MIT SLOAN SCHOOL OF MANAGEMENT

15.232
Business Model Innovation:
Global Health in Frontier Markets

Course team
Anjali Sastry, instructor
Senior Lecturer

sastry@mit.edu

Course websites

nsze@mit.edu

617.253.0965

847.644.0309

Alison Prosek, course assistant

E62-331 aprosek@mit.edu

617.324.2117

https://stellar.mit.edu/S/course/15/fa13/15.232/index.html
link via Stellar nav bar
https://wikis.mit.edu/confluence/display/sastry/Office+Hours

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Stellar:
Blog:
Office hours:

Nick Sze, teaching assistant

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E62-433

5 September - 17 October 2013

Tuesdays and Thursdays, 1:00-2:30 pm
On 9/5, 9/10, and 9/19: E62-221; 9/12, 9/17, and 9/24 on: E51-149

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Learn what works (and what doesnt) in innovative startups and inspiring leading-edge organizations
that are remaking healthcare delivery across the globe. Business Model Innovation: Global Health in
Frontier Markets explores successful approaches to delivering healthcare in challenging settings. An
engaging mix of content, case studies, student investigations, and class guests inspires our ideas and
insights. To frame the issues and opportunities, we analyze varied organizations, asking why some fall
short while others grow in size and contribute to the health of the people they serve. Our
understanding of bottlenecks, constraints, and opportunities sets the context for the courses ongoing
exploration of promising business model and social enterprise innovations.

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Modern medicine could reduce disease greatly, yet fails to reach millions across the globe. Innovations in
technology, process, marketing, and finance have the potential to help address the delivery challenges
not just in frontier markets, but everywhere. In this class, we explore novel solutions and new business
models for delivering health care in resource-limited settings. The aim is to apply business and
management lenses to what global health experts call the implementation gap. Our focus on the enterprise
makes the most of MIT Sloan strengths and interests in strategy, entrepreneurship, globalization,
innovation, sustainability, systems, logistics, economic development, and healthcare delivery.

Course overview

Business Model Innovation: Global Health in Frontier Markets investigates how specific arrangements of
organizational design and function enable scale and sustainability for health care delivery amid resource
constraints. We examine a variety of promising enterprises to understand what differentiates the
successful from those that fall short in delivering health care in the most challenging settings. Over the
course of our twelve 80-minute class sessions, well explore varied cases, compelling video content, and
interactive discussions, along with mini case studies that student teams develop. Throughout the course,

students draw on their education and experience in finance, operations, strategy, and marketing to
investigate a variety of unique delivery challenges in emerging markets. Professor Sastry builds on her
experience with global health delivery in Sub-Saharan Africa and South Asia, background in system
dynamics, and an extensive network of experts.

First offered as 15.965 in 2010, and subsequently as 15.S02, the course offers an invaluable perspective on
what worksor could workin global health. Health outcomes, scale, and financial and other aspects of
sustainability are all central concerns. Well be exploring these concepts in a variety of ways.

Course design

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Interested in on-the-ground projects? A companion projects-based class, GlobalHealth Lab, is offered in the
spring, with the application process taking place in November (MIT graduate students only). Students who
take 15.232 stand a better chance of admission to the Lab course; students who have already taken
GlobalHealth Lab will find that Business Model Innovation: Global Health in Frontier Markets offers an
invaluable opportunity to explore and analyze successful global health enterprises. Their experience
enriches our class discussion. By combining the problem-driven focus of the action learning Lab with
15.232s analytical study of what works and what doesnt, our pair of global health classes equips students
to analyze, take action, and innovate. For more on GlobalHealth Lab and our broader work in global health
delivery at MIT Sloan, see www.groundwork.mit.edu.

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In the first part of the course, we analyze the issues through a set of case studies, readings, and
discussions. As we build our library of examples, well be developing a map of potential linkages between
business models, health impacts, and context. Well also be generating a list of open questions and
continuing an evolving dialog about the role of business and business thinking in global health.

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The course takes on several linked themes: growth and scale; philanthropy and partnerships; promising
business models; and new ideas and difficult tradeoffs in scale, sustainability, and impact. In over a dozen
case discussions, youll discover how these themes are linked to key business issues of strategy,
operations, marketing, finance, and human resource management.

Course requirements

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In the final segment of the course youll share your operational and strategic insights from your own mini
case study with the class, connecting your insights and questions on performance, innovation, and
sustainability for your focal enterprise with themes from the class. These presentations set the stage for
expert guest commentators to share feedback and perspectives.
Our class sessions promise to be lively and include interactions and exercises designed to build the dialog
within the class and the wider community. Many of our discussions are case-based, so preparation and
participation are important. Some cases are non-traditional in format, and include video and other
content. Early on, youll form small teams and your group will be assigned an organization or program to
examine. There is no final exam. Course requirements and key deliverables fall into three categories,
described below.
Detailed assignments and useful materials are posted on Stellar.

Individual managerial briefing assignment (15%): Early in the course, turn in a 2-3 page memo aimed at
business executives outlining the critical facts and implications for management and delivery of health care
for A disease or health condition you select from our list (due 12 September).

Class participation (25%) is assessed on the basis of the quality (not quantity!) of contributions to class
sessions as well as the feedback offered to classmates. We take into account your performance during your
teams check-in meeting with the Professor or TA and your teams in-class presentation.
Business Model Innovation: Global Health in Frontier Markets syllabus. F13. A. Sastry, MIT Sloan

Mini case portfolio: Organizational analysis, presentation, executive summary, and team learning memo
(60%): Self-selected teams will be assigned a global health organization or program with a compelling
model or mission. Each student group will analyze the organizations model and potential for impact, scale,
and sustainability from financial, operational, strategic, and marketing perspectives, linking to themes
from class discussions

Your team will present a subset of your slides in class on 8 or 10 October. We will distribute your
draft executive summary to the class and our invited guests before your presentation, and
therefore should be as polished and complete as possible.
Check-in meeting: Each team is required to meet with the courseteam to seek feedback on their
draft presentation and executive summary. This meeting takes place in the first week of October.

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Mini case portfolio:

o Team memo on value measures, value chain, and value proposition (due 24 September)
o Presentation deck (draft due 1 October; final version due 17 October)
o Two-page executive summary (draft due 1 October; final version due 17 October)
o Integrated sources and bibliography (due 17 October)
o Team learning memo (due 17 October)

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Other student responsibilities include reading and complying with our statement of values in practice (on
Stellar). Come to class on time, keep laptops closed and mobile phones off, do not leave early, and avoid
stepping out of class for any reasonit is highly disruptive and a particular irritant to speakers and
students (and your professor). To make the most of our interactive design, it is important that you submit
materials when requested.

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We hate you to miss class. We have only 12 sessions! If you must miss class for any reason, please inform
the TA 24 hours in advance so that the teaching team is prepared and so that we can help you to find
alternatives to missing class if at all feasible. Recall that missing class for interviews is not acceptable. To
make up for any session you miss you are required to
read and prepare all assigned materials, then
debrief thoroughly with a classmate. Next,
prepare an original commentary to be sent to the TA within one week of the missed class. We will
post this commentary as a blog post. Guidelines follow.

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Guidelines for commentary blog post: Develop an original discussion of a business or healthcare issue
related to the case or class topic. Refer to at least one assigned reading for the class and also include one
additional resource or idea that you can cite (e.g. a paper, textbook, MIT Sloan course, or online source). If
at all possible, include one image saved as a jpeg, with a caption, either your own or one selected from a
website that allows content sharing (e.g. via http://www.flickr.com/creativecommons/ ). Include all these
materials in a single document. Your commentary should be 200-300 words and saved as a word file with
a title and your name and program in the byline. To enable us to insert hyperlinks, simply place explicit
urls in square brackets immediately following an underlined reference within your text.

Course materials

Most readings are posted to the class Stellar site, but to get selected required cases you will need to
purchase an electronic coursepack. The link to the Study.Net coursepack is in Stellar. Some material may
be distributed in hard copy only. Respect all copyrights and do not disseminate or forward any material
you do not have permission to share. Some required and optional materials take the form of video or mp3
content; please plan accordingly.
Make sure youre prepared for each class, having read carefully and considered the assigned materials.
Reflect on how what youre reading relates to the class content and your own interests, and set aside time
Business Model Innovation: Global Health in Frontier Markets syllabus. F13. A. Sastry, MIT Sloan

for follow up or additional reading and research connected to topics you find interesting or for areas
where you need to shore up your background knowledge. As you know, case preparation requires you to
go beyond simply reading the caseyoull need to study and then reflect on the case and prepare your
thoughts to enable the best class session possible.

Course credit, assignments, and background knowledge

Business Model Innovation: Global Health in Frontier Markets is a 6-credit half-semester course that must
be taken for a letter grade. There are no prerequisites, save the requirement that non-business school
students require the instructors permissionwe will want to see at least three business classes in
applicants backgrounds. Cross-registered graduate students are welcome, space permitting.

Well ask for some assignments to be submitted electronically and others as hard copy. If a hard copy is
required it is due in class or during an in-person meeting, so you need not make a special trip to turn in
materials.

Course communications

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Wondering how you can learn more about global health, business models, and the settings we explore? A
twelve-session course offers little scope for covering the vast terrain of global health and management.
The course team has curated a set of additional readings that you can explore on your own; assignments
and optional readings throughout the course provide opportunities and resources for you to develop your
knowledge in key domains.

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The course team sends a weekly email highlighting themes from class, upcoming events, schedule changes
or additional resources, some of which may be required preparation; please make sure to check the Stellar
site regularly. In a very rare case, we may add a note, pdf, or link as late as the day before class, but we
strive to avoid anything last-minute.
To build a dialog about global health delivery and management, well be referring and contributing to a
class blog linked to from the Stellar site. Check the blog every week and add your comments. Recall that
students who must miss class will post thoughtful comments there. Some of our in-class discussions
generate great blog posts, so do follow and join the dialog.

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We designed this course to make the most of our shared resources for this class for future students at MIT and
elsewhere. Please contribute to our growing body of knowledge: send in links, make comments, share ideas
and resources. Business Model Innovation: Global Health in Frontier Markets examines issues at the
intersection of entrepreneurship, management, economic development, and healthcarea nexus of
innovation where new ideas, practices, and models are constantly emerging. Join us in exploring this new
frontier!

This version 9/11/2013 2:51:00 PM

.232 syllabus BusMdl Innovation for GlblHlth 13.08.30.docx

Business Model Innovation: Global Health in Frontier Markets syllabus. F13. A. Sastry, MIT Sloan

Schedule of classes and assignments

Please read the optional materials if your background knowledge in this domain needs to be shored up.
Additional readings may be added; check Stellar. All readings are posted or linked to on Stellar, including
coursepack materials marked * which must be purchased from Study.Net.
Part One: Growth and scale

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Thur. 09/05
Class 1 Intro to global health; Challenges in reaching scale and why we focus on business models
Class discussion
Prepare to discuss CFW Shops and the challenges of reaching scale. Watch the video and read the two brief
articles [plus two optional if needed] to prepare.
1. PBS. 2007. Health Care Franchise (video: 24 minutes run time). You may skip the first two minutes: the
content starts at 2:04 and ends at 26:48. Click through on the links for more information. (Alternative link
to video.) This video first aired in May 2007, but the ideas remain relevant. (A .mov version is posted on
Stellar.)
2. Kim, Peter and Jeffrey Bradach. 2012. Why More Nonprofits are Getting Bigger. Stanford Social
Innovation Review, Spring: 15-16. (link)
3. Rottenburg, Linda and Rhett Morris. 2013. If you want to Scale Impact, Put Financial Results First.
Harvard Business Review Blog Network, January 9. (link)
[Optional] Magretta, Joan. 2002. Why Business Models Matter. Harvard Business Review, May: 3-8. (link)
[Optional] Bradach, Jeffrey. 2003. Going to scale: The challenge of replicating social programs. Stanford
Social Innovation Review, Spring: 19-25. (link)

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Tues. 09/10
Class 2 Cooperative approaches as growth strategies
Hello Healthcare case, in-class call with CEO York Zucchi; Rapid mixer
Prepare Hello Healthcare case (purchase it and other * materials via Stellar link):
1. *Wocke, Albert. 2013. Hello Healthcare: Taking a Cooperative Business into Africa. Ivey Case.
2. Guest, Peter. 2011. Spelling out Growth: Africa has big potential, but those that wish to invest need a
healthy appetite for risk and deep pockets. Wall Street Journal, September 19.
3. Johnson, Mark W, Clayton M Christensen, and Henning Kagerman. 2008. Reinventing Your Business
Model. Harvard Business Review, December: 51-59.
[optional] Ehrbeck, Tilman, Nicolaus Henke, and Thomas Kibasi. 2010. The emerging market in health
care innovation McKinsey Quarterly, May. (link)

As soon as possible, visit our google doc (link on Stellar), adding any details useful to potential teammates.
By midnight Thursday 12 September submit your team selection. Email TA with any issues or concerns.
due Thursday 12 September Individual assignment: Managerial briefing
Memo on critical disease (individual assignment, in Stellar).
Thur. 09/12
Class 3 Innovations in operational efficiency and potential for scaling up
Case discussion: Riders for Health
Prepare case, reading, and video; individual assignment due today.
1. *Lee, Hau and Tayan, Brian. 2007. Riders for Health: Health Care Distribution Solutions in sub-Saharan
Africa. Stanford Graduate School of Business case.

Business Model Innovation: Global Health in Frontier Markets syllabus. F13. A. Sastry, MIT Sloan

2. Riders for Health. 2011. Uncommon Heroes (video: 8 minutes run time)
3. Yadav, Prashant, Orla Stapleton and Luk Van Wassenhove. 2013. Learning From Coca-Cola. Stanford
Social Innovation Review, Winter: 51-55.
[Optional] Two videos: on Riders sample transport model in Lesotho, featured on BBC World (video); and
highlighting Riders model in Zambia, part of BBC series guide to good business. (video)

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Tues. 09/17
Class 4 Business thinking, innovation, and scale
Case discussion: Avahan India AIDS Initiative
Prepare to discuss the case and readings in class:
1. Cole, Claire, Maria May, Julie Rosenberg Talbot, Rebecca Weintraub, and Michael Porter. 2012. The
Avahan India AIDS Initiative: Managing Targeted HIV Prevention at Scale. GHD/HBS case.
2. Kim, Jim Yong, Paul Farmer, and Michael Porter. 2013. Redefining global health-care delivery. Lancet.
May 20.
[Optional] Sgaier, Sema, Aparajita Ramakrishnan, Neeraj Dhingra, Alkesh Wadhwani, Ashok Alexander,
Sara Bennett, Aparajita Bhalla, and Sameer Kumta. 2013. How the Avahan HIV Prevention Program
Transitioned From the Gates Foundation to the Government of India. Health Affairs, July: 1265-1273.
[Optional] Rhatigan, Joseph, Sachin Jain, Joia S. Mukherjee and Michael E. Porter. 2009. Applying the Care
Delivery Value Chain: HIV/AIDS care in resource poor settings. Harvard Business School Working Paper.

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Part Two: Philanthropy and partnerships

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Thurs. 09/19
This class is in room E62-221
Class 5 Strategy workshop
Youll work in your teams to apply a strategy framework to youre the organization you are
studying for your mini-case
Prepare readings:
1. Porter, Michael E. 2010. What Is Value in Health Care? N Engl J Med 363: 2477-2481.
[Optional] Porter, Michael E. 2010. Value in Health Care and Measuring Health Outcomes N Engl J Med
363 Supplementary Framework Papers (link)

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due Tuesday 24 September Team memo on value measures, value chain, and value proposition
Tues. 09/24
Class 6 Public-private collaboration
Case discussion: SMS for Life
Prepare case and readings:
1. *Moncef, Anna and Donald A. Marchand. 2012. SMS for Life (A): A public-private collaboration to
prevent stock-outs of life-saving malaria drugs in Africa. IMD Case.
2. Kania, John and Mark Kramer. 2011. Collective Impact. Stanford Social Innovation Review, Winter: 3641.
3. Gupta, Anil K. 2013. Tapping the Entrepreneurial Potential of Grassroots Innovation. Stanford Social
Innovation Review. Summer.
[Optional] Hanleybrown, Fay, John Kania, and Mark Kramer. 2012. Channeling Change: Making Collective
Impact Work. Stanford Social Innovation Review, January 26.
Business Model Innovation: Global Health in Frontier Markets syllabus. F13. A. Sastry, MIT Sloan

[Optional] Sekhri, Neelam, Richard Feachem, and Angela Ni. 2011. Public-Private Integrated Partnerships
Demonstrate the Potential to Improve Health Care Access, Quality, and Efficiency. Health Affairs,
August: 1498-1507.
[Optional] Jakobsen, Palle, Ming-Wei Wang, and Soloman Nwaka. 2011. Innovative Partnerships for Drug
Discovery against Neglected Diseases. PLoS, September, 5 (9).
Part Three: Promising business models
Thurs. 09/26
Class 7 Innovative strategy meets innovative operations: A systems thinking assessment
Case discussion: Aravind Eye Clinic and the application of strategy to the enterprise
Prepare to discuss the following in class, treating the materials as a case (allow plenty of time to view
video, jot notes, and prepare for case discussion):
1. Ravilla, Thulasiraj. How low-cost eye care can be world-class. TED video. Paying careful attention to the
underlying business model and taking notes for our class case discussion, watch 17-minute video at

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http://www.ted.com/talks/thulasiraj_ravilla_how_low_cost_eye_care_can_be_world_class.html

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2. Rangan, V. Kasturi, and R. D. Thulasiraj. 2007. Making Sight Affordable Innovations: Technology,
Governance, Globalization 2(4): 35-49.

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due Tuesday 1 October Draft executive summary and presentation deck for group mini case study
Submit your draft executive summary and presentation deck. Make an appointment to meet the TA for
feedback this week.

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Tues. 10/01
Class 8 Franchising
Case discussion: Living Goods and the promise of business-format franchise models
Prepare the following; draft executive summary and presentation deck due.
1. Gupta, Vivek and Indu Perepu. 2009. Living Goods: Developing a Sustainable Business Model to Provide
Healthcare Services in Uganda. ICMR IBS Case.
2. Beck, Steve, with Wouter Deedler and Robin Miller. 2010. Franchising in frontier markets: Whats
working, whats not, and why. Innovations, Winter: 153-162.
3. Additional reading TBA
[Optional] Pindyck, Robert. 2011. Franchising Section 4, pp. 21-26 in Lecture Notes on Vertical Structure
Sloan School of Management, Industrial Economics for Strategic Decisions (August). Include Section 3,
Downstream Distributors, or the entire note if needed. (link)
[Optional] Bishai, David M, Nirali M Shah, Damian G Walker, William R Brieger, and David H Peters. 2008.
Social franchising to improve quality and access in private health care in developing countries.
Harvard Health Policy Review, Spring 9(1): 184-197. (link)

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Thurs. 10/03
Class 9 Organizational sustainability and scale
Case discussion: Narayana Hrudayalaya
Prepare case and reading:
1. *Khanna, Tarun V and Kasturi Rangan. 2005. Narayana Hrudayalaya Heart Hospital: Cardiac Care for
the Poor (A) HBS Case.
2. Prahalad, C K, and R A Mashelkar. 2010. Innovations Holy Grail. Harvard Business Review, JulyAugust: 2-10.
Business Model Innovation: Global Health in Frontier Markets syllabus. F13. A. Sastry, MIT Sloan

Part Four: New ideas and challenging tradeoffs in scale, sustainability, and impact
Tues. 10/08
Class 10 Group 1: First set of student team presentations, with special guests; Discussion on
learning, innovation
Read and carefully consider the following along with the executive summaries provided by each of todays
presenting groups. Also read the guests bios. (see Stellar.)
1. Milway, Katie Smith, and Amy Saxton. 2011. The Challenge of Organizational Learning. Stanford
Social Innovation Review, Summer: 44-49.
2. Seelos, Christian and Johanna Mair. 2013. Innovate and Scale: A Tough Balancing Act. Stanford Social
Innovation Review, Summer.

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Thurs. 10/10
Class 11 Group 2: Second set of student team presentations, with special guests; Discussion on
transfer and reverse innovation
Read and carefully consider the following along with the executive summaries provided by each of todays
presenting groups. Also read the guests bios. (see Stellar.)
1. *Govindrajan, Vijay and Chris Trimble. 2012. Partners in Healths radical model for care Chapter 12
in Reverse innovation: Create far from home, win everywhere. Boston MA: HBR Press.
2. Onie, Rebecca, Paul Farmer, and Heidi Behforouz. 2012. Realigning Health with Care Stanford Social
Innovation Review, Summer. (link)
[Optional] DePasse, Jacqueline W and Patrick T Lee. 2013. A model for reverse innovation in health
care. Globalization and Health, 9:40. (doi:10.1186/1744-8603-9-40; link)]
[Optional] Additional readings TBA.

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Tues. 10/15 No Class; Student Holiday

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due Thursday 17 October Final group project executive summary, presentation deck, bibliography,
and team learning memo.
Taking into account feedback and discussions, refine your executive summary and presentation deck. Check
that your bibliography is complete. This material will be uploaded to the web for others to read and
download, and could be useful to many others.
Also prepare a 2-page team memo documenting what you learned from this class.
Thurs. 10/17
Class 12 Group 3: Third set of student team presentations, with special guests; Discussion reflecting
on class themes.
Read and carefully consider the following along with the executive summaries provided by each of todays
presenting groups. Also read the guests bios. (see Stellar.)
Wrap up discussion
Final group assignments due in class today.
To prepare, finalize your work, and also prepare readings
1. Readings TBA.

Business Model Innovation: Global Health in Frontier Markets syllabus. F13. A. Sastry, MIT Sloan

15.232: Business Model Innovation for Global Health

Fall 2013 (H1) Revised Syllabus Overview
Date

Topic

Case

1 Th
5 Sept

CFW shops (PBS

video)

2 Tu
Cooperative approaches as
10 Sep growth strategies
E62-221 In-class rapid mixer
3 Th
Operations; Other growth
12 Sep strategies

Hello Healthcare*
(Ivey case)

Intro to global health;

Challenges in reaching scale;
E62-221 Business models

6 Tu
Public-private collaboration
24 Sep

Riders for
Health* (Stanford
case); videos
Avahan India
AIDS Initiative
(GHD case)
Bring your own
minicase
materials
SMS For Life A*
(IMD case)

7 Th
Systems thinking
26 Sep

Aravind (TED
video)

E51-149

E51-149

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4 Tu
Business thinking, innovation,
17 Sep and scale

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5 Th
Workshop on strategy
19 Sep

E62-221

E51-149

9 Th
3 Oct

Organizational sustainability
and scale

E51-149

10 Tu
8 Oct

Presentations & expert

response, discuss links to
E51-149 learning & innovation theme
11 Th Presentations & expert
10 Oct response, discuss transfer /
E51-149 reverse innovation theme
12 Th
17 Oct

E51-149

Presentations & expert

response; wrapup discussion

Team memo on
value measure,
value chain &
value proposition

Living Goods*
(ICMR case)
Other TBA

Beck, Deedler & Miller

Other TBA
[Pindyk]
[Bishai et al]
Prahalad & Mashelkar

Draft Executive
Summary & Deck

Narayana
Hrudayalaya A*
(HBS case)
Mini-case
executive
summaries
Mini-case
executive
summaries
Mini-case
executive
summaries

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E51-149

Franchise models

2-page individual
managerial
briefing paper
Team selection

Gupta
Kania & Kramer
[Hanleybrown, Kania & Kramer
[Sekhri, Feachem & Ni]
[Jakobsen, Wang & Mwaka]
Rangan & Thulasiraj

8 Tu
10/01

Kim, Porter & Farmer

[Sgaier et al]
[Rhatigan et al]
Porter
[Porter supplements]

Due

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E51-149

Readings
[optional]
Kim & Bradach
Rottenburg & Morris
[Magretta]
[Bradach]
Guest
Johnson, Christensen &
Kagerman
Yadav, Stapleton & Van
Wassenhove

Meet with TA to
review Executive
Summary & Deck

Milway & Saxton

Seelos & Mair

Govindrajan & Trimble*

Onie, Farmer & Behfouz
[dePasse & Lee}
[frugal innovation collection]
TBA

Updated Final
Exec Summary &
Deck; Team
learning memo

All readings and assignment instructions are on Stellar where you can purchase *cases via Study.Net; optional
materials in brackets [ ]. Turn in assignments by class start on due date, on Stellar or in hard copy as instructed.
Team selection by 11:59PM on Thursday, September 12
Business Model Innovation: Global Health in Frontier Markets syllabus. F13. A. Sastry, MIT Sloan