Publications

    Madore A, Rosenberg J, Dreisbach T, Weintraub R. Positive Outlier: Health Outcomes in Kerala, India over Time. Harvard Business Publishing. 2018.Abstract

    This case explores how Kerala, India developed a reputation for exemplary health outcomes despite low per capita income. After providing historical background, including the social, political, and health system factors that contributed to a culture of seeking health care, the case describes Kerala’s health system and outcomes. The case describes how the fiscal decline in the latter half of the 20th century led to decreased spending on public services, including health, creating an opening for private-sector providers to meet a growing share of the demand for health services and the impact on out-of-pocket health spending. Readers must think about how emerging health threats such as noncommunicable diseases should be addressed in the 21st century, including the health department’s response and a new initiative to increase capacity in the public health sector, including efforts to improve the quality and reliability of health data through an electronic medical record system. The case concludes with Additional Chief Secretary for Health and Family Welfare Rajeev Sadanandan wondering if the new strategy will succeed and if Kerala can maintain its status as a positive outlier in health for the decades to come.

    Teaching Note available for registered faculty through Harvard Business Publishing and the Case Centre.

    Learning Objectives: to appreciate the relationships between education, literacy, and health; what the components of a health system are; the limitations of health indicators as measures of a national health system’s effectiveness; and, the challenges of sustaining demand and maintaining the supply and quality of public health services over time.

    Key words: health care policy, universal health care, demand generation, health care delivery, health system, health outcomes, social determinants of health

    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.

    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

    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

    Pabo E, Rhatigan J, Ellner A, Lyon E. HIV Voluntary Counseling and Testing in Hinche, Haiti. Harvard Business Publishing. 2011.Abstract

    This case examines the potential for a non-governmental organization, Zanmi Lasante/Partners in Health (ZL/PIH), to aid in improving voluntary counseling and testing (VCT) services for HIV at a government hospital in Hinche, Haiti. The events of the case begin when the local government official who oversees the hospital invites ZL/PIH to work with the government to improve the hospital’s VCT services. After providing background information on the history of Haiti, on Hinche, and on the state of the current VCT program, the case describes ZL/PIH’s health care delivery model including its management systems, its use of community health workers, and its social programs. It explains how ZL/PIH adapted its mod

    Teaching Note available through Harvard Business Publishing.

    Rainy season on the roads, Central Plateau, Haiti
    Rainy season on the roads, Central Plateau, Haiti; Credit: Evan Lyon

    Learning Objectives: To understand how social, economic and political factors influence health care delivery and to examine effective strategies to address these factors in the design of health care programs.

    Supporting Content: This case has a supplementary summary of history and next steps, titled Two Years in Hinche.

    Keywords: Community-based organizations, HIV prevention, government-NGO partnerships