Publications

    Rosenberg J, Ahmad I, Sharara N, Weintraub R. Improving Maternal Health by Addressing Stockouts: Integrating the Private Sector into the Public Health Supply Chain in Senegal. Harvard Business Publishing. 2021.Abstract

    This case traces the development of a series of initiatives to intended to reduce stockouts of family planning commodities in Senegal’s public health system and the eventual scale up of the redesigned supply chain to include additional commodities and its transfer of management to the government. After providing some background on the history of Senegal, including its governance and health system, the case explores early efforts to overhaul the supply chain in the country and reproductive health efforts. It then describes the Gates Foundation’s involvement and how the relationship between family planning and supply chain management came to light. The Gates Foundation, along with others, supported the launch of the Informed Push Model with Third Party Logisticians (IPM-3PL), which proved to reduce stockouts dramatically. Despite significant initial support from both government ministries and international donor agencies, as the program scaled IPM-3PL did not survive the transition to a fully government-run model, and the program was eventually discontinued in 2019 after two attempts to hand over the program to Senegal’s National Supply Pharmacy (Pharmacie Nationale d'Approvisionnement; PNA), the government agency in charge of distribution of medicines. The case ends with the director of the PNA contemplating what was next for Senegal and what she could tell others who had been so closely watching the country as an example.

    Learning Objectives:

    This case documents the need for and process to overhaul Senegal’s public health supply chain. A productive class discussion will allow students to appreciate the following:

    1. The benefits and challenges of transitioning aspects of a public health supply chain between push and pull models
    2. The trade-offs of private sector integration in public health supply chains
    3. How the management and financing structure of a public health supply chain impacts its efficacy and scalability
    4. The need for cross-sector and intragovernmental collaboration for effective supply chain management and the relationship between policy and last mile delivery

    Supply Chain Scenarios

    Keywords: supply chain management, private-public partnership, maternal health, third party logisticians, informed push model, scale up, distribution

    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.