Publications

    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.

    Rosenberg J, Donovan C, Madore A, Weintraub R. Working as an ASHA to Improve Maternal and Child Health in Uttar Pradesh, India. 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 frontline health worker. The case is intended to be used in conjunction with GHD-39N (Maternal and Child Health in Uttar Pradesh, India: A Mother’s Story) and GHD-040 (Improving Maternal and Child Health Outcomes in Uttar Pradesh, India).

    Teaching Note available through Harvard Business Publishing.Khairabad Community Health Center

    Learning 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, human resources, health care delivery, decision making, maternal and child health, behavioral economics, resource-limited settings, health care policy, data collection, performance management

    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

    May M, Rhatigan J. BRAC’s Tuberculosis Program: Pioneering DOTS Treatment for TB in Rural Bangladesh. Harvard Business Publishing. 2011.Abstract

    This case examines the development of a tuberculosis (TB) treatment program in Bangladesh by the non-governmental organization, BRAC, from 1984 to 2006. After providing background about Bangladesh, the burden of TB there, and BRAC, the case examines how this program was piloted and grew to cover a population of 80 million people. It details how BRAC was able to create a TB control program that utilized community health workers to perform most of its essential functions including case finding, directly-observed therapy, identification of complications, and record keeping. The case concludes with a brief summary of BRAC’s expansion to Afghanistan and recently, Africa, and asks the reader to consider the feasibility of this TB care model in other contexts and in other conditions, such as HIV/AIDS.

    Teaching Note available through Harvard Business Publishing.

    Timeline of BRAC TB Program Expansions
    Timeline of BRAC TB Program Expansions. Source: From One to Many: Scaling Up Health Programs in Low-Income Countries. Edited by Richard A Cash, A Mushtaque R. Chowdhury, George B. Smith, and Faruque Ahmed (2010). Ch 13. Islam A and May MA. Decentralized Management in the Expansion of BRAC's Rural Tuberculosis Program (DOTS). Pgs. 207-214. (Exhibit 3 in "BRAC’s Tuberculosis Program: Pioneering DOTS Treatment for TB in Rural Bangladesh" case.)

    Learning Objectives: To understand effective strategies for effectively engaging community health workers to deliver complex medical and public health interventions to large populations in low resource settings.

    Supporting Content: The sequel to this case is titled Tuberculosis in Dhaka: BRAC’s Urban TB Program.

    Keywords: Community health workers, tuberculosis control, rural nongovernmental organizations, social enterprise

    May M, Cash R, Rhatigan J. Tuberculosis in Dhaka: BRAC’s Urban TB Program. Harvard Business Publishing. 2011.Abstract

    This case examines BRAC’s experience expanding its rural TB program to the urban environment of Dhaka between 2002 and 2008. The case provides background information about Dhaka and describes what TB services existed at the time. The case then describes the expansion of BRAC’s TB program into Dhaka and details innovations in the Urban program. Students should gain an understanding of how these program modifications were a response to the specific challenges the program faced in the urban setting. The case allows an exploration of how successful health care delivery program adapt to new environments.

    Teaching Note available through Harvard Business Publishing.

    Map of Dhaka
    Map of Dhaka. Source: Available at http://www.urpnissues.com/webpage/maps/Districts/13.GIF. (Exhibit 1 in "Tuberculosis in Dhaka: BRAC’s Urban TB Program" case.)

    Learning Objectives: To understand how a successful health care delivery program that is uniquely tailored to a particular setting can adapt its operations in a new environment.

    Supporting Content: This case is a sequel to BRAC’s Tuberculosis Program: Pioneering DOTS Treatment for TB in Rural Bangladesh

    Keywords: Service delivery innovation, tuberculosis control, urban nongovernmental organizations

    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

    Pabo E, Ellner A, Rhatigan J, Lyon E. Two Years in Hinche. Harvard Business Publishing. 2011.Abstract

    Two Years in Hinche is a brief supplement to HIV Voluntary Counseling and Testing in Hinche, Haiti. The first case describes an underperforming HIV Voluntary Counseling and Testing Program in government run hospital in Hinche, Haiti, and the decision by a government official to invite, Zanmi Lasante/Partners in Health (ZL/PIH), a non governmental organization, to help revamp the program. After a detailed examination of the program and of the ZL/PIH health care delivery model, the case ends with ZL/PIH agreeing to collaborate with the government to revamp the program. This case describes the subsequent steps ZL/PIH took to increase the amount of patients that received HIV counseling and testing by ten-fold, and to begin an HIV treatment program. It details how they were able to adapt their model for the public sector, improve supply chains, integrate staffs, and build community trust.

    Teaching Note available through Harvard Business Publishing.

    VCT Room at Sainte Thérèse Hospital

    Learning Objectives: To examine effective strategies for improving uptake of preventive health services in low-resource settings.

    Supporting Content: This case is the supplement to HIV Voluntary Counseling and Testing in Hinche, Haiti.

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