Publications

    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

    Madore A, Rosenberg J, Weintraub R. Project ECHO: Expanding the Capacity of Primary Care Providers to Address Complex Conditions. Harvard Business Publishing. 2017.Abstract

    This case takes place in the United States (US) and traces the inception and growth of Project Extension for Community Healthcare Outcomes (Project ECHO)—a web-based "guided practice" model for primary care providers—from 2003 to 2016. After providing background on the US health system, including medical education, health care financing, and the supply and distribution of primary care and specialist providers, the case explores what motivated Project ECHO founder and liver specialist Sanjeev Arora, MD to train primary care providers in rural New Mexico in hepatitis C treatment and management. It describes early replication of the ECHO model in the US and across medical conditions and what the Project ECHO model entailed—including leveraging technology to expand access to specialty resources, best practices, case-based learning, and outcome monitoring, as well as good will among participants. A professional communications campaign, ongoing research, and persistence supported Project ECHO’s growth. The case displays three dimensions of Project ECHO’s early work: creating a new mode to redistribute the expertise of specialists to primary care practitioners, scaling this new care delivery model and measuring its impact, and identifying sustainable funding sources. The case concludes with the US Congress passing the ECHO Act to promote research on the model and Arora contemplating what else he might need to continue to scale to reach his goal of touching 1 billion lives.

    Teaching Note available through Harvard Business Publishing. 

    TeleECHO Clinic - hub and spoke
    TeleECHO Clinic. Source: Case writers.

    ECHO Institute
    ECHO Institute. Source: Case writers.

    Learning Objectives: To understand what is needed to design a service model; the potential for redistribution of expertise among practitioners to enhance value; the role of operational effectiveness in enabling scale up; and the importance of measuring impact for stakeholders.

    Keywords: Public health, health care delivery, scale-up, resource-limited settings, human resource, information technology, primary care, information management, data collection, mentorship

    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 http://www.neglecteddiseases.gov/target_diseases/trachoma/.

    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

     

    Talbot JR, Cole C, May M, Weintraub R. Voluntary Medical Male Circumcision in Nyanza Province, Kenya (Condensed Version). The Lancet Commission on Global Surgery. 2015.Abstract

    This case traces the development of the voluntary medical male circumcision (VMMC) campaign in Nyanza Province, Kenya as it transformed from the subject of a randomized clinical trial into national policy. After providing some background on the cultural, political, and scientific context surrounding male circumcision, the case traces the PEPFAR-funded implementers' advances in delivering male circumcision in Nyanza. It examines the various delivery models used in Nyanza and the evolution of the relationship between implementers as well as on the development of the national strategic plan for VMMC released in 2009. The case ends with the implementers having come together successfully for two rapid, aggressive, 30-day implementation campaigns and the head of Kenya's National AIDS and Sexually Transmitted Infections Control Programme wrestling with how to make such campaigns sustainable and what lessons from the campaign to pass on to the national program. This is a condensed version of the case Voluntary Medical Male Circumcision in Nyanza Province, Kenya.

    Teaching Note available through Harvard Business Publishing.

    Mobile Service Delivery Model
    (A) Group counseling on male circumcision; (B) mobile circumcision counseling site; and (C) circumcision being conducted in tented delivery site. Source: Nyanza Reproductive Health Society.

    Learning Objectives: To understand how a randomized controlled trial may be translated into a large-scale public health program; how a surgical campaign was designed and implemented for rapid impact; the role of national and international collaboration in large-scale health delivery; and the ethical tradeoffs that arise in large-scale public health programs.

    Supporting Content: This is a condensed version of the case Voluntary Medical Male Circumcision in Nyanza Province, Kenya.

    Keywords: Project management, AIDS, policy, supply and demand, partnerships, strategy, innovation

    Madore A, Yousif H, Rosenberg J, Desmond C, Weintraub R. Political Leadership in South Africa: HIV. Harvard Business Publishing. 2015.Abstract

    This case describes the rapid scale-up of South Africa’s national HIV/AIDS response from 2009 until 2015. After providing background on apartheid, the impact of HIV/AIDS denialism, and an overview of the health system in South Africa, the case follows Minster of Health Aaron Motsoaledi’s leadership of the national department of health’s HIV/AIDS program. The response included four key components: a countrywide counseling and testing campaign, capacity building to increase access to treatment, an overhaul of the ARV bidding and procurement processes, and promotion of voluntary male medical circumcision. The case highlights how Motsoaledi and his team leveraged expertise and resources from domestic and international organizations to support ambitious testing and treatment goals. It focuses on Motsoaledi’s communication strategies and the factors that influenced his planning and implementation decisions. The case ends with Motsoaledi considering how to advance the national HIV/AIDS program amid larger health system issues, including overcrowding and limited monitoring capacity.

    Teaching Note available through Harvard Business Publishing.

    Promotion of prevention of mother-to-child transmission (PMTCT) of HIV
    Promotion of prevention of mother-to-child transmission (PMTCT) of HIV (source: Global Health Delivery Project case writers)

    Learning Objectives: A productive class discussion will allow students to appreciate how politics can shape the trajectory of an epidemic; the importance of leveraging existing resources to scale services in a public health system; the challenges of transitioning from an emergency response to a sustainable public program; and the competing interests of a vertical intervention program and the complex health system within which it operates.

    Keywords: Political leadership, data and health policy, counseling and testing, adherence, advocacy, HIV treatment, health care delivery, cross-sector collaboration, vertical programs, value creation, drug procurement, civil society, strategy

     

    Madore A, Rosenberg J, Weintraub R. “Sin Taxes” and Health Financing in the Philippines. Harvard Business Publishing. 2015.Abstract

    This case traces the implementation of tobacco tax policy and health system reforms in the Philippines from 2009 to 2015 in the context of the global tobacco control movement, the economic and political influence of the Philippine tobacco industry, and the Philippine health system. After providing background on the prevalence and costs of smoking in the Philippines, the case follows the steps taken by a diverse group of actors to design, promote, and implement higher taxes on tobacco and alcohol products, the primary goals of which were to reduce smoking and raise funds to achieve universal health care. The case highlights the strategies used to counter opposition from the tobacco industry and allied politicians. It focuses on Health Secretary Enrique Ona’s efforts to support sin tax reform and how the country used the resulting revenues to try to improve health care and health insurance coverage. It ends with Ona contemplating the impact of his investments in national health insurance and public health infrastructure as a new health secretary takes his place.

    Teaching Note available through Harvard Business Publishing.

    From left to right: House of Representatives; Woman selling cigarettes
    From left to right: House of Representatives; Woman selling cigarettes. Source: Global Health Delivery Project case writers.

    Learning Objectives: A productive class discussion will allow students to appreciate the complexity and trade-offs governments may face in stimulating their economy, regulating industry, and improving public health; the importance of data in driving and sustaining policy reform; the role of financing policies and funding as tools for health system strengthening and value creation when leveraged strategically; and the potential for health to unify different actors and sectors to generate new policy and restructure fiscal and financial systems.

    Keywords: Health insurance, health care financing, tobacco control, smoking, universal health care implementation, policy, cross sector collaboration, health system reform, political leadership, management

    ole-MoiYoi K, Talbot JR, Weintraub R. Roll-Out of Rapid Diagnostic Tests for Malaria in Swaziland. Harvard Business Publishing. 2012.Abstract

    After outlining the history of malaria in Swaziland, this focused case study examines the implementation of rapid diagnostic tests (RDTs) for malaria in Swaziland to improve case management and to strengthen the national malaria surveillance system as the National Malaria Control Program (NMCP) aims to implement a national elimination strategy. In addition to information on RDT selection, the case details Swaziland's quality assurance program-the first of its kind in the region, the public health benefits of the immediate disease notification system for active case detection, and Simon Kunene's leadership qualities as the manager of the NMCP for 24 years. The case addresses the necessary increases in financing and human resources to support the strategy and evaluates the impact of RDTs on the strategy. Challenges the NMCP faces in achieving malaria elimination include sustaining political will, interest, and financial commitments from donors and strengthening health workforce training and RDT procurement and distribution.

    Teaching Note available through Harvard Business Publishing.

    Milestones toward Malaria Elimination
    Milestones toward Malaria Elimination. Source: The Global Malaria Action Plan: For a malaria-free world. Roll Back Malaria Partnership, 2008. (Exhibit 4 from "Roll-Out of Rapid Diagnostic Tests for Malaria in Swaziland" case.

    Learning Objectives: To understand the role of diagnostics in a malaria elimination strategy, what it takes to effectively integrate a new diagnostic into care delivery, how leaders generate social and political capital over time, and the intricacies of managing a national disease program.

    Keywords: National strategy, supply chain management, diagnostic testing strategies, malaria eradication and control

    Arnquist S, Talbot JR, Weintraub R. loveLife: Transitions After 2005. Harvard Business Publishing. 2012.Abstract

    This case focuses on how loveLife, South Africa's largest youth-focused nongovernmental organization, recovered from losing one-third of its operating revenues in 2006 when the Global Fund to Fight AIDS, Tuberculosis and Malaria chose not to renew funding to South Africa. The case describes managers' decisions to downsize and secure additional government funding to save the organization and the ways in which the original strategy guided these changes. The case ends in 2009 with loveLife's new chief executive officer contemplating how to secure the organization's future amid national political changes and funding challenges.

    Teaching Note available through Harvard Business Publishing.

    loveLife Program Coverage, 2007. Source: loveLife
    loveLife Program Coverage, 2007. Source: loveLife. (Exhibit 6 from "loveLife: Transitions After 2005" case.)

    Learning Objectives: To appreciate how crises can impact program management and activities, the role of leadership in responding to crises, the benefits of second generation leadership for an organization, and the implications of transitioning from international funding sources to domestic government funding sources.

    Supporting Content: This case is a sequel to loveLife: Preventing HIV Among South African Youth.

    Keywords: National strategy, impact of financing, HIV prevention, leadership, sustainability

    Madore A, Talbot JR, Weintraub R. Electronic Medical Records at ISS Clinic Mbarara, Uganda. Harvard Business Publishing. 2012.Abstract

    This case traces the evolution of the medical records system at the Immune Suppression Syndrome (ISS) Clinic in Mbarara, Uganda. After providing some background on Uganda, its HIV epidemic, and the general rise of electronic medical records and software, it explains the history of the ISS Clinic and its service delivery model. ISS Clinic had used paper records to manage care, treatment, and reporting needs until it partnered with the University of California, San Francisco on research initiatives. In 2004 ISS Clinic became a global health initiative beneficiary and the outpatient antiretroviral therapy center of Mbarara Regional Hospital. Offering free treatment, patient enrollment jumped dramatically. The clinic's electronic Access database was unable to keep up. The clinic secured a grant to implement a new medical record system, and leaders struggled to convince the physicians and other stakeholders of its value. The most clinically-relevant pieces were slow to be put in place, and new Ministry of Health regulations posed minor setbacks. At the end of 2010, the clinic had seen nearly 21,000 patients. Clinic research had contributed to more than 20 peer-reviewed articles, but the long-term prospects for the database were unknown.

    Teaching Note available through Harvard Business Publishing.

    Screenshot of an Electronic Form in OpenMRS, ISS Clinic
    Screenshot of an Electronic Form in OpenMRS, ISS Clinic. Source: ISS Clinic. (Exhibit 12 from "Electronic Medical Records at ISS Clinic Mbarara, Uganda" case.)

    Learning Objectives: This case documents the evolution of medical records at an HIV/AIDS clinic in a resource-limited setting. A productive class discussion will allow students to appreciate what it takes to collect and systemize accurate health data for patient care and research, what it takes to implement an electronic medical system in a resource-limited setting, and the relationship between a health record system, clinical care, and public health.

    Keywords: Management and operations, HIV treatment, health research, health information systems

     

    Talbot JR, Rhatigan J. Scaling up Iran’s Triangular Clinic. 2012.Abstract

    This case is a sequel to Iran's Triangular Clinic. It examines how the Triangular Clinic model of integrated care was replicated and integrated into Iran's primary health care system.

    Teaching Note available through Harvard Business Publishing.

    Executive Order Legalizing Harm Reduction Program Components
    Executive Order Legalizing Harm Reduction Program Components. Source: Salmon et al, 2007. (Exhibit 2 from "Scaling up Iran's Triangular Clinic" case.)

    Learning Objectives: To examine how tailored health care delivery models can be scaled up and replicated.

    Supporting Content: This case is a sequel to Iran's Triangular Clinic.

    Keywords: Marginalized populations, comprehensive HIV prevention, harm reduction

    Talbot JR, Cole C, May M, Weintraub R. Voluntary Medical Male Circumcision in Nyanza Province, Kenya. Harvard Business Publishing. 2012.Abstract

    This case traces the development of the voluntary medical male circumcision (VMMC) campaign in Nyanza Province, Kenya as it transformed from the subject of a randomized clinical trial into national policy. After providing some background on the cultural, political, and scientific context surrounding male circumcision, the case traces the PEPFAR-funded implementers' advances in delivering male circumcision in Nyanza. It examines the various delivery models used in Nyanza and the evolution of the relationship between implementers as well as on the development of the national strategic plan for VMMC released in 2009. The case ends with the implementers having come together successfully for two rapid, aggressive, 30-day implementation campaigns and the head of Kenya's National AIDS and Sexually Transmitted Infections Control Programme wrestling with how to make such campaigns sustainable and what lessons from the campaign to pass on to the national program.

    Teaching Note available through Harvard Business Publishing.

    Mobile Service Delivery Model
    (A) Group counseling on male circumcision; (B) mobile circumcision counseling site; and (C) circumcision being conducted in tented delivery site. Source: Nyanza Reproductive Health Society.

    Learning Objectives: To understand how a randomized controlled trial may be translated into a large-scale public health program; how a surgical campaign was designed and implemented for rapid impact; the role of national and international collaboration in large-scale health delivery; and the ethical tradeoffs that arise in large-scale public health programs.

    Supporting Content: There is a shorter version of this case titled Voluntary Medical Male Circumcision in Nyanza Province, Kenya (Condensed Version).

    Keywords: Project management, AIDS, policy, supply and demand, partnerships, strategy, innovation

    ole-MoiYoi K, Rodriguez W. Investing in Global Health: Botanical Extracts Ltd. Harvard Business Publishing. 2011.Abstract

    This case traces the establishment of Botanical Extracts (BE) as a manufacturer of artemisinin, the active pharmaceutical ingredient in artemisinin-based combination therapies (ACTs) for malaria in East Africa. After providing background on the disease and its epidemiology and history, the case delves into the malaria eradication and control efforts of the past 50 years, with emphasis on treatment with anti-malarials. It describes how artemisinin made the transition from a traditional Chinese medicine to Novartis’ largest pharmaceutical product by volume. The case presents background information on the artemisinin industry, with emphasis on the WHO, Novartis, artemisinin extractors, and Artemisia farmers. The case details the founding of BE, its role in the ACT industry, and the complex supply chain for ACTs from the cultivation of the raw material to the delivery of ACTs as well as the public private partnership that was driving the manufacturing and delivery of ACTs. The case ends by describing the challenges faced by BE in June 2008, asking how best the company should move forward.

    Teaching Note available through Harvard Business Publishing.

    The Artemisia Plant and Cultivation
    The Artemisia Plant and Cultivation. Image A Source: Advanced Bio-Extracts. Image B Source: Farmer in Central Kenya, June 2008. (Exhibit 7 from "Investing in Global Health: Botanical Extracts Ltd." case.)

    Learning Objectives: To understand 1) the challenges of manufacturing necessary healthcare commodities for a populace that is unable to afford them, 2) how risk is distributed among actors in public-private partnerships, and 3) how investment in health commodities in developing countries can promote sustainable economic development.

    Keywords: Public-private partnerships, pharmaceutical supply chains, malaria eradication and control, health commodity manufacturing

    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

    ole‐MoiYoi K, Rodriguez W. Building Local Capacity for Health Commodity Manufacturing: A to Z Textile Mills Ltd. Harvard Business Publishing. 2011.Abstract

    This case focuses on the establishment of the Olyset® Consortium—a public-private partnership that was created to facilitate the manufacture of long-lasting insecticidal bed nets to prevent malaria infection in sub-Saharan Africa—and A to Z Textile Mills (“A to Z”), the manufacturer of the nets in Arusha, Tanzania. The case examines how the public-private partnership was developed, its use of an incentive-based supply chain, A to Z’s business model and impact, and the sustainability of the venture. The case reveals that despite significant success in attaining objectives, the misaligned incentives of the many partners presented major obstacles to the overall sustainability of A to Z’s Olyset® production line.

    Teaching Note available through Harvard Business Publishing.

    Long Lasting Insecticide Nets and Olyset Production Process
    Long Lasting Insecticide Nets and Olyset Production Process. Source: A to Z Textile Mills Ltd., Arusha, Tanzania (Case Exhibit 9).

    Learning Objectives: To understand the potential for public-private partnerships to leverage innovation and scalability from the private sector and quality and equitable access from the public sector and to examine the costs and benefits of local manufacturing of technologically complex global health commodities in resource-limited settings.

    Keywords: Public-private partnerships, incentive-based supply chain, global health commodity manufacturing, malaria prevention

    Park P, Bhatt A, Rhatigan J. The Academic Model for the Prevention and Treatment of HIV/AIDS. Harvard Business Publishing. 2011.Abstract

    This case traces the development of the Academic Model for the Prevention and Treatment of HIV/AIDS (AMPATH), and its founding organization, the Indiana University – Moi University (IU-MU) Partnership in Eldoret, Kenya. The case opens with a discussion of AMPATH’s new Home-Based Counseling and Testing Program (HCT) and its prospects for improving HIV care in Western Kenya. After providing some background on the general political, economic, and health situation in Kenya, it follows the development of the IU-MU Partnership from 1990 to 2000, its subsequent entry into HIV care services through AMPATH in 2001, and AMPATH’s rapid growth to become the largest provider of HIV services in Kenya. It then describes the organizational and operational characteristics of AMPATH and concludes with the organization wrestling with the opportunities and operational challenges that HCT presents.

    Teaching Note available through Harvard Business Publishing.

    AMPATH Center in Eldoret, Kenya
    AMPATH Center in Eldoret, Kenya. Source: Case writer. (Exhibit 12 in "The Academic Model for the Prevention and Treatment of HIV/AIDS " case.)

    Learning Objectives: To understand the development and design of a large scale HIV care program in a resource-limited setting and to examine how HIV treatment programs can effectively configure their services to provide maximum value to the populations they serve.

    Keywords: Service expansion, the role of academic medical centers, HIV treatment and prevention, home-based counseling and treatment

    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

    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

    Talbot JR, Rhatigan J. Multidrug-Resistant Tuberculosis Treatment in Peru. Harvard Business Publishing. 2011.Abstract

    This case traces the development of a multidrug-resistant tuberculosis (MDR-TB) treatment program in Peru between 1994 and 1999 by Socios en Salud (SES), a community-based nonprofit organization, in a shantytown of Northern Lima called Carabayllo. After providing some background on existing TB treatment services and the organizational history of SES, it follows the organization up to 1999 and frames its work within the context of international MDR-TB policy. The case presents background information on the epidemiology of TB and MDR-TB in Peru as well as the shantytown of Carabayllo. It describes how SES implemented community-based treatment for cadre of patients with MDR-TB and achieved cure rates comparable with those obtained in the US. The case begins with a vignette that illuminates the problem of MDR-TB from a patient’s perspective and ends with the program needing to strategize about how to scale-up and expand its reach to more patients.

    Teaching Note available through Harvard Business Publishing.

    Outdoor sputum collection booth to prevent TB transmission in (MOH) national hospital in northern shantytown of Peru
    Outdoor sputum collection booth to prevent TB transmission in (MOH) national hospital in northern shantytown of Peru; Credit: Julie Rosenberg Talbot

    Learning Objectives: To understand strategies that innovative programs use to improve access to health care and to explore ways that community health workers can deliver complex medical interventions within well-designed public health programs.

    Keywords: Community health workers, multi-drug resistant tuberculosis treatment, policy change, advocacy

    Blumenthal D, Ellner A, Jain S, Rhatigan J. Polio Elimination in Uttar Pradesh. Harvard Business Publishing. 2011.Abstract

    This case describes key elements of the Global Polio Eradication Initiative’s (GPEI) campaign in India and explores the challenges faced in eliminating polio from the northern state of Uttar Pradesh. Throughout the 1990s, India began implementing coordinated national polio immunization days to supplement routine immunization in health clinics in an effort to eliminate polio from the nation. The case provides contextual information about India and Uttar Pradesh as well as polio and polio vaccines. It then examines the roles of key partners in the GPEI, including Rotary International, the World Health Organization (WHO), the US Centers for Disease Control (CDC) and UNICEF, and it describes the local operational challenges of the mass immunization campaign in Uttar Pradesh. The campaign has been unable to eliminate polio from this state, and the program leaders grapple with ways to improve the campaign’s performance there.

    Teaching Note available through Harvard Business Publishing.

    Comic Book, Crusade Against Polio, Front Cover
    Comic Book, Crusade Against Polio, Front Cover. Source: Rotary International.

    Learning Objectives: To understand the political and operational challenges of implementing a nation-wide disease elimination program and to appreciate how local, contextual factors influence the delivery of health interventions.

    Keywords: Polio elimination and immunization campaigns, supply chain management, global collaboration

     

    Arnquist S, Weintraub R. loveLife: Preventing HIV Among South African Youth. Harvard Business Publishing. 2011.Abstract

    This case describes the strategy of the nongovernmental organization (NGO), loveLife, to prevent HIV among South African youth in the face of the world’s largest HIV epidemic, youth culture in post-apartheid South African, and a national government hostile to HIV/AIDS programs. The case traces loveLife from its inception and rapid scale up in 1999 to 2005, when loveLife lost one-third of its operating budget after the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) chose not to renew its second phase of funding. This case documents loveLife’s strategy in scaling up and sustaining delivery of HIV prevention services at scale. A short, optional case coda describes loveLife’s restructuring and positioning after the Global Fund crisis up to 2009.

    Teaching Note available through Harvard Business Publishing.

    Examples of loveLife media. Source: loveLife.
    Examples of loveLife media. Source: loveLife. (Exhibit 10 from "loveLife: Preventing HIV Among South African Youth" case.)

    Learning Objectives: To learn the application of strategic thinking in HIV prevention using Michael Porter’s “Five Tests of a Good Strategy” and to understand the organizational changes required in transitioning from scaling up to operating at scale.

    Supporting Content: This case has a supplementary summary of history and next steps titled loveLife: preventing HIV among South African youth (Part B). There is also an additional sequel, loveLife: Transitions After 2005.

    Keywords: Demand generation, scale up, sustaining delivery at scale, HIV prevention among youth, strategy, stigma

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