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.

    Donovan C, Rosenberg J, Madore A, Weintraub R. Maternal and Child Health in Uttar Pradesh, India: A Mother's Story. Harvard Business Publishing. 2018.Abstract

    Set in India’s most populous state, Uttar Pradesh, this case explores the complexity of addressing maternal and child health and care delivery by looking at health-related behaviors and decision making from the perspective of a mother. The case is intended to be used in conjunction with GHD-039 (Working as an ASHA to Improve Maternal and Child Health in Uttar Pradesh, India) and GHD-040 (Improving Maternal and Child Health Outcomes in Uttar Pradesh, India).

    Teaching Note available through Harvard Business Publishing.

    Khairabad Community Health CenterLearning Objectives: A productive class discussion will allow students to appreciate the decisions facing frontline providers and their beneficiaries, and the numerous factors that influence their choices; how households prioritize health among other needs; and the complexity of aligning health programs with beneficiary needs, cultural context, household dynamics, and other factors to impact health behaviors and outcomes.

    Keywords: public health, consumers, health care delivery, maternal and child health, consumer behavior, behavioral economics, resource-limited settings, health care policy, data collection, decision making

     

    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

    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

     

    Arnquist S, Rosenberg J, Weintraub R. The Indus Hospital: Building Surgical Capacity in Pakistan (Condensed Version). The Lancet Commission on Global Surgery. 2015.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. This is a condensed version of the case The Indus Hospital: Delivering Free Health Care in Pakistan

    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: This is a condensed version of the case The Indus Hospital: Delivering Free Health Care in Pakistan.

    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 (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

    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

    Cole C, Talbot JR, Rhatigan J, Weintraub R, Porter ME. HIV Prevention in Maharashtra, India. Harvard Business Publishing. 2011.Abstract

    The case examines Avahan's delivery model for targeted HIV prevention in India within a value-based framework by describing an implementing nongovernmental organization's district level activities. After providing information about the epidemiological, organizational, and political context, the case shows how the nongovernmental organization, Muslim Samaj Prabodhan Va Shikshan Sanstha (MSPSS), is able to tailor a set of activities to match the needs of its target communities under the guidance of one of Avahan's six "state lead partners," Mukta, which is contracted to recruit and manage grantee NGOs. Through a detailed description of MSPSS' activities, the case examines how high-value, comprehensive HIV preventive services can be delivered to a high-risk population. The case ends with MSPSS's leaders challenged to preserve the value of the program as they prepare to transition the program to government ownership.

    Teaching Note available through Harvard Business Publishing.

    MSPSS Ceremony Honoring Female Police Officer
    MSPSS Ceremony Honoring Female Police Officer. Source: MSPSS. (Exhibit 19 from "HIV Prevention in Maharashtra, India " case.)

    Learning Objectives: To understand the role of strategy in health care delivery through an examination of how HIV prevention programs generate value for the populations they serve through their selection and configuration of program activities.

    Keywords: Marginalized populations, targeted interventions, strategy, HIV prevention

    Charumilind S, Jain SH, Rhatigan J. HIV in Thailand: The 100% Condom Program. Harvard Business Publishing. 2011.Abstract

    Thailand’s 100% Condom Program, which was implemented nationwide in 1991, is widely credited with averting a generalized HIV epidemic in that nation. This case traces the development and implementation of Thailand’s 100% Condom Program including its conception, the development of a pilot program in one province, and the program’s early regional expansion. It frames these events within the country’s general political, economic, and health situation; the epidemiology and public perception of HIV/AIDS; the government’s early HIV policy; and the economics of the commercial sex industry. The case explores how public health interventions are designed, refined, and spread. The case ends in early 1991 with the program’s founder trying to find ways to spread the successful regional program nationwide.

    Teaching Note available through Harvard Business Publishing.

    Sex establishments in Patpong Area, including go-go bars and members clubs
    Sex establishments in Patpong Area, including go-go bars and members clubs. Source: "HIV in Thailand: The 100% Condom Program" case.

    Learning Objectives: To understand the principles behind the design of disease prevention programs and to examine how successful programs align incentives among various stakeholders to achieve their objectives.

    Supporting Content: This case has a supplementary summary of history and next steps, titled The 100% Condom Program: Part B.

    Keywords: HIV prevention, stakeholder alignment, harm reduction

     
    Bitton A, Talbot JR, Clarke L. Tobacco Control in South Africa. Harvard Business Publishing. 2011.Abstract

    This case reviews the policy changes in tobacco control in post-apartheid South Africa from 1994 to 1996 under the leadership of Minister of Health Dr. Nkosazana Zuma. After providing contextual information on South Africa, including historical, demographic, social, and health information, the case delves into the history of tobacco and of global tobacco control efforts. The case then details the history of tobacco in South Africa, including data collection, epidemiology, early control efforts, and the policy efforts of the mid-1990s. The case describes the African National Congress (ANC)’s policy victories under Zuma’s leadership. Knowing that tobacco disproportionately affected certain racial and minority groups, Zuma made tobacco control a top priority. With the support of the President, local tobacco experts, and anti-tobacco advocates, Zuma worked hard to break previous connections between the government and the tobacco industry and to reduce smoking. The case ends in 1996 when smoking prevalence had declined to 32% from 34% in 1995, but South Africa still had one of the highest levels in the developing world. As the ANC was preparing to enact the new Constitution that reinforced health promotion, Zuma had to determine what her next move would be for tobacco control and how she would prioritize it with the other health needs of the country.

    Teaching Note available through Harvard Business Publishing.

    Tobacco Control as Health Promotion
    Tobacco Control as Health Promotion. Source: Reddy, SP and Swart D. Unraveling Health Promotion: A Framework for Action: Tobacco Control. MRC: 1998. (Exhibit 8 in "Tobacco Control in South Africa" case.)

    Learning Objectives: To understand the political and economic forces that impact tobacco control legislation in a country undergoing an epidemiological shift, the role of research and data, and the value of health communication, chronic disease prevention, and advocacy in health care delivery.

    Supporting Content: This case has a supplementary summary of history and next steps, titled Tobacco Control in South Africa: Next Steps.

    Keywords: Chronic disease prevention, advocacy, health policy, tobacco control

     

    Bitton A, Taranto L, Talbot JR, Kadar E. Tobacco Control in South Africa: Next Steps. Harvard Business Publishing. 2011.Abstract

    This case is a supplement to Tobacco Control in South Africa, which reviews the policy changes in tobacco control in post-apartheid South Africa from 1994 to 1996 under the leadership of Minister of Health Dr. Nkosazana Zuma. This case explains what happened after 1996, the steps Zuma took to continue her fight against tobacco (including expanding research capacity, getting increases in excise taxes passed, and pushing national legislation through) and what happened after her departure in 1999.

    Teaching Note available through Harvard Business Publishing.

    Relationship between Excise Tax Rate and Cigarette Consumption in South Africa
    Relationship between Excise Tax Rate and Cigarette Consumption in South Africa. Source: van Walbeek C, WHO. Tobacco Excise Taxation in South Africa. (Exhibit 2 in "Tobacco Control in South Africa: Next Steps" case.)

    Learning Objectives: To understand the political and economic forces and the role of research and data in implementing tobacco control legislation in a country undergoing an epidemiological shift, and the value of health communication, chronic disease prevention, and advocacy in health care delivery.

    Supporting Content: This case is the supplement to Tobacco Control in South Africa.

    Keywords: Chronic disease prevention, advocacy, health policy, tobacco control

    Talbot JR, Bohrer M, Rhatigan J. Iran’s Triangular Clinic. Harvard Business Publishing. 2011.Abstract

    This case traces the development and implementation of Iran’s Triangular Clinic, an innovative health care delivery program, from its beginning as a site for counseling HIV-infected individuals to an integrated facility offering comprehensive HIV, sexually transmitted disease (STD), and drug addiction treatment, care, and support. The case examines the need for such services among the marginalized population that the first clinic served within the historical, political, economic, and health context of Iran and, specifically, in Kermanshah province, where the project begins. The case raises the question of how the clinic model might be integrated into primary health care and replicated throughout the country as part of the Iranian Ministry of Health’s Integrated Health Program.

    Teaching Note available through Harvard Business Publishing.

    Triangular clinic model
    Triangular clinic model. Source: World Health Organization and Regional Office for the Eastern Mediterranean, Best Practice in HIV/AIDS Prevention and Care for Drug Abusers: The Triangular Clinic in Kermanshah, Islamic Republic of Iran 2004, WHO: Cairo.

    Learning Objectives: To examine how health care delivery organizations can configure their services to deliver high value health care to the populations they serve and to understand methods to engage marginalized populations in order to increase their access to and demand for health services.

    Supporting Content: The sequel to this case is titled Scaling up Iran's Triangular Clinic.

    Keywords: Marginalized populations, comprehensive HIV prevention, harm reduction

     

    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

     

    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

    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

    Arnquist S, Weintraub R. loveLife: Preventing HIV among South African youth (Part B). 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.

    HIV Incidence among 15-20-year-old South Africans, 2002-2008. Source: Rehle T, Hallett T, Shisana O, et al. A Decline in New HIV Infections in South Africa: Estimating HIV Incidence from Three National HIV Surveys in 2002, 2005 and 2008. PloS one. 2010;5(6):e11094. (Exhibit 2 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 is the supplement to loveLife: Preventing HIV Among South African Youth.

    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.