MIT Sloan’s new Global Health Delivery tackles constraints in delivering health care in emerging markets

MIT students working on-site in Africa throughout January

Cambridge, Mass., December 29, 2008 – Graduate students enrolled in MIT Sloan School of Management’s newest global entrepreneurship course, Global Health Delivery, are venturing to resource-poor settings in Africa this January to tackle practical constraints in delivering health care to the neediest with new approaches that have implications for the United States.

This new course is the result of collaborative efforts between MIT Sloan’s Global Entrepreneurship Laboratory (G-Lab) and Harvard University’s Global Health Delivery Project.

G-Lab, an international project-based class, pairs its students with real-world startups in emerging markets across the globe wrestling with management challenges. Like G-Lab, Global Health Delivery harnesses the expertise of engineering, bio-medical, and social science students from across MIT as well as its core group of MBAs. Harvard’s project, meanwhile, draws from the expertise of physicians led by Jim Yong Kim, MD, a former director of the World Health Organization’s HIV/AIDS Department.

Throughout January, thirteen teams comprised of 53 MIT students will apply knowledge gained in the classroom to on-site projects at clinics, hospitals, research organizations, and NGOs in Uganda, Kenya, Tanzania, Zambia, Malawi, and Sierra Leone. These partner organizations proposed the projects and collaborated with course faculty and students to scope each team’s work to best match the students’ skills and interests.

“Surprisingly, key roadblocks in global health delivery are not medical – they are managerial,” says Anjali Sastry, an MIT Sloan senior lecturer and a co-creator of the Global Health Delivery curriculum. “Poverty in underserved African populations speaks to market failures vis-à-vis health, infrastructure and economics. What differentiates our program from others is our ability to tackle each of these issues as a whole with teams composed of experts in management, medicine, and engineering created through our collaborative efforts.”

Indeed, the over-subscribed course, which boasts a waiting list, has particularly resonated with Sloan MBAs eager to re-tool solutions from other sectors and countries to create sustainable enterprise models for more efficient and effective operations. To do this, students are exploring such goals as balancing revenue generation with providing critical community health services in African communities.

Back on campus in February, students will complete their projects and use the last six weeks of the class to learn from their own and others’ experiences via interactive exercises and conversations with experts in the field. The goal, says Sastry, is to create materials that distill their learning, insights, and work in the field to benefit other students—and the wider community.

“Perhaps the biggest challenge in healthcare today is figuring out how to take what works—and what we know from research and others’ experiences—and make it work elsewhere,” says Sastry. “This need exists in Africa, as well as in parts of the United States and many other developed countries. That’s why we’re focusing on the delivery of health care—what it takes to get the medical workers, the medical knowledge, the medicines and devices, and the information to the people who need it. If we can partner with practitioners working on the ground to improve how their patients and community members get healthcare in resource-constrained settings globally, we believe we will learn how to apply our findings to areas in the US.”

For over fifty years, the MIT Sloan School of Management, based in Cambridge, Massachusetts, has been one of the world’s leading academic sources of innovation in management theory and practice. With students from more than 60 countries, it develops effective, innovative, and principled leaders who advance the global economy.

We had a fascinating discussion about the promise that franchising offers in the quest for efficient, scalable, sustainable models for global health delivery in resource-constrained settings. Could being “in business for yourself but not by yourself” offer a way to link social benefits to individuals’ drive to build and create?

First, it’s important to understand what franchising offers. Our MBA students have that one down–please post comments to discuss what you think the value, and the drawbacks, might be in drawing on franchising to address the global health delivery gap. Look through some of these links, then come up with your own analysis.

Social entrepreneurs have discussed social franchising in recent years. Here’s a discussion on Social Edge hosted by Benjamin Litalien, President & CEO of Social Franchise Ventures (January 2007). Noting that “there are real risks associated with choosing the franchise route. So, as the social benefit community begins to engage the franchise sector it is critical to go in with eyes wide open, realizing that a disciplined approach is vital to tapping into the value that seems so apparent” he lists some pros and cons .

To begin to explore franchising for global health delivery in a little more depth: a blog post entitled Franchising Health Care as a Business Model for Social Marketing by Craig Lefebvre makes many of the points that came up in class:

One of the shortcomings of social marketing and social change programs is the lack of attention given to their business models. ….. the idea about now being able to build a potentially sustainable program that includes quality control measures and requires the staff to pay close attention to the marketplace, and benefit when they do, is an appealing option…. But the research needed to figure out better business models and how to transition from one to another in a social change program’s life cycle is way behind what the need is.

How to sort out which models work and why, when it comes to franchising? One starting point is a small set of published papers in this area:

Dominic Montagu, 2002. “Franchising of Health Services in Developing Countries“ Bay Area International Group. (June 1).

Jeff Ruster, Chiaki Yamamoto, and Khama Rogo. 2003. Franchising in Health: Emerging Models, Experiences, and Challenges in Primary Care. Public Policy for the Private Sector (June; No. 263)

Edith Patouillard, Catherine A Goodman, Kara G Hanson and Anne J Mills. 2007. Can working with the private for-profit sector improve utilization of quality health services by the poor? A systematic review of the literature. International Journal for Equity in Health.

David Lehr, 2008.  Microfranchising at the Base of the Pyramid.  Acumen Fund working paper. (August.)

Bishai DM, Shah NM, Walker DG, Brieger WR, Peters DH. Social Franchising to Improve Quality and Access in Private Health Care in Developing Countries. Harvard Health Policy Review.  Vol. 9, No. 1, Spring 2008: 184-197.

Finally, a useful resource has just been created by the University of California, San Francisco, featuring brief and up-to-date reviews of issues in private sector healthcare delivery in developing countries–check out Private Sector Delivery of Healthcare Goods and Services the many resources reachable from Private Healthcare in Developing Countries.

We kicked off the new course with some great material. Things are moving quickly at the moment, and there’s a lot to cover. We’ll use this blog to add resources, ideas, and follow-up readings for everyone to share.

In our first class, we spent a little time on the question: why do we need a new science of global health delivery? We drew on ideas from our Global Health Delivery Project colleagues to explain what a better understanding of the delivery challenge entails:

• Understanding health care delivery as a complex, multidimensional phenomenon
• A focus on the whole and the parts
• Data-driven design of outcomes focused health care systems
• Pragmatic focus on dissemination of innovative health care delivery models
• Frameworks that identify context-specific and context-independent factors affecting health care delivery

We’ll build up our understanding in each of these areas as we go. And in so doing, we’ll draw on existing theory, models, and frameworks that may help in the task. What readings, ideas, and resources might be helpful in this area? Please post a comment!