Publications

2012
Rosenberg J, 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

Download GHD-027 Kenya's VMMC Program
2011
Charumilind S, Jain SH, Rhatigan J. The 100% Condom Program: Part B. Harvard Business Publishing. 2011.Abstract

This document supplements HIV in Thailand: the 100% Condom Program and recounts the eventual nationwide adoption of that program and its impact on HIV in Thailand.

Teaching Note available through Harvard Business Publishing.

HIV and AIDS Projections, 1985-2020
HIV and AIDS Projections, 1985-2020. Source: Department of Disease Control, Ministry of Health (projections based on data up to 2003). (Exhibit 6 from the "HIV in Thailand: The 100% Condom Program" case.)

Learning Objectives: To examine the national spread of a regional disease prevention program and evaluate its impact.

Supporting Content: This document supplements HIV in Thailand: the 100% Condom Program.

Keywords: HIV prevention, stakeholder alignment, harm reduction

Download GHD-001B HIV in Thailand Condom Program Part B
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

Download GHD-013 AMPATH
Cole C, May M, Rosenberg J, Weintraub R, Porter ME. The Avahan India AIDS Initiative: Managing Targeted HIV Prevention at Scale. Harvard Business Publishing. 2011.Abstract

This case is the second in a two-part series describing the Avahan Indian AIDS Initiative (Avahan), a large-scale HIV prevention delivery program of the Bill & Melinda Gates Foundation (Gates Foundation). The case examines Avahan's choice of intervention strategies in the face of the HIV epidemic of India in 2002. It describes Avahan's structure, operations, and execution style, as well as how Avahan's management system for its seven "state lead partners" and 137 district-level nongovernmental organizations was applied initially to scale and later to sustain the delivery model. The case ends with Avahan's director planning to transfer program ownership to the Government of India.

Teaching Note available through Harvard Business Publishing.

Examples of Microplanning Tools Developed by Avahan SLPs
Examples of Microplanning Tools Developed by Avahan SLPs. Source: Created by case writers. (Exhibit 10 "The Avahan India AIDS Initiative: Managing Targeted HIV Prevention at Scale" case.)

Learning Objectives: To understand the strategies needed to deliver HIV prevention services at scale; how the configuration of management activities can enable rapid scale up of HIV prevention programming; and how these management activities must evolve to sustain delivery at scale.

Keywords: Management and operations, HIV prevention, transferring large-scale programs to government ownership, scaling up, sustainability, strategy

Download GHD-020 Avahan at Scale
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

Download GHD-010 BRAC's TB Control Program
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

Download GHD-009 A to Z Textile Mills Ltd
Charumilind S, Jain SH, Rhatigan J. HIV in Thailand: The 100% Condom Program. Harvard Business Publishing. 2011.Abstract

Thailand’s 100% Condom Program, which was implemented nationwide in 1991, is widely credited with averting a generalized HIV epidemic in that nation. This case traces the development and implementation of Thailand’s 100% Condom Program including its conception, the development of a pilot program in one province, and the program’s early regional expansion. It frames these events within the country’s general political, economic, and health situation; the epidemiology and public perception of HIV/AIDS; the government’s early HIV policy; and the economics of the commercial sex industry. The case explores how public health interventions are designed, refined, and spread. The case ends in early 1991 with the program’s founder trying to find ways to spread the successful regional program nationwide.

Teaching Note available through Harvard Business Publishing.

Sex establishments in Patpong Area, including go-go bars and members clubs
Sex establishments in Patpong Area, including go-go bars and members clubs. Source: "HIV in Thailand: The 100% Condom Program" case.

Learning Objectives: To understand the principles behind the design of disease prevention programs and to examine how successful programs align incentives among various stakeholders to achieve their objectives.

Supporting Content: This case has a supplementary summary of history and next steps, titled The 100% Condom Program: Part B.

Keywords: HIV prevention, stakeholder alignment, harm reduction

 
Download GHD-001 HIV in Thailand Condom Campaign
Cole C, Rosenberg J, 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

Download GHD-019 HIV Prevention in Maharashtra
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

Download GHD-004 HIV Voluntary Counseling and Testing in Hinche, Haiti
Arnquist S, Ellner A, Weintraub R. HIV/AIDS in Brazil: Delivering Prevention in a Decentralized Health System. Harvard Business Publishing. 2011.Abstract

This case describes the Brazilian National AIDS Program's strategy in the late 2000s to prevent HIV infections. The case is set against the context of a heterogeneous, concentrated epidemic and decentralized public health system that guaranteed access to care and treatment. The case traces the nation's response to HIV from the late 1980s through 2009 via a human rights framework, highlighting the cooperation with civil society. Readers are challenged to understand the relationships between HIV/AIDS prevention and treatment, decentralization and sustainability.

Teaching Note available through Harvard Business Publishing.

Decentralization Policy M&E Indicators
Decentralization Policy M&E Indicators. Source: National Department of STD, AIDS and Viral Hepatitis. (Exhibit 14 from "HIV/AIDS in Brazil: Delivering Prevention in a Decentralized Health System" case.)

Learning Objectives: Students should understand the tradeoffs involved in a decentralized governance structure, the levers a central government department can pull to influence local health care delivery in a decentralized health system, and how civil society advocacy contributes to program sustainability.

Keywords: Human rights, HIV prevention, Sustainability, Role of civil society, Strategy

Download GHD-018 HlV/AIDS in Brazil
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

Download GHD-021 HIV in Indonesia
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

Download GHD-016 Investing in Global Health: Botanical Extracts Ltd.
Rosenberg J, Bohrer M, Rhatigan J. Iran’s Triangular Clinic. Harvard Business Publishing. 2011.Abstract

This case traces the development and implementation of Iran’s Triangular Clinic, an innovative health care delivery program, from its beginning as a site for counseling HIV-infected individuals to an integrated facility offering comprehensive HIV, sexually transmitted disease (STD), and drug addiction treatment, care, and support. The case examines the need for such services among the marginalized population that the first clinic served within the historical, political, economic, and health context of Iran and, specifically, in Kermanshah province, where the project begins. The case raises the question of how the clinic model might be integrated into primary health care and replicated throughout the country as part of the Iranian Ministry of Health’s Integrated Health Program.

Teaching Note available through Harvard Business Publishing.

Triangular clinic model
Triangular clinic model. Source: World Health Organization and Regional Office for the Eastern Mediterranean, Best Practice in HIV/AIDS Prevention and Care for Drug Abusers: The Triangular Clinic in Kermanshah, Islamic Republic of Iran 2004, WHO: Cairo.

Learning Objectives: To examine how health care delivery organizations can configure their services to deliver high value health care to the populations they serve and to understand methods to engage marginalized populations in order to increase their access to and demand for health services.

Supporting Content: The sequel to this case is titled Scaling up Iran's Triangular Clinic.

Keywords: Marginalized populations, comprehensive HIV prevention, harm reduction

 

Download GHD-006 Iran's Triangular Clinic
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

Download GHD-017 loveLife: Preventing HIV Among South African Youth
Arnquist S, Weintraub R. loveLife: Preventing HIV among South African youth (Part B). 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.

HIV Incidence among 15-20-year-old South Africans, 2002-2008. Source: Rehle T, Hallett T, Shisana O, et al. A Decline in New HIV Infections in South Africa: Estimating HIV Incidence from Three National HIV Surveys in 2002, 2005 and 2008. PloS one. 2010;5(6):e11094. (Exhibit 2 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 is the supplement to loveLife: Preventing HIV Among South African Youth.

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

Download GHD-017B loveLife Part B
Rosenberg J, 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

Download GHD-003 MDR-TB Treatment in Peru
Rosenberg J, 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

Download GHD-002 Peruvian National TB Control Program
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

 

Download GHD-005 Polio Elimination in Uttar Pradesh
Bitton A, Rosenberg J, Clarke L. Tobacco Control in South Africa. Harvard Business Publishing. 2011.Abstract

This case reviews the policy changes in tobacco control in post-apartheid South Africa from 1994 to 1996 under the leadership of Minister of Health Dr. Nkosazana Zuma. After providing contextual information on South Africa, including historical, demographic, social, and health information, the case delves into the history of tobacco and of global tobacco control efforts. The case then details the history of tobacco in South Africa, including data collection, epidemiology, early control efforts, and the policy efforts of the mid-1990s. The case describes the African National Congress (ANC)’s policy victories under Zuma’s leadership. Knowing that tobacco disproportionately affected certain racial and minority groups, Zuma made tobacco control a top priority. With the support of the President, local tobacco experts, and anti-tobacco advocates, Zuma worked hard to break previous connections between the government and the tobacco industry and to reduce smoking. The case ends in 1996 when smoking prevalence had declined to 32% from 34% in 1995, but South Africa still had one of the highest levels in the developing world. As the ANC was preparing to enact the new Constitution that reinforced health promotion, Zuma had to determine what her next move would be for tobacco control and how she would prioritize it with the other health needs of the country.

Teaching Note available through Harvard Business Publishing.

Tobacco Control as Health Promotion
Tobacco Control as Health Promotion. Source: Reddy, SP and Swart D. Unraveling Health Promotion: A Framework for Action: Tobacco Control. MRC: 1998. (Exhibit 8 in "Tobacco Control in South Africa" case.)

Learning Objectives: To understand the political and economic forces that impact tobacco control legislation in a country undergoing an epidemiological shift, the role of research and data, and the value of health communication, chronic disease prevention, and advocacy in health care delivery.

Supporting Content: This case has a supplementary summary of history and next steps, titled Tobacco Control in South Africa: Next Steps.

Keywords: Chronic disease prevention, advocacy, health policy, tobacco control

 

Download GHD-012 Tobacco Control in South Africa
Bitton A, Taranto L, Rosenberg J, Kadar E. Tobacco Control in South Africa: Next Steps. Harvard Business Publishing. 2011.Abstract

This case is a supplement to Tobacco Control in South Africa, which reviews the policy changes in tobacco control in post-apartheid South Africa from 1994 to 1996 under the leadership of Minister of Health Dr. Nkosazana Zuma. This case explains what happened after 1996, the steps Zuma took to continue her fight against tobacco (including expanding research capacity, getting increases in excise taxes passed, and pushing national legislation through) and what happened after her departure in 1999.

Teaching Note available through Harvard Business Publishing.

Relationship between Excise Tax Rate and Cigarette Consumption in South Africa
Relationship between Excise Tax Rate and Cigarette Consumption in South Africa. Source: van Walbeek C, WHO. Tobacco Excise Taxation in South Africa. (Exhibit 2 in "Tobacco Control in South Africa: Next Steps" case.)

Learning Objectives: To understand the political and economic forces and the role of research and data in implementing tobacco control legislation in a country undergoing an epidemiological shift, and the value of health communication, chronic disease prevention, and advocacy in health care delivery.

Supporting Content: This case is the supplement to Tobacco Control in South Africa.

Keywords: Chronic disease prevention, advocacy, health policy, tobacco control

Download GHD-012B Tobacco Control in South Africa: Next Steps

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