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

    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

    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

    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

    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

    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

    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: Image B Source: CDC: Image 6887. Public Health Image Library. Available at (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