Use of the case method to show the link between health and economic development in rural Malawi

Abstract

Background: The link between economic development and health is well established, but not necessarily straightforward. We explored the economic effect of investing in health-care infrastructure in Neno, Malawi. We documented findings in a teaching case that is one of the open-access Cases in Global Health Delivery on Harvard Business Publishing. The cases show value-based health-care delivery and improve students' understanding of strategy and management in health care. Methods: We did background research on Malawi's history, health system, and economy. We interviewed 40 informants in Neno, including leaders of Abwenzi Pa Za Umoyo (APZU) and its founding organisation (Partners In Health), Ministry of Health administrators, hospital staff, villagers, and business owners. We reviewed quantitative data to assess indicators of development and documented changes in Neno's economy. We investigated the management decisions APZU made, while supporting the government in building a hospital and scaling up clinical and social programmes across Neno. We piloted the case in the Global Health Delivery intensive programme at Harvard. Findings: The case discussion tested students' ability to assess synergies between APZU's work and the local economy, including population and employment growth, improved public infrastructure, improved patient outcomes, and increased government investment in the district. Students also assessed challenges related to the shifting political landscape in Malawi, APZU budget cuts, reduced staff morale, and the Malawian currency devaluation. Interpretation: Students gained a greater understanding of how investment in health-care infrastructure leads to economic development. Funding: Harvard Medical School, Harvard Global Health Institute.