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Case Studies

Case Studies

Case Studies

These case studies are meant to support the teaching of health systems and health policy as well as to help practitioners and policy makers with operational examples to assist in problem solving and policy formulation. The emphasis is on positive stories, but we include many with negative and mixed learnings as well. One caution- case studies are very contextual- and therefore they are dated.

We present four case study sets on the Organization of Health Care Services from Across India.

The set of 17 case studies was published as an online book in 2018, and titled- “The Archetypes of Inclusive Health Care- Where healthcare for the poor is NOT poor healthcare.” We urge readers to read the introduction and a concluding chapter called “what we learn from the case studies.” We also annexe a case study is of the Thailand Health System. The individual case studies that constitute this volume are listed below. We have provided links to three of the 18 case studies- but for the rest you would have to go through the entire publication.

Positive Practices in developing primary health-care oriented health systems- A South East Asia Regional Office of World Health Organization presentation.

This is a collection of 20 case studies from the countries in this region and each of them relate to the experiences and challenges of the transition from Selective to Comprehensive Primary Health Care. This collection has an elaborate introduction that also discusses methodology and a penultimate chapter summing up the lessons. You may also like to access the introduction that we published as a conversation called “ Grounds for Optimism” in September, 2024 The individual case studies in this volume are listed below.

  • Transforming primary health care in Indonesia through scale-up of Integrasi Pelayanan Keshatan Primer (ILP): Case study from Puskesmas Plantungan, Central Java; Indonesia
  • Integrated capacity building for primary health care in Faafu Atoll; Maldives
  • Re-skilling and organization of the Health Assistant cadre for comprehensive primary health care; Bhutan
  • Deploying mid-level healthcare providers at scale for achieving comprehensive primary health care; India
  • Capacity building for community health officers: The NHSRC-CMC mentoring programme; India
  • PHC team for the provision of Family Health Care approach; Timor-Leste.
  • Performance incentives linked to quality & outcomes; Thailand
  • Common Review Mission: Monitoring for building a learning-adaptive system; India.
  • Public Private Partnerships under the UCS in Bangkok City and Scale Up; Thailand
  • Bangkok public health and digital health volunteers; Thailand
  • ULAMA: Engaging elderly in the planning and implementation of healthy city programme of Wajo Regency; Indonesia
  • The Jaffna Healthy City programme; Sri Lanka
  • Government Pharmaceutical Organization for universal access to essential medicines; Thailand
  • State role in manufacture and supply of medicines at affordable cost for primary health care; Bangladesh.
  • Local government in primary health care and community engagement; Nepal
  • Kerala palliative care programme with involvement of local government (Panchayat); Kerala/India
  • Inter-sectoral platform for community action on health and determinants: Swasthya Panchayat Yojana; Chhattisgarh/India
  • Grievance redressal with civil society engagement Thailand
  • Bangladesh Health Watch: Taking voices of the grassroots to policy makers; Bangladesh
  • NGO role in providing Primary Health Care: Gonoshasthaya Kendra.

Case Studies in response to Covid 19 pandemic.

This was done for the people’s science movement and health movement in Tamil Nadu. We have not posted the individual case studies separately but these are available in chapters 4, 5 and 6. Chapter 4 is the Chennai case study which itself has four subsets from different areas by socio-economic groups. Chapter 5 is the case study of the response in Cuddalore district- and these have three sub-set case studies. And chapter 6 is illustrative case studies from Pudukkottai, Palani districts and Union Territory of Pondicherry. Many of these can be seen as models of case study writing as well as public health inquiry.

Public Private Partnerships

We then introduce our collection of case studies with a booklet “Public Private Partnership- Reflecting on 20 years of theory and practice” which has four case studies each of which illustrate the problems and challenges of PPPs at the primary, secondary, tertiary care level and the outsourcing of ancillary services.  This booklet was prepared for sharing in the National Health Assembly 2018 on behalf of PHRN. The first case study is the outsourcing of primary health centers in Rajasthan. The second case study is the outsourcing of CHCs in Uttarakhand. The third is the PPP between Apollo hospitals and the Delhi government and the fourth case study presents the outsourcing of diagnostics in Andhra Pradesh and Maharashtra.

We follow with a case study-based paper on PPPs in Healthcare in India published in EPW by Sulakshana Nandi and 8 other authors, all of them from Public Health Resource Network (PHRN). This paper presents and discusses four case studies. We also share two of these case studies by PHRN on “Outsourcing of Haemodialysis Servies in Delhi” , and on “Outsourcing of Radio-diagnostics in Bihar” . Then we close with an example of De-privatization of a public private partnership from Chhattisgarh by Deepika Joshi and others.

Others

There are also a number of case studies and field visit reports that have never been published as a collection. Many of these are, or at least were, available in the NHSRC website. We categorise them into three categories here and share them for our readers.  These three groups are:

  • Innovations in Human Resource Management:
    We begin with three case studies. One on “Innovations in Workforce Management in Karnataka” whose main strength is how it addresses problems of transfers and postings. The other is on the “Chhattisgarh Rural Medical Corps” which is an innovative approach to attracting and retaining skilled health professionals in rural and remote areas. And the third is on “Rural Health Practitioners in Assam: Mid-Level Healthcare providers for comprehensive service delivery in sub-centres.” This is an important case study, for along with Chhattisgarh’s RMA programme they were the forerunners to the current nation-wide mid-level healthcare provider programme. These are part of the NHSRC repository of best practices and come from the Srinagar National Summit. A much longer list of such case studies are also available in the NHSRC website in the page on “National Summits on Good, Replicable Practices & innovations in Public Healthcare Systems in India.” The case studies presented there are of varied quality, but you may find what you are looking for there and then explore it with the contact persons.
  • Public Health and Health Systems Inquiries:
    We begin with an inquiry into concerns related to newborn deaths in a district headquarters hospital, done at the instance of the state human rights commission. This study relates to 2017-2018 period and was done in response to a media outcry against what was considered a spate of excessive newborn deaths.
    We then share an inquiry into an Outbreak of malaria in Tripura in 2014. This is not only a study of an epidemic outbreak but also a health systems inquiry.
    We have found both of these very useful as case studies to share with student and then place for a group discussion. These case studies illustrate the importance of why and how disease specific programmes need to be studied in synergy with a broader health systems approach.
  • Health Systems Strengthening Case Studies.
    We then share a number of case studies related to health systems strengthening. The first is on the Tamil Nadu Medical Services Corporation(TNMSC); the benchmarked best practice in the procurement and supply chain management for drugs and other consumables in public health services.
    The next is a case study of the Maharashtra state outsourcing of diagnostics to HLL– another public service company.
    We then share three common review mission type district reviews done in 2013 (prior to the inclusion on NCDs and UHC). These are the district review of Madurai in Tamil Nadu, Kinnaur in Himachal Pradesh, and Gajapathi district in Odisha. Such assessments are available for many more districts. We hope to replace these with more upto date reviews in due course- but this is shared here as a sort of template for district reviews that should form the back-bone of district health planning.