Welfare. It describes the evolution of TTCIH as leaders strive to make it self-sustaining and responsive to Tanzania’s health workforce crisis. The case highlights the challenges of successfully integrating corporate management practices and values into a global health program and the role of strategic leadership to sustain TTCIH.

    Teaching Note available through Harvard Business Publishing.

    TTCIH Income and Number of Students, 2005–2013
    TTCIH Income and Number of Students, 2005–2013

    Learning Objectives: A productive class discussion will allow students to appreciate the challenges of designing sustainable, high-quality health training institutions in low-resource settings; the training and resources needed to support task shifting and to address health workforce shortages in health care delivery; and, the importance of maintaining a sound strategy for medical education programs in the midst of changing national health needs and the evolving medical education landscape.

    Keywords: Global health, public health, health care delivery, education, government, value creation, Human Resources for Health, health care, nongovernmental organizations, Public-Private partnerships, learning, revenue growth, organizational effectiveness

     

    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

    Arnquist S, Talbot JR, Weintraub R. loveLife: Transitions After 2005. Harvard Business Publishing. 2012.Abstract

    This case focuses on how loveLife, South Africa's largest youth-focused nongovernmental organization, recovered from losing one-third of its operating revenues in 2006 when the Global Fund to Fight AIDS, Tuberculosis and Malaria chose not to renew funding to South Africa. The case describes managers' decisions to downsize and secure additional government funding to save the organization and the ways in which the original strategy guided these changes. The case ends in 2009 with loveLife's new chief executive officer contemplating how to secure the organization's future amid national political changes and funding challenges.

    Teaching Note available through Harvard Business Publishing.

    loveLife Program Coverage, 2007. Source: loveLife
    loveLife Program Coverage, 2007. Source: loveLife. (Exhibit 6 from "loveLife: Transitions After 2005" case.)

    Learning Objectives: To appreciate how crises can impact program management and activities, the role of leadership in responding to crises, the benefits of second generation leadership for an organization, and the implications of transitioning from international funding sources to domestic government funding sources.

    Supporting Content: This case is a sequel to loveLife: Preventing HIV Among South African Youth.

    Keywords: National strategy, impact of financing, HIV prevention, leadership, sustainability

    Talbot JR, 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

    Redditt V, ole-MoiYoi K, Rodriguez W, Talbot JR, Weintraub R. Malaria Control in Zambia. Harvard Business Publishing. 2012.Abstract

    This case reviews the changes in national policy and the subsequent interventions used to reduce the incidence of malaria in Zambia from 2005 to 2010. After providing contextual information on Zambia-including historical, demographic, social, and health information-the case delves into the history of malaria control efforts worldwide and in Zambia. Though Zambia was at the forefront of malaria control-changing policy, adopting new treatment, and aggressively pursuing comprehensive malaria control efforts-in the early 2000s, by 2005 the Zambian government was still falling short of its targets. The National Malaria Control Center (NMCC) resolved to intensify its efforts by developing one national plan to improve coordination, data collection, and partner involvement, and ultimately, to scale up interventions rapidly in order to meet the national malaria targets. The new NMCC director, Dr. Elizabeth Chizema, guided the program toward success through several key interventions described in the case. With basic improvements in monitoring and evaluation, Chizema could demonstrate progress in malaria control. Nonetheless, she worried that partners might lose interest in helping Zambia given the decreasing burden even though the program still had many challenges to overcome.

    Teaching Note available through Harvard Business Publishing.

    Plasmodium Falciparum life cycle
    Plasmodium Falciparum life cycle. Source: United Nations Integrated Regional Information Networks. Killer Number One: The Fight against Malaria. 2006; 47.

    Learning Objectives: To understand the development of a successful malaria control program over time and the components that led to its success, including the value of setting bold national goals, the merits of a health system with centralized governance and decentralized implementation, the importance of multiple coordinated interventions as opposed to a "silver bullet" approach for malaria control, and the use of data as an outcome measure, planning tool, and fundraising tool.

    Supporting Content: There is a shorter version of this case titled Malaria Control in Zambia (Condensed Version).

    Keywords: National strategy, supply chain management, malaria eradication and control, leadership

    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

    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

    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

    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

    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

    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

    Kleinman S, Talbot JR, Harris J, Ellner A. The AIDS Support Organization (TASO) of Uganda. Harvard Business Publishing. 2011.Abstract

    This case traces the development of The AIDS Support Organization (TASO), a Ugandan non-governmental organization, from 2001 to 2006. One of the first organizations to become involved in HIV/AIDS in the late 1980s, TASO began as a meeting place for people infected and affected by HIV/AIDS, helping people to live positively. The organization provided free counselling, social support, limited medical care, community mobilizing, advocacy and networking. TASO worked alongside government facilities and trained government medical personnel in HIV counselling. After many years, TASO got a new director who brought management skills, a commitment to professionalizing the organization, and a drive to expand services. TASO began incorporating antiretroviral therapy (ART) into its offerings. The ART delivery model combined home and clinic-based care in order to maximize patient adherence. The case follows the development of the organization and scale up of services and raises the question of how to deliver care most cost effectively while maintaining its values and meeting the changing needs of the population and clients.

    Teaching Note available through Harvard Business Publishing.

    Training health workers to care for HIV/AIDS patients in Uganda. Credit: Sarah Kleinman; TASO
    Training health workers to care for HIV/AIDS patients in Uganda. Credit: Sarah Kleinman; TASO

    Learning Objectives: Students should learn how a healthcare delivery organization can expand and evolve over time in response to changes in external context and the needs of its clients; how public and private organizations can coordinate to meet the varied needs of a population; and the importance of leadership, management, and strategic vision in creating successful global health programs.

    Keywords: Service expansion, Home- and clinic-based care, HIV prevention and treatment.