Tuesday, September 25, 2007

A Business Model for Global Health

What can business teach public health experts--and everyone else--about how to improve people's health around the world? One idea that's gaining ground around Harvard (and elsewhere) is the use of case studies--and not just the gold standard of scientifically controlled clinical trials--to figure out what works and what doesn't.

Some days I wonder if I'm at the School of Public Health or the Business School. Jim Kim--champion of the 3 x 5 initiative to get more poor people on anti-AIDS therapies--is working with Mike Porter--corporate strategy guru--on developing case studies of what does and doesn't work in global health. They'll both be teaching classes that tap into this approach in January.

Peter Piot, head of UNAIDS, brought up the case-study method in a keynote speech yesterday at, of all places, a symposium on "Meeting Children's Needs in a World with HIV/AIDS." You still need controlled trials, Piot was quick to point out when several journalists spoke with him after his speech. But there may be some ways to use case studies--to learn from past experience--to figure out how best to deliver on the promise found in controlled research studies.

Case studies, for those of us who don't have MBAs, are well-researched 3 or 4 page summaries that lay out a particular real-world problem that a real-world organization faced at some point and then ask the group to put themselves in the place of the chief executive officers or others and propose strategies for going forward.

Of course, case studies aren't going to tell you if a particular antibiotic works or not. That's the realm of a scientifically controlled clinical trial. But a case study may give insight into how to introduce a new antibiotic into the developing world, or decide between a couple of different choices of antibiotics as to which works best in the poorest parts of the world, what kind of health-care infrastructure is needed, what might happen when the antibiotic gets out into the gray market, and whether, on balance, these factors sway you towards one course of action or another.

But the use of case studies is just a piece of this business approach to global health. A more critical look at the costs and benefits of borrowing the business world's tools--which often includes a decidedly anti-government bias (very convenient for academic researchers and NGOs who are not in government)--is beyond the scope of one blog post. But it's definitely something to keep an eye on.

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