This case takes place in the United States (US) and traces the inception and growth of Project Extension for Community Healthcare Outcomes (Project ECHO)—a web-based guided model for primary care providers—from 2003 to 2016. After providing background on the US health system, including medical education, health care financing, and the supply and distribution of primary care and specialist providers, the case explores what motivated Project ECHO founder and liver specialist Sanjeev Arora, MD to train primary care providers in rural New Mexico in hepatitis C treatment and management. It describes early replication of the ECHO model in the US and across medical conditions and what the Project ECHO model entailed—including leveraging technology to expand access to specialty resources, best practices, case-based learning, and outcome monitoring, as well as good will among participants. A professional communications campaign, ongoing research, and persistence supported Project ECHO’s growth. The case displays three dimensions of Project ECHO’s early work: creating a new mode to redistribute the expertise of specialists to primary care practitioners, scaling this new care delivery model and measuring its impact, and identifying sustainable funding sources. The case concludes with the US Congress passing the ECHO Act to promote research on the model and Arora contemplating what else he might need to continue to scale to reach his goal of touching 1 billion lives.
Teaching Note available through Harvard Business Publishing.
Above: TeleECHO Clinic; Below: ECHO Institute. Source: Global Health Delivery Project case writers.
Learning Objectives: To understand what is needed to design a service model; the potential for redistribution of expertise among practitioners to enhance value; the role of operational effectiveness in enabling scale up; and the importance of measuring impact for stakeholders.
Keywords: Public health, health care delivery, scale-up, resource-limited settings, human resource, information technology, primary care, information management, data collection, mentorship
Raj Panjabi is CEO of Last Mile Health and Associate Physician in the Division of Global Health Equity at Brigham and Women’s Hospital and Harvard Medical … Read more about Raj Panjabi, MD, MPHRead more
Davin Eurich earned her BA from the University of the Pacific, where she majored in International Relations and Global Studies with a minor in Spanish … Read more about Davin Eurich
Congratulations to our Faculty Director Rebecca Weintraub! "Over the past nine years, Rebecca has helped adapt the case method to teach global health delivery to students in a diverse range of programmes to do the same." Learn more about our work in this profile by our global partner, The Case Centre.
Ashti Doobay-Persaud, MD is Faculty Director for the Masters of Science in Global Health and Assistant Professor of Medicine at Northwestern University Feinberg School of Medicine. She has been a GHDonline Faculty Network member for five years, and has taught GHD's Cases in Global Health Delivery for three.
Several barriers challenge development, adoption and scale-up of diagnostics in low and middle income countries. An innovative global health discussion platform allows capturing insights from the global health community on factors driving demand and supply for diagnostics. We conducted a qualitative content analysis of the online discussion ‘Advancing Care Delivery: Driving Demand and Supply of Diagnostics’ organised by the Global Health Delivery Project (GHD) (http://www.ghdonline.org/) at Harvard University. The discussion, driven by 12 expert panellists, explored what must be done to develop delivery systems, business models, new technologies, interoperability standards, and governance mechanisms to ensure that patients receive the right diagnostic at the right time. The GHD Online (GHDonline) platform reaches over 19 000 members from 185 countries. Participants (N=99) in the diagnostics discussion included academics, non-governmental organisations, manufacturers, policymakers, and physicians. Data was coded and overarching categories analysed using qualitative data analysis software. Participants considered technical characteristics of diagnostics as smaller barriers to effective use of diagnostics compared with operational and health system challenges, such as logistics, poor fit with user needs, cost, workforce, infrastructure, access, weak regulation and political commitment. Suggested solutions included: health system strengthening with patient-centred delivery; strengthened innovation processes; improved knowledge base; harmonised guidelines and evaluation; supply chain innovations; and mechanisms for ensuring quality and capacity. Engaging and connecting different actors involved with diagnostic development and use is paramount for improving diagnostics. While the discussion participants were not representative of all actors involved, the platform enabled a discussion between globally acknowledged experts and physicians working in different countries.
For people with terminal illness in rural Guatemala, God and religion are ever present. God is a principal actor in their lives: God provides money and jobs; God provides food; God heals illnesses, either through doctors or in spite of them; God guides one down her path in life and knows the obstacles ahead; God carefully chooses the hour of her death.