Publications

    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.

    Madore A, Rosenberg J, Weintraub R. “Sin Taxes” and Health Financing in the Philippines. Harvard Business Publishing. 2015.Abstract

    This case traces the implementation of tobacco tax policy and health system reforms in the Philippines from 2009 to 2015 in the context of the global tobacco control movement, the economic and political influence of the Philippine tobacco industry, and the Philippine health system. After providing background on the prevalence and costs of smoking in the Philippines, the case follows the steps taken by a diverse group of actors to design, promote, and implement higher taxes on tobacco and alcohol products, the primary goals of which were to reduce smoking and raise funds to achieve universal health care. The case highlights the strategies used to counter opposition from the tobacco industry and allied politicians. It focuses on Health Secretary Enrique Ona’s efforts to support sin tax reform and how the country used the resulting revenues to try to improve health care and health insurance coverage. It ends with Ona contemplating the impact of his investments in national health insurance and public health infrastructure as a new health secretary takes his place.

    Teaching Note available through Harvard Business Publishing.

    From left to right: House of Representatives; Woman selling cigarettes
    From left to right: House of Representatives; Woman selling cigarettes. Source: Global Health Delivery Project case writers.

    Learning Objectives: A productive class discussion will allow students to appreciate the complexity and trade-offs governments may face in stimulating their economy, regulating industry, and improving public health; the importance of data in driving and sustaining policy reform; the role of financing policies and funding as tools for health system strengthening and value creation when leveraged strategically; and the potential for health to unify different actors and sectors to generate new policy and restructure fiscal and financial systems.

    Keywords: Health insurance, health care financing, tobacco control, smoking, universal health care implementation, policy, cross sector collaboration, health system reform, political leadership, management

    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

    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