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The Global Health Initiative (GHI) is a tripartite collaboration among Northwestern University, non-profit donors, and commercial diagnostics companies. GHI attempts to bridge the gap between the market for sophisticated medical diagnostics equipment in wealthy nations and the need for point-of-care diagnostics in resource limited settings. In 2006 GHI narrowed its focus to HIV diagnostics for underserved nations. The case examines the accuracy-access tradeoff related to the roll-out of infant HIV diagnostics in Tanzania. Tanzania has a prevalent HIV/AIDS problem, particularly in children. As of 2007, Tanzania had an estimated 140,000 children infected with HIV. Existing lab-based diagnostic equipment was either inaccurate for use in infants or required highly skilled health workers. Tanzania's limited infrastructure also forced healthcare providers to choose between providing advanced care to a minority of the population and offering minimal care to the majority with poor access. A Kellogg MBA student research team performed more than thirty in-country interviews to collect data on stakeholder perceptions of three infant test concepts: the strip test, the squeeze test, and the filter paper test. Across the three tests, access decreased as accuracy increased---rural labs could not find or afford health workers skilled enough to conduct the test. In general, interviewees closely affiliated with the government preferred accuracy over access. In contrast, private health facilities had to follow fewer regulations and preferred access over accuracy. The case focuses on the decisions facing Kara Palamountain, the executive director of GHI, in her roll-out recommendations for infant HIV tests in Tanzania. It examines key factors of working in a developing country, including the need to operate in the absence of sufficient market research, balance the competing agendas of different stakeholders, and mitigate external risks such as major international funding.

This case was written to be used as a teaching case for students unfamiliar with how to approach and analyze a typical business school case. Unlike many cases used in specific classroom settings, this case is intended to be broad enough that any single student will not have a significant advantage because of his or her background. Moreover, the case is designed to guide students' thinking in a certain direction, using open-ended and more focused discussion questions provided at the case's end.

In January 2005 Dr. Mean Chhi Vun, director of the Cambodian National Center for HIV/AIDS, Dermatology and STDs (NCHADS), needed to decide how to control the spread of HIV/AIDS and save the lives of thousands of Cambodians who were dying from it each year. In the seven years since Dr. Vun had been appointed director, NCHADS had built an organization that was transparent and efficient, had implemented a nationwide 100 percent Condom Use Program, had established a system that allowed individuals to voluntarily seek confidential counseling and testing, and had instituted a set of guidelines and procedures for staff at health facilities to refer HIV-positive patients to treatment clinics and link them with NGOs providing financial and psychosocial support. Now, however, Dr. Vun faced decisions about three initiatives that were critical to expanding care and treatment programs in his country. First, he needed to decide how to quickly and cost-effectively improve the national HIV/AIDS laboratory support infrastructure. Second, Dr. Vun needed to improve logistics and supply management in order to get the best prices and ensure patients had access to life-saving medicines. Finally, he needed to figure out how to provide sustainable care and treatment to the thousands of Cambodian children living with HIV/AIDS.

Create innovative solutions for large-scale, socially relevant challenges. Understand how to start, scale, and lead cross-sector public health initiatives, or any initiative requiring behavior change by a range of players on a large scale over the long term. Discover and implement operating models that balance the needs of for-profit, non-profit, and government organizations. More effectively manage situations where required resources are not under one's direct control.

The learning outcomes of this case study are to identify the role of non-governmental organizations (NGOs) in social upliftment of developing countries, understand the functioning of NGOs, understand the challenges faced by the NGOs in day-to-day operations and discuss the probable solutions for the same, appreciate the role of leader and leadership in an NGO, study the working style of NGO leaders, appreciate the importance of having a formal organizational structure for these informal organizations (NGOs) to ensure the sustainability of their ventures and design a sustainable organization structure having a proper succession plan for the NGOs.

The case study is about one NGO – Mahesh Foundation – located in a small town named Belagavi, nestled in the state of Karnataka, India. Mahesh Foundation worked towards the upliftment of poor children infected with HIV. Today, fighting against all odds, Mahesh Foundation is a safe shelter home for 45 HIV-infected children in the age group of 6–18 years and has reached more than 2,000 beneficiaries from the time of its inception (2008). In addition, Mahesh Foundation also provides skill-based education to the HIV-infected, slum and underprivileged children. The foundation also supported the livelihood of underprivileged women and till date has supported more than 1,500 needy women. Mr Mahesh Jadhav, the founder member of Mahesh Foundation, has been successful in overcoming different challenges faced by the NGO, may it be the requirement for funds or shelters or social agitation. However, Jadhav was worried about the succession planning of his organisation. Mahesh Foundation, being run as a one-man show, Jadhav was bothered about its sustainability after him. The case study therefore highlights and discusses the importance of having a formal organization structure for such informal organizations, thereby having a proper succession plan to ensure their perpetual existence.

This case study is best taught as part of a graduate and postgraduate Business Administration (BBA/MBA) programme, Management Development Programme or Executive MBA Programme.

Teaching notes are available for educators only.

CSS 11: Strategy.

Roger Osayende, a former management consultant, must advise the Ministry of Health of Ektu, a fictional country in Central Africa, on how to implement a new point-of-care diagnostic test for infants with HIV. In Ektu, mothers often transmitted HIV infection to infants during pregnancy, delivery, or breastfeeding due to inadequate resources to invest in prevention efforts. The existing procedure to diagnose infants with HIV required collecting dried blood samples at more than two hundred healthcare facilities around the country and transporting them to a central laboratory in the capital for testing. This process was characterized by significant delays due to long transportation times, batching of samples in transportation and processing in the lab, and concomitant congestion in the lab. This delay resulted in loss to follow-up, that is, lost patients due to mothers not collecting their infants' results. A new point-of-care device was about to be introduced, which would obviate the need for this centralized processing and the resulting diagnostic delay. The key decision under consideration is where to place the devices to maximize their effectiveness.

Understand the importance of making public health decisions based on a data-driven, logical framework   Uncover the link between operational performance of the healthcare system and health outcomes at the population level   Appreciate the relevance of operational decisions in enhancing or diminishing the effectiveness of a medical technology   Use process analysis concepts to characterize various components of delays

Hewlett-Packard (HP) had a long history of engaging in corporate citizenship, dating back to its founding. By 2009, however, under the leadership of its latest CEO, Mark Hurd, the company had lost its focus on corporate social responsibility (CSR). Hurd instead focused on undertaking a financial turnaround and overcoming other reputational challenges; he viewed CSR and philanthropic efforts as costs rather than as strategic levers. He instituted widespread cost-cutting measures to get HP back on track, including reducing CSR expenditure. The HP board, however, did not want to let CSR go by the wayside; in fact, it wanted HP to reorganize and restrategize its approach to corporate citizenship.

The case focuses on this strategic transformation from traditional, cost-center CSR to business-aligned social innovation. It outlines the details of the board's approval of the new strategy, and then discusses how HP employees worked to reorganize their CSR activity. The new team, the Office of Global Social Innovation (OGSI), had to devise a pilot project to demonstrate the new approach. The project under consideration was an engagement that would improve the early infant diagnosis process for testing infants for HIV in Kenya—an area virtually unknown to HP. The case asks students to assess the work of the OGSI team thus far, and to put themselves in the shoes of one team member who had to justify the project to HP's leadership.

The case is especially important for demonstrating the most recent shifts across some leading companies regarding how they position CSR, as well as how for-profit leaders can structure partnerships for impact.

After reading and analyzing the case, students will be able to: understand current shifts from traditional corporate social responsibility work to social innovation; understand the challenges facing leading companies as they seek to do well (enhance the company's bottom-line performance) by doing good (making social impact); identify best practices for developing partnerships for impact; articulate a project's social impact and how it aligns with a desirable business impact.

In the 1960s thalidomide, a popular new drug considered to be safe and effective, was revealed to cause severe nerve damage and birth defects in newborn infants, prompting health officials to ban the use of the drug and tighten overall restrictions on new drugs and drug use. Twenty years later, after recognizing the positive effects of thalidomide when treating patients with leprosy and its potential role in the treatment of certain types of cancer and cases of HIV/AIDS, the Celgene corporation would be forced to contend with stringent FDA regulations, liability concerns, public skepticism, and poor mass media portrayal in order to secure the drug's approval.

To illustrate how regulators are subject to political pressure, which companies much recognize and consider when making business decisions.

For discussion of social entrepreneurship in middle-income economies, emerging markets generally and Africa, specifically, Quali Health presents interesting questions about entrepreneurial funding, scaling and the interplay between social entrepreneurial activities and the informal sector.

South Africa’s primary health outcomes do not correspond to the country’s spending on public health, with South Africa ranking among the worst globally in the incidence of tuberculosis, HIV prevalence, infant mortality and life expectancy. In part, this poor outcome can be explained by high inequality in access to healthcare, which reflects South Africa’s grossly skewed income and wealth distributions, with the bulk of the country’s population reliant upon an underfunded, inefficient and poorly managed public health system. This substandard service for the working poor in South Africa’s townships with high population densities offered a profitable entrepreneurial opportunity to provide affordable and effective primary care with vast gains in quality and outcomes improved dignity for patients. After receiving her MBA, physician and entrepreneur Dr Nthabiseng Legoete self-funded the launch of Quali Health in 2017. The business model set out to disrupt healthcare delivery for South Africa’s poorest citizens. Drawing patients from the working poor in Diepsloot, Quali Health’s inaugural site was cash flow positive within five months when the facility hit only 30% of installed service capacity. With quick success, Dr Legoete faced the strategic question of how fast to scale and finance the expansion. She also considered a new micro-insurance product for her clientele.

For discussion of social entrepreneurship in middle-income economies, emerging markets generally and Africa, specifically, Quali Health presents interesting questions about entrepreneurial funding, scaling and the interplay between social entrepreneurial activities and the informal sector.

Teaching notes are available for educators only.

CSS: 3 Entrepreneurship.

Management: human resources management.

Undergraduate and postgraduate.

This case gives critical insights in the complex issues surrounding the management of employment relationship in Africa, specifically focusing on Botswana. It is set in the context of explosive industrial relations involving Debswana Diamond Mining Company and the Botswana Mine Workers Union over the contentious issues of pay bonus and collective bargaining. Failure to reach an amicable compromise by both parties' results in a debilitating strike which costs the company millions of funds and affected it's the corporate image contrary to its well crafted social responsibility. More painfully, the end game is a loss of employment and dreams shattered for 461 dismissed workers who depended solely on this work as their only source of income.

At the end of reading the case students are expected to: understand the limits of managerial prerogative and the right to manage; appreciate the inherent conflict of interests between labour and capital; consider more equitable compensation schemes in dealing with collective bargaining; and discuss the concept of social responsibility in the context internal customers-employees.

Teaching note.

This case describes a community-based healthcare clinic and the issues facing the management and board of directors. The issues raised are common problems faced by all types of nonprofit organizations: insufficient fundraising and marketing policies to guide board decision making, confusion over staff and board roles in decision making, poorly thought-out bylaws that contribute to the confusion over board and staff roles, the challenge of harnessing the diverse backgrounds and opinions of a community-based board of directors, and lack of sound financial planning.

The Whitney Clinic case identifies common pitfalls in board governance and includes a roleplay to help students understand the difficulties inherent in implementing the basics of good governance.

Impact investing, Social entrepreneurship.

MBA, EMBA, Executive Education.

CareCross Health describes the impact due diligence leading up to an investment into CareCross Health by impact investor Palm Capital. The case follows the protagonist, Caitlin Stevens, CEO of Palm Capital, as she identifies CareCross Health as a potential investment target, performs an initial screening of the company and visits the company and its sites as part of an in-depth impact due diligence.

By the end of this case, the student should be able to consider the critical steps associated with conducting an impact due diligence; understand the challenges associated with conducting an impact due diligence, with a particular focus on due diligence in an emerging market scenario; analyse a potential impact investment, in this case CareCross Health, and make a preliminary recommendation on whether the investment is viable from an impact perspective; identify the trade-offs between private sector and public sector provision of services to low-income groups, and consider unintended consequences in analysing the impact of a social enterprise; and prepare possible scenarios and weigh the potential outcomes of various arrangements to ensure alignment of investor objectives.

Teaching Notes are available for educators only. Please contact your library to gain login details or email support@emeraldinsight.com to request teaching notes.

CSS 1: Accounting and Finance.