Botswana's Program in Preventing Mother-to-Child HIV Transmission

This case traces the development of Botswana’s prevention of mother-to-child HIV transmission (PMTCT) program. It covers the time since its inception as a pilot program in 1999 through its national expansion in 2002 and its struggle to improve outcomes and integrate with broader maternal and child care services through 2008. After providing background on Botswana, its demographics and health situation, including HIV/AIDS and that national response, the case provides an overview of PMTCT - a critical challenge in global health - and describes the inception of the PMTCT program in Botswana. Readers see the challenges the program faced upon the initial scale-up and explore the key efforts and advances in process and policy that help the country overcome them and become a well known PMTCT success story. The case ends with the program wrestling with a relatively small group of women and their infants who fell through the cracks in the program and several holes in the health system that are preventing the program from eradicating infant HIV completely and tracking its progress.

Learning Objectives: To understand the role of a robust strategy, including experimentation, adoption, process improvement, and policy in global health implementation and national scale-up strategies.

The Global Health Delivery (GHD) Project, an interdisciplinary collaboration between Harvard Business School, Harvard Medical School, and Brigham and Women’s Hospital, investigates the management decisions behind disease treatment and prevention globally. The Global Health Delivery (GHD) Case Collection is a set of teaching case studies that are available for all at no cost online through Harvard Business Publishing, GHDonline, and The Case Centre.