Mel Melaku Negussie, chief operating officer and general counsel of the Ethio-American Doctors Group (EADG), jumped at the chance to partner again with U-M students participating in a travel-study course on healthcare delivery in emerging markets.
He was very pleased with the student team’s work last year, saying one of the things he liked most is that they were on the ground in the country collecting data “as opposed to gathering information from publications.”
“All of this led to high-quality business consulting service last year that was extremely cost effective,” he said. “Since our first engagement, we have validated the quality of the work produced by the team to be equal, if not superior, to top-tier consulting firms.”
BA685: International Business Immersion, which is mostly comprised of MBA2 students, is designed to enhance participants’ international leadership capabilities, increase awareness of diverse business issues on the current global landscape, provide on-the-ground experience in a foreign country, and contribute to the success of partner health clinics and hospitals. The course responds to the increasing need for managers to have an international business perspective to augment their business and management knowledge.
During the first part of the term, students learned about healthcare in emerging markets through lectures, guest speakers and case discussions. Students were then divided into five teams and they prepared for visits to their selected country. They traveled there in late February and early March.
WDI President Paul Clyde teaches the course, which is organized and mostly funded by the Ross School of Business. WDI and the International Institute at U-M also provide financial support.
The EADG, a coalition of more than 250 U.S. doctors of Ethiopian descent who want to establish a state-of-the-art tertiary care hospital in the capital city of Addis Ababa, is one of four partners who collaborated with students for last year’s course. The others are Ruli District Hospital in Rwanda, Grace Care Center in Sri Lanka, and SughaVazhvu in India. Only Unicorpus Health Foundation in India is new this year.
In addition, Ruli, EADG, and Grace Care Center have partnered with WDI on several summer internships and/or Multidisciplinary Action Projects in past years. Being involved with the same organizations year after year in different ways allows WDI to “be more of a partner as the projects continue to grow,” Clyde said.
“We’re developing deep relationships, building trust,” he said. “We have continuity, and the partners know that we will continue to work with them. Further, we know what has worked in the past with other partners and what has not worked. So we bring that knowledge to bear in each project.”
Here’s an overview of the course’s projects:
Ethio-American Doctors Group – Addis Ababa, Ethiopia
The main focus of the project is to assess major equipment needed for the proposed hospital, and determine how much it would cost to maintain and repair these items. The student team will try to determine the total cost for each piece of major equipment, develop an assessment of total utilization and, where relevant, make a recommendation on what to purchase. The team also will make a recommendation on lab services and whether to outsource them.
Unicorpus Health Foundation – Hyderabad, India
A core group of eight clinicians (including a pediatric cardiologist, a neurosurgeon, a pediatric dentist and a senior nurse practitioner for geriatric care) have established a private, not-for-profit organization that will provide healthcare to the elderly in Hyderabad, India. It will target those who can’t afford the more expensive for-profit hospitals but are willing to pay something instead of using the government system. The student project will focus on a business plan for a self-sustaining rehabilitation center in Hyderabad, a city of 8 million. Hyderabad has several advanced tertiary care hospitals but there are very few rehabilitation centers, and those that do exist are very expensive. The current plan is to set up a 20-bed facility as a stopgap measure between hospital and home.
SughaVazhvu Clinics – Thanjavur, India
SughaVazhvu Healthcare implements innovative health systems strategies in expanding access to primary care services to underserved populations in rural Thanjavur, in the state of Tamil Nadu, India. In India, chronic diseases are increasing and pose an additional challenge for rural populations due to the added economic burden. SughaVazhvu’s data show that at least 12 percent of its patients suffer from diabetes, hypertension and hyperlipidemia. The challenge is ensuring treatment adherence among patients, which is critical to prevent terminal complications and associated economic distress. Therefore, SughaVazhvu launched a pre-payment model for chronic disease management for diabetes, hypertension and hyperlipidemia accessible through a mobile clinic. Enrolled patients are offered medication, diagnostic check-ups and consultations with a physician (including lifestyle counseling). The students will put together financial reports to give an idea of sustainability at different volumes, based on a subscription model where patients pay up front to enroll in the service for three, six, nine or 12 months.
Ruli District Hospital – Ruli, Rwanda
Over the past five years, Ross teams have worked on projects for Ruli District Hospital, responding to specific requests from hospital leadership at the time of the project. Some recommendations have been implemented; others have not. After reflecting on this, the hospital leadership believes that one of the reasons some haven’t been implemented is that the staff doesn’t see the need or doesn’t understand how the project recommendations relate to Ruli Hospital’s overall mission. This project is designed to take a step back and lay the groundwork for a staff retreat that will be held in March. The team will interview as many staff members as possible, conduct focus groups, and contact some staff at clinics to gain an understanding of the main challenges that the staff sees in accomplishing the hospital’s mission. The team will then synthesize the findings into topics to be addressed at the retreat. The team also will recommend the best way to conduct the retreat given the constraints at the hospital.
Grace Care Center – Trincomalee, Sri Lanka
Grace Care Center is developing a healthcare delivery model that will reach the poorest parts of the Sri Lankan community it serves. It is a community-based system that regularly tracks certain health metrics and flags those who need further attention by a local physician. The students will develop a subscription model in which patients pay a monthly fee for regular monitoring and, when necessary, specified care by a physician. This can build on some of the work done at Sugha Vazhvu in Tamil Nadu, India, but also utilize the data collection methods under development in Sri Lanka. Specifically, the project will: identify different customer groups based on willingness to pay; develop a way to offer clinically identical but otherwise differentiated services to allow a cross subsidization model to work; and develop financials based on revenue generated through this model and an estimate of costs.
For Erica Dancik, a dual master’s degree student at Michigan Ross and the U-M School of Public Health (SPH), and Tajesi Patel, an SPH master’s degree student, signing up for the course was a no-brainer.
“As a dual degree student focusing on global health and business, there couldn’t possibly be a more perfect course for me,” Dancik said.
Patel said the Ross course gives students a project-based experience working with healthcare providers in-country in addition to discussion of cases that explore innovative solutions in the space.
“There is no other course that I know of that combines theory and practice quite so much on this topic, so I jumped at the chance to take it,” Patel said.
Dancik, who will go to Sri Lanka, and Patel, who will work with Unicorpus in India, are excited to employ some of the things they’ve learned in the classroom, work in a team environment and experience a different country and culture.
“First and foremost, I am hoping to learn about chronic disease management in Sri Lanka and then use that knowledge, in combination with the skills and strengths of my teammates, to answer some of the challenging questions that have been posed by our client,” said Dancik, who will work after graduation with a company focused on chronic kidney disease.
“This project offers me a learning opportunity that I can carry with me as I leave Ross and start in my new position,” she said.
Patel said her team project would allow her to augment her public health background with some business side knowledge.
“I do not expect to be able to get a full MBA’s worth of knowledge from one course, but I would like to walk away from this class with more comfort and skill thinking through the more financial and practical issues of healthcare delivery in these settings,” she said.
She said she is excited to work on the Unicorpus project, which is in its infancy, and looking forward to meeting with healthcare providers, administrators and patients to get a better feel for the local landscape of this type of healthcare.
“There are just so many local nuances that no amount of background research or phone conversations can compare to,” she said, “so actually being on the ground and talking with these people will be invaluable to us in terms of working toward an end result that truly serves the needs and interests of the community.”
WDI’s Scaling Impact Initiative is working with Walmart to chronicle what the retail giant has learned from its efforts to include small producers in global supply chains.
The successes, challenges, and lessons learned will become a policy brief and a teaching case, both written by WDI in collaboration with Professor Linda Scott of Oxford University’s Said Business School. Both documents will be published this spring, and are geared toward Walmart and other retailers looking to develop more effective sourcing programs in the future.
WDI Vice President of Scaling Impact Ted London and Research Manager Colm Fay, along with Scott, are studying two Walmart programs.
One is Empowering Women Together, which sources handicrafts from women-owned base of the pyramid businesses in East Africa, Nepal, India and other emerging markets to sell online. The other is Direct Farm, which buys fresh fruits and vegetables from small- and medium-sized farmers to supply Walmart’s stores in Central and South America, Mexico, South Africa, and India.
The team has interviewed managers from Walmart, the Walmart Foundation, and their implementing partners.
This is the second collaboration between WDI and Walmart. Last year, WDI Publishing released a case study on the evolution of a global cross-sector partnership between Walmart and the United States Agency for International Development (USAID). The case looked at what had been gleaned – both positive and negative – during the 15-year collaboration between the two organizations.
The free case, “Walmart and USAID: The Evolution of a Global Cross-Sector Partnership,” focused on partnerships that sought to engage smallholder farmers in the developing world, and highlighted examples from Honduras, Guatemala, Rwanda and Bangladesh. It explored the ways in which these collaborations came about, how they were supported by the partners, and the level of success achieved as measured by Walmart, the Walmart Foundation, and USAID.
The case also identified lessons learned for the future of the Walmart/USAID collaboration, and insights that may apply to the development of public-private partnerships for development more broadly.
In addition, NextBillion’s Kyle Poplin wrote a post on how the case was developed. And Beth Keck, senior director of Women’s Economic Empowerment at Walmart, sat down for a video interview with WDI’s London about the company’s global work.
Image courtesy of Navel Zaveri/Flickr.
Speaker: David Griswold, President and Founder of Sustainable Harvest, Inc.
David Griswold, founder of the market leading Sustainable Harvest Coffee based in Portland, Oregon, reflected on growing business challenges to create authentic and scaled commodity supply chains which are sustainable and can impact the growers and rural communities in the developing world. In times of rapid industry consolidation, venture capital money and acquisitions in the specialty coffee industry, the question for the future of the coffee industry is: Do consumers really care about sustainability?
Currently operating in India and East Africa, Nuru Energy was seed-funded in 2008 and has an enduring commitment to solving the global problem of energy poverty, which affects over 2 billion people worldwide. Nuru Energy has developed a one-of-a-kind robust and simple-to-use, off-grid recharging platform, the Nuru POWERCycle™ pedal generator. The POWERCycle™ provides reliable clean, sustainable power anytime, anywhere and is hundreds of times more efficient than current solar-based solutions at a fraction of the cost. Student intern Therese Miranda-Blackney formulated a social media strategy and operational improvements for Nuru.
World Vision opened an office in Rwanda in 1994 in response to the genocide, which caused millions to flee the country. World Vision initially provided emergency help to those displaced and cared for unaccompanied children. The organization also helped people resettle as they returned home. Since 2000, World Vision has been working with communities in Rwanda to find long term solutions to poverty and injustice. As Rwandans are still recovering from Africa’s worst genocide in modern times, World Vision is supporting more than 2.5 million people via 29 long term, child-focused Area Development Programs. Student intern Amanda Aweh participated in a Lean and Six Sigma implementation at World Vision Rwanda to find ways to improve key internal processes and to help transform its culture towards continuous improvement.
Funded by the Rwandan government and user fees, the Ruli District Hospital is a 150-bed facility with eight physicians on staff. It is located about 50 miles from Kigali. The Ihangane Project empowers Rwandan communities to develop integrated approaches to the complex challenges of HIV by supporting community-driven projects that increase access to healthcare, improve healthcare quality and foster long term success through economic development. Student intern Anna Chan reviewed communication within the health system, as well as factors that influenced patient empowerment.
Funded by the Rwandan government and user fees, the Ruli District Hospital is a 150-bed facility with eight physicians on staff. It is located about 50 miles from Kigali. Ross and Medical School dual degree student intern Daniel Bickley worked with the hospital and a network of health centers to analyze the complex chain of information flowing between clinicians and administrators and between the different levels of the Rwandan health care system. He provided recommendations and implemented improvements congruent with and sustainable within the existing health care system. Ihangane Project founder Wendy Leonard said “Dan worked diligently to accomplish his goal. Just as importantly, he engaged all stakeholders in this process and empowered his Rwandan translator to actively participate in his research and implemention.”
Sustainable Harvest is an importer of high quality, specialty-grade coffees from over 15 countries worldwide. As pioneer of the Relationship Coffee Model, it has led the paradigm shift that has served as the foundation for the direct trade model and the interest in creating a closer connection between farmers and consumers. In Rwanda, the student MAP team conducted an in-depth market analysis of coffee consumption and potential coffee retail channels including hotels, restaurants, and ecotourism. The team then used the market analysis to develop a business plan for the cafe and wholesale operation.
King Faisal Hospital, located in Kigali, Rwanda, is one the preferred multidisciplinary specialist hospitals in the region. The student MAP team evaluated the ability to pay for health services, of patients from Rwanda and four neighboring countries. The team then combined this information with data from a separate, but ongoing, cost accounting project to identify strategic decisions that could move the hospital toward self-sustainability.
The government of Rwanda wanted to turn its School of Finance and Banking (SFB) into a regional center of excellence among East African business schools and signed a five-year agreement with the William Davidson Institute to provide capacity building for the school. Among the goals and prioritites of the project were: improving curricular and programmatic activities, creating local faculty development mechanisms and strengthening the school’s academic staff, identifying degree and non-degree educational needs for both the civil and business sectors in Rwanda and positioning the SFB to serve those needs, creating leadership and management structure to support the school’s mission, and working with SFB management to upgrade the school’s physical facilities and technological infrastructure.