Publications

    Rosenberg J, 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

    Rosenberg J, Wachter K, Weintraub R. Concept Note: Malnutrition. Harvard Business Publishing. 2015.Abstract

    This concept note provides an overview of malnutrition, including its definition, causes, and management related to prevention, diagnosis, and treatment. It also describes the state of global malnutrition, including national and international efforts to reduce malnutrition and the stakeholders involved.

    Learning Objectives: To further students’ and instructors’ understanding of malnutrition-related concepts presented in the Global Health Delivery (GHD) Case Collection (e.g., GHD-031: Reducing Child Malnutrition in Maharashtra, India).

    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

    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

    Wachter K, Talbot JR, Weintraub R. Partners In Health in Neno District, Malawi. Harvard Business Publishing. 2013.Abstract

    Set in Neno District, Malawi from 2007–2012, the case focuses on the economic impact of investing in health care infrastructure. It examines management decisions that leaders of Abwenzi Pa Za Umoyo (APZU) and its founding organization—Partners In Health (PIH)—made as they supported the Government of Malawi in building a hospital and scaling up the delivery of APZU clinical and social programs across Neno district. The case highlights how a non-governmental organization can navigate the politics and local culture to improve Malawi’s health care system in close partnership with a strong, protocol-driven government. The case begins with Ophelia Dahl, co-founder and executive director of Partners In Health, reflecting on her December 2011 trip to Neno, nearly four years after her first visit. She observed signs of progress unrelated to health—bank branches had opened in town, a new road had been built, and the market had expanded dramatically. Ultimately, the case explores what this demonstrates about the value of her organization’s investments in health.

    Teaching Note available through Harvard Business Publishing.

    Neno rural hospital
    In the foreground: One-story original structures of Neno Rural Hospital used for outpatient and maternity services. In back: Two-story building constructed by APZU and partners used for inpatient wards, meetings, computer use, laboratory work, and government offices. Source: Keri Wachter, 2012.

    Learning Objectives: To understand the challenges of hiring and retaining local and expat staff, the complexity of an international NGO partnering with the government to improve health care, how leadership acumen and approaches impact scaling up and sustaining health care delivery, the relationship between the district hospital and the local economy, and how to assess impact beyond health measures.

    Keywords: Global health, social equality, project management, business and government relations, partnerships, strategy, economic development, health care policy, health care delivery, public health, human resource management, developing countries, innovation

    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

    Arnquist S, Ellner A, Weintraub R. HIV/AIDS in Brazil: Delivering Prevention in a Decentralized Health System. Harvard Business Publishing. 2011.Abstract

    This case describes the Brazilian National AIDS Program's strategy in the late 2000s to prevent HIV infections. The case is set against the context of a heterogeneous, concentrated epidemic and decentralized public health system that guaranteed access to care and treatment. The case traces the nation's response to HIV from the late 1980s through 2009 via a human rights framework, highlighting the cooperation with civil society. Readers are challenged to understand the relationships between HIV/AIDS prevention and treatment, decentralization and sustainability.

    Teaching Note available through Harvard Business Publishing.

    Decentralization Policy M&E Indicators
    Decentralization Policy M&E Indicators. Source: National Department of STD, AIDS and Viral Hepatitis. (Exhibit 14 from "HIV/AIDS in Brazil: Delivering Prevention in a Decentralized Health System" case.)

    Learning Objectives: Students should understand the tradeoffs involved in a decentralized governance structure, the levers a central government department can pull to influence local health care delivery in a decentralized health system, and how civil society advocacy contributes to program sustainability.

    Keywords: Human rights, HIV prevention, Sustainability, Role of civil society, Strategy

    Charumilind S, Jain SH, Rhatigan J. The 100% Condom Program: Part B. Harvard Business Publishing. 2011.Abstract

    This document supplements HIV in Thailand: the 100% Condom Program and recounts the eventual nationwide adoption of that program and its impact on HIV in Thailand.

    Teaching Note available through Harvard Business Publishing.

    HIV and AIDS Projections, 1985-2020
    HIV and AIDS Projections, 1985-2020. Source: Department of Disease Control, Ministry of Health (projections based on data up to 2003). (Exhibit 6 from the "HIV in Thailand: The 100% Condom Program" case.)

    Learning Objectives: To examine the national spread of a regional disease prevention program and evaluate its impact.

    Supporting Content: This document supplements HIV in Thailand: the 100% Condom Program.

    Keywords: HIV prevention, stakeholder alignment, harm reduction

    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

    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, 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

    Talbot JR, Rhatigan J. Multidrug-Resistant Tuberculosis Treatment in Peru. Harvard Business Publishing. 2011.Abstract

    This case traces the development of a multidrug-resistant tuberculosis (MDR-TB) treatment program in Peru between 1994 and 1999 by Socios en Salud (SES), a community-based nonprofit organization, in a shantytown of Northern Lima called Carabayllo. After providing some background on existing TB treatment services and the organizational history of SES, it follows the organization up to 1999 and frames its work within the context of international MDR-TB policy. The case presents background information on the epidemiology of TB and MDR-TB in Peru as well as the shantytown of Carabayllo. It describes how SES implemented community-based treatment for cadre of patients with MDR-TB and achieved cure rates comparable with those obtained in the US. The case begins with a vignette that illuminates the problem of MDR-TB from a patient’s perspective and ends with the program needing to strategize about how to scale-up and expand its reach to more patients.

    Teaching Note available through Harvard Business Publishing.

    Outdoor sputum collection booth to prevent TB transmission in (MOH) national hospital in northern shantytown of Peru
    Outdoor sputum collection booth to prevent TB transmission in (MOH) national hospital in northern shantytown of Peru; Credit: Julie Rosenberg Talbot

    Learning Objectives: To understand strategies that innovative programs use to improve access to health care and to explore ways that community health workers can deliver complex medical interventions within well-designed public health programs.

    Keywords: Community health workers, multi-drug resistant tuberculosis treatment, policy change, advocacy

    Dhillon R, Rhatigan J. The Measles Initiative. Harvard Business Publishing. 2011.Abstract

    This case examines the work of the Measles Initiative (MI), a consortium of multiple international organizations, in helping catalyze a global effort to reduce worldwide measles-related mortality by expanding delivery of measles vaccinations. After providing background information on the biology of the measles virus and the epidemiology of measles, it recounts the formation of the MI, its partnership structure, its goals, its program design, and its financing. The case focuses on how multilateral global health initiatives coordinate with national governments to improve health care delivery. By 2009, the MI had made significant gains in reducing measles mortality, but was facing decreased funding and was questioning its strategy going forward.

    Teaching Note available through Harvard Business Publishing.

    Clinical Presentations of Measles
    Clinical Presentations of Measles. Image A Source: CDC: Image 132. Public Health Image Library. Available at: http://phil.cdc.gov/phil/details.asp?pid=132. Image B Source: CDC: Image 6887. Public Health Image Library. Available at http://phil.cdc.gov/phil/details.asp?pid=6887. (Exhibit 1 from “The Measles Initiative” case.)

    Learning Objectives: To understand how multi-lateral, international disease-control initiatives are designed, coordinated, and financed and to examine how these initiatives interact with national health systems to achieve their objectives.

    Keywords: Coordination of multilateral global health initiatives and national governments, international partnerships, measles vaccination campaigns, strategy