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Wachter K, Rosenberg J, Singal R, Weintraub R. Reducing Child Malnutrition in Maharashtra, India. Harvard Business Publishing. 2015.Abstract
Download GHD-031 Reducing Child Malnutrition in Maharashtra
This case demonstrates what it takes to address a chronic, intergenerational public health issue. It explores the drivers behind the reduction of malnutrition in Maharashtra State, India, from 2001–2013. Specifically, the case examines the strategies and management decisions of leaders of the government-established Rajmata Jijau Mother-Child Health and Nutrition Mission as they worked to reduce the incidence of malnutrition in children and women through a multi-sectoral collaborative approach.
Teaching Note available through Harvard Business Publishing.
Stunting Syndrome from Conception through Adulthood. Dark blue denotes the period between conception and 2 years ('the first 1000 days') when interventions are most effective. Light blue denotes the time period between 2 years and mid-childhood and during the adolescent growth spurt when some catch-up in linear growth may occur. The light blue period before Conceptus reflects evidence that dietary interventions targeting stunted women pre-conception improve birth outcomes. Gray denotes periods when the stunting syndrome appears unresponsive to interventions. Dashed line–a stunted child whose environment becomes more affluent with abundant access to food, causing excessive weight gain; solid line–a stunted child whose environment remains resource-constrained/food insecure. Source: Adapted by case writers with assistance from Isabelle Celentano from Pendergast AJ, Humphrey JH. "The stunting syndrome in developing countries," Paediatr Int Child Health. 2014;34(4):250-265; doi:10.1179/2046905514Y.0000000158.
Learning Objectives: A productive class discussion will allow students to appreciate how to configure specific interventions and indicators to ameliorate and measure malnutrition for a local setting; the complexity and importance of crafting policies and generating political will across sectors in support of nutrition programs; and the role of a strong community workforce in enabling nutrition programs to reach the target population.
Keywords: Maternal and child health, children, intergenerational disease, public-private partnership, nutrition, strategy, political leadership, scale-up, community health workers, health care delivery, malnutrition, cross-sector collaboration
Madore A, Yousif H, Rosenberg J, Desmond C, Weintraub R. Political Leadership in South Africa: National Health Insurance. Harvard Business Publishing. 2015.Abstract
Download GHD-032 South Africa NHI
This case traces the development of national health insurance (NHI) in South Africa under Minister of Health Aaron Motsoaledi. After providing background on health financing and health insurance policy in South Africa, the case explores Motsoaledi's approach to realizing universal health coverage by establishing a government-administered NHI system and overhauling primary health care in the public sector. The case highlights the importance of strategic communication and stakeholder engagement in the highly political process of health system reform. It focuses on the complexity of the NHI policy process and the steps Motsoaledi and his team took to increase standards and accountability for public primary health care facilities. It concludes with the national health department rolling out new tools for monitoring facility progress and Motsoaledi awaiting approval of his team's 19th draft plan for NHI, wondering what to do in the meantime to improve health care.
National Department of Health, South Africa (Source: Global Health Delivery case writers)
Learning Objectives: A productive class discussion will allow students to appreciate the relationship between policy development, financing, and implementation of public health care delivery; the complexity of implementing standards and accountability for primary care infrastructure; and the work and negotiation needed to build consensus among private and public payers and providers with competing financial interests to generate greater value in health care delivery.
Keywords: Political leadership, health system strengthening, stakeholder engagement, primary health care reform, policy development, politics and health care, health care financing, health insurance, strategy
Madore A, Yousif H, Rosenberg J, Desmond C, Weintraub R. Political Leadership in South Africa: HIV. Harvard Business Publishing. 2015.Abstract
Download GHD-033 South Africa HIV
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.
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
Chao T, Patel P, Rosenberg J, Riviello R. Surgery at AIC Kijabe Hospital in Rural Kenya. Harvard Business Publishing. 2015.Abstract
Download GHD-028 Surgery at AIC Kijabe Hospital in Rural Kenya
This case traces the development of surgical and anesthesia services at a rural mission hospital in Kijabe, Kenya. After providing some background of the health system in Kenya, it follows the history of AIC Kijabe Hospital from its founding in 1915 to 2013. The hospital provided high quality surgical services that were supported by many long-term missionary staff members, updated operating theaters, an intensive care unit, and a robust surgical training program. The case describes how the mission of the hospital affects its culture of care provision. It follows the executive director, Mary Muchendu, and her process in turning a mission-focused hospital into a business-focused hospital. The case ends with Muchendu weighing the tradeoffs of providing sustainable growth versus caring for the poor.
Postoperative recovery area with wall oxygen, suction, and vital sign monitoring at AIC Kijabe Hospital Surgical Facilities. Source: Case Writers.
Learning Objectives: This case documents the development of a robust surgical program at a mission hospital in rural Kenya, including human resource training and infrastructure improvement. A productive class discussion will allow students to appreciate the factors that allow high-quality surgical care to be delivered in a resource-limited setting; how a mission-driven culture affects a hospital, its sustainability, and the care it provides; what is required to provide high-quality surgical training; and the tensions and tradeoffs between sustainable growth and care for the poor.
Supporting Content: There is a shorter version of this case titled Surgery at AIC Kijabe Hospital in Rural Kenya (Condensed Version).
Keywords: Surgical disease, mission-based hospitals, rural surgery services, management, speciality training, global health care delivery, faith based organizations, human resources for health, anesthesia
Madore A, Rosenberg J, Weintraub R. "Sin Taxes" and Health Financing in the Philippines. Harvard Business Publishing. 2015.Abstract
Download GHD-030 Philippines Tobacco Control
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.
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
Wachter K, Talbot JR, Weintraub R. Partners In Health in Neno District, Malawi. Harvard Business Publishing. 2013.Abstract
Download GHD-029 PIH in Malawi
Set in Neno District, Malawi from 2007–2012, the case focuses on the economic impact of investing in health care infrastructure. It examines management decisions that leaders of Abwenzi Pa Za Umoyo (APZU) and its founding organization—Partners In Health (PIH)—made as they supported the Government of Malawi in building a hospital and scaling up the delivery of APZU clinical and social programs across Neno district. The case highlights how a non-governmental organization can navigate the politics and local culture to improve Malawi's health care system in close partnership with a strong, protocol-driven government. The case begins with Ophelia Dahl, co-founder and executive director of Partners In Health, reflecting on her December 2011 trip to Neno, nearly four years after her first visit. She observed signs of progress unrelated to health—bank branches had opened in town, a new road had been built, and the market had expanded dramatically. Ultimately, the case explores what this demonstrates about the value of her organization's investments in health.
In the foreground: One-story original structures of Neno Rural Hospital used for outpatient and maternity services. In back: Two-story building constructed by APZU and partners used for inpatient wards, meetings, computer use, laboratory work, and government offices. Source: Keri Wachter, 2012.
Learning Objectives: To understand the challenges of hiring and retaining local and expat staff, the complexity of an international NGO partnering with the government to improve health care, how leadership acumen and approaches impact scaling up and sustaining health care delivery, the relationship between the district hospital and the local economy, and how to assess impact beyond health measures.
Keywords: Global health, social equality, project management, business and government relations, partnerships, strategy, economic development, health care policy, health care delivery, public health, human resource management, developing countries, innovation
Cases in Global Health Delivery Glossary. The Global Health Delivery Project at Harvard University. 2012.Abstract
Download GHD-C04 Cases in Global Health Delivery Glossary
This glossary supports the Cases in Global Health Delivery by providing definitions and explanations of terms, metrics, and concepts used in the cases. While some of the terms can be found in dictionaries, often with multiple definitions, others stem from our own research.
Learning Objectives: To aid students in fully understanding the concepts in the Cases in Global Health Delivery.
Keywords: Global health, health care delivery, public health, developing countries
Arnquist S, Talbot JR, Rhatigan J, Weintraub R, Plank R. Concept Note: HIV Prevention. Harvard Business Publishing. 2012.Abstract
Download GHD-C06 Concept Note: HIV Prevention
This concept note reviews the epidemiological landscape of HIV/AIDS; the history and challenge of HIV prevention; means for preventing sexual transmission of HIV, transmission through blood exposure, and mother-to-child transmission as well as potential benefits of pre-exposure prophylaxis. It discusses strategies for implementing HIV prevention programs and the outlook for future programs.
Type of epidemic by area, data collection strategy, and intervention. Source: Wilson D, Halperin DT. "Know your epidemic, know your response": a useful approach, if we get it right. The Lancet. 2008;372(9637):423-426.
Learning Objectives: To aid students in fully understanding the HIV prevention landscape and concepts in the Cases in Global Health Delivery.
Keywords: Policy, AIDS, R&D, prevention
Sullivan E, Goentzel J, Weintraub R. Concept Note: The Global Health Supply Chain. Harvard Business Publishing. 2012.Abstract
Download GHD-C01 Concept Note: The Global Health Supply Chain
This concept note provides students, providers, and managers with an introduction to the concepts related to global health supply chain management using the functional process view-the broad areas of manufacturing, procurement, and distribution. It explains how patient care and supply chains interface and affect operations and may be useful background reading for the Cases in Global Health Delivery Series.
The Global Health Supply Chain. Source: Prashant Yadav.
Learning Objectives: To examine the global health supply chain and its importance in global health delivery.
Keywords: Procurement, manufacturing, and distribution, how patient care and supply chains interface and affect operations
Talbot JR, Rhatigan J. Concept Note: The Development of Tuberculosis Treatments and Policy. Harvard Business Publishing. 2012.Abstract
Download GHD-C05 Concept Note: The Development of Tuberculosis Treatments and Policy
This concept note reviews the history of tuberculosis control with a focus on the development of chemotherapy for the disease, the creation of public health programs, and the evolution of international tuberculosis control policy.
British Medical Research Council Tuberculosis Research Studies,1946-1986. Source: Fox, W., G.A. Ellard, and D.A. Mitchison, Studies on the treatment of tuberculosis undertaken by the British Medical Research Council Tuberculosis Units, 1946-1986, with relevant subsequent publications. International Journal of Tuberculosis and Lung Disease, 1999. 3(10): p. S231-S279.
Learning Objectives: To aid students in fully understanding the history of tuberculosis control and policy and concepts in the Cases in Global Health Delivery.
Keywords: Policy, innovation, R&D
Arnquist S, Weintraub R. The Indus Hospital: Delivering Free Health Care in Pakistan. Harvard Business Publishing. 2012.Abstract
Download GHD-023 Indus Hospital
Set in Karachi, Pakistan, this case examines a private hospital's potential to impact health in a resource-constrained setting. Within Pakistan's health care system and its political, socioeconomic, and epidemiological context, the case focuses on the Indus Hospital, a charity hospital started in 2007. The case explores the effect of financing, leadership, and a mission-driven culture on health care delivery and the hospital's efforts to provide high-quality care for free to poor patients. It concludes with Indus' leaders planning how to expand their service delivery to include primary and preventative care.
Indus Hospital Open-Air TB Clinic. Pakistani architect Tariq Quaiser designed the Indus Hospital's open-air TB clinic with a specialized design that optimized natural ventilation for increased airflow that effectively minimized the spread of disease. Source: Case writers.
Learning Objectives: To understand a private hospital's potential to impact health in a resource-constrained setting, how private financing impacts health care delivery, and the impact of leadership on health care delivery.
Supporting Content: There is a shorter version of this case titled The Indus Hospital: Building Surgical Capacity in Pakistan (Condensed Version).
Keywords: Human rights, workforce management, sustainability, role of civil society, information systems, organizational culture
ole-MoiYoi K, Talbot JR, Weintraub R. Roll-Out of Rapid Diagnostic Tests for Malaria in Swaziland. Harvard Business Publishing. 2012.Abstract
Download GHD-025 Roll-Out of Rapid Diagnostic Tests for Malaria in Swaziland
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.
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
Download GHD-022 loveLife: Transitions After 2005
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.
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
Sullivan E, ole-MoiYoi K, Weintraub R. Concept Note: The Global Fund to Fight AIDS, Tuberculosis and Malaria. Harvard Business Publishing. 2012.Abstract
Download GHD-C02 Concept Note: The Global Fund to Fight AIDS, Tuberculosis and Malaria
This concept note explains the history, management, structure, financing, and strategy of the Global Fund to Fight Aids, Tuberculosis and Malaria-a public-private partnership and international financing institution created to attract and disburse resources to prevent and treat HIV and AIDS, tuberculosis, and malaria. The note also provides some insight to its impact on grantees. Because the Global Fund plays an important role for many of the organizations featured in the Cases in Global Health Delivery Series, this note will be useful background reading for students engaging in those cases.
Global Fund–Supported Program Results. Source: Making a Difference, Global Fund 2011 Results Report. (Exhibit 3 from "Concept Note: The Global Fund to Fight AIDS, Tuberculosis and Malaria.")
Learning Objectives: To understand the structure, management, and role of the Global Fund to Fight AIDS, Tuberculosis and Malaria as an international financing institution.
Keywords: Structure, financing, tuberculosis and malaria, history, Global Fund to Fight Aids, strategy, management
Madore A, Talbot JR, Weintraub R. Electronic Medical Records at ISS Clinic Mbarara, Uganda. Harvard Business Publishing. 2012.Abstract
Download GHD-026 EMR at ISS Clinic
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.
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
Download GHD-06B Scaling up Iran's Triangular Clinic
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.
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
Download GHD-027 Kenya's VMMC Program
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.
(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
Redditt V, ole-MoiYoi K, Rodriguez W, Talbot JR, Weintraub R. Malaria Control in Zambia. Harvard Business Publishing. 2012.Abstract
Download GHD-024 Malaria Control in Zambia
This case reviews the changes in national policy and the subsequent interventions used to reduce the incidence of malaria in Zambia from 2005 to 2010. After providing contextual information on Zambia-including historical, demographic, social, and health information-the case delves into the history of malaria control efforts worldwide and in Zambia. Though Zambia was at the forefront of malaria control-changing policy, adopting new treatment, and aggressively pursuing comprehensive malaria control efforts-in the early 2000s, by 2005 the Zambian government was still falling short of its targets. The National Malaria Control Center (NMCC) resolved to intensify its efforts by developing one national plan to improve coordination, data collection, and partner involvement, and ultimately, to scale up interventions rapidly in order to meet the national malaria targets. The new NMCC director, Dr. Elizabeth Chizema, guided the program toward success through several key interventions described in the case. With basic improvements in monitoring and evaluation, Chizema could demonstrate progress in malaria control. Nonetheless, she worried that partners might lose interest in helping Zambia given the decreasing burden even though the program still had many challenges to overcome.
Plasmodium Falciparum life cycle. Source: United Nations Integrated Regional Information Networks. Killer Number One: The Fight against Malaria. 2006; 47.
Learning Objectives: To understand the development of a successful malaria control program over time and the components that led to its success, including the value of setting bold national goals, the merits of a health system with centralized governance and decentralized implementation, the importance of multiple coordinated interventions as opposed to a "silver bullet" approach for malaria control, and the use of data as an outcome measure, planning tool, and fundraising tool.
Supporting Content: There is a shorter version of this case titled Malaria Control in Zambia (Condensed Version).
Keywords: National strategy, supply chain management, malaria eradication and control, leadership
Redditt V, ole-MoiYoi K, Rodriguez W, Talbot JR, Weintraub R. Malaria Control in Zambia (Condensed Version). Harvard Business Publishing. 2012.Abstract
Download GHD-24S Malaria Control in Zambia (Condensed Version)
The case delves into the history of malaria control efforts in Zambia, including control and treatment policy changes in the in the early 2000s that set Zambia apart from other countries. Because by 2005 Zambia was still falling short of its targets, the National Malaria Control Center (NMCC) resolved to intensify its efforts by developing one national plan to improve coordination, data collection, partner involvement, and ultimately, rapidly scale-up interventions to meet the national malaria targets. The new NMCC director, Dr. Elizabeth Chizema, helped the program achieve success through several key interventions described in the case. With improved monitoring and evaluation, Chizema could demonstrate progress in malaria control, but she worried that partners might lose interest in helping Zambia given the low burden, and the program still had many challenges to overcome. This is a condensed version of the case Malaria Control in Zambia.
Learning Objectives: To understand the development of a successful malaria control program over time and the components that led to its success including the value of setting bold national goals, the merits of a health system with centralized governance and decentralized implementation, the importance of multiple coordinated interventions as opposed to a "silver bullet" approach for malaria control, and the use of data as an outcome measure, planning tool, and fundraising tool.
Supporting Content: This is a condensed version of the case Malaria Control in Zambia.
ole-MoiYoi K, Rodriguez W. Investing in Global Health: Botanical Extracts Ltd. Harvard Business Publishing. 2011.Abstract
Download GHD-016 Investing in Global Health: Botanical Extracts Ltd.
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.
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
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The Global Health Delivery Project is a joint initiative of Brigham and Women's Hospital and Harvard University.