A Teaching Case on Option B-Plus in Malawi: Toward Locally Inspired Global Health Training

Abstract

Background: The University of Malawi College of Medicine (COM) launched a new Master’s in Global Health Implementation (MSc-GHI) in 2017 in collaboration with Partners in Health (PIH) Malawi . The program employs the Teaching Case Method, a widely used model in professional schools, to facilitate in-depth discussions. Initial experience from this method identified an unmet need for new teaching cases that may have contextual implications for trainees in Malawi and beyond. While global health cases abound in other resources, this project sought to generate a locally inspired teaching case to support training at COM and other resource-limited settings. Method: In addition to an extensive literature review, semi-structured interviews were conducted to collect firsthand experiences from 17 policymakers and early adopters in Malawi. Employing a narrative approach, a teaching case was generated from these interviews, to reflect some of the ‘lived moments’ behind policy discussions and provide contextual insights for class-room discussions. Results: Against the realities of a struggling HIV prevention program in the early 2000s, Malawi pioneered Option B+ in 2010, an unpopular policy that expanded life-long HIV treatment for all affected pregnant and breastfeeding women. The World Health Organization (WHO) rapidly embraced this initiative within two years, making it the cornerstone moment that emboldened other initiatives in HIV policy. Conclusion: Here I present a teaching case with an accompanying discussion guide, in response to an unmet need for locally inspired cases and toward capacity-building in Malawi and elsewhere. Acknowledging the contributions that low-income nations make to health delivery science, this case invites its audience to examine the political and socioeconomic factors that influence policies like Option B+ and broader global health initiatives in low-resource settings.