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.

    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

    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