Publications

    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.

    Donovan C, Rosenberg J, Madore A, Weintraub R. Maternal and Child Health in Uttar Pradesh, India: A Mother's Story. 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 mother. The case is intended to be used in conjunction with GHD-039 (Working as an ASHA to Improve Maternal and Child Health in Uttar Pradesh, India) and GHD-040 (Improving Maternal and Child Health Outcomes in Uttar Pradesh, India).

    Teaching Note available through Harvard Business Publishing.

    Khairabad Community Health CenterLearning 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, consumers, health care delivery, maternal and child health, consumer behavior, behavioral economics, resource-limited settings, health care policy, data collection, decision making

     

    Cole C, Talbot JR, Rhatigan J, Weintraub R, Porter ME. HIV Prevention in Maharashtra, India. Harvard Business Publishing. 2011.Abstract

    The case examines Avahan's delivery model for targeted HIV prevention in India within a value-based framework by describing an implementing nongovernmental organization's district level activities. After providing information about the epidemiological, organizational, and political context, the case shows how the nongovernmental organization, Muslim Samaj Prabodhan Va Shikshan Sanstha (MSPSS), is able to tailor a set of activities to match the needs of its target communities under the guidance of one of Avahan's six "state lead partners," Mukta, which is contracted to recruit and manage grantee NGOs. Through a detailed description of MSPSS' activities, the case examines how high-value, comprehensive HIV preventive services can be delivered to a high-risk population. The case ends with MSPSS's leaders challenged to preserve the value of the program as they prepare to transition the program to government ownership.

    Teaching Note available through Harvard Business Publishing.

    MSPSS Ceremony Honoring Female Police Officer
    MSPSS Ceremony Honoring Female Police Officer. Source: MSPSS. (Exhibit 19 from "HIV Prevention in Maharashtra, India " case.)

    Learning Objectives: To understand the role of strategy in health care delivery through an examination of how HIV prevention programs generate value for the populations they serve through their selection and configuration of program activities.

    Keywords: Marginalized populations, targeted interventions, strategy, HIV prevention