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It is January 2017, and Nikki Tyler, market access advisor at the U.S. Agency for International Development's Center for Accelerating Innovation and Impact, must recommend an actionable strategy for how to use the $10 million contributed by global donors and foundations to scale up the use of chlorhexidine in Nigeria. It was clear that chlorhexidine, a substance applied to newborns' umbilical cord stumps to prevent infection, could reduce infant mortality significantly. However, changing behavior would be an enormous challenge. This case gives students an appreciation for the importance and complexity of global health issues, along with an understanding of key analytic techniques for approaching a complex market situation. Students quickly learn that there are no easy answers to encouraging chlorhexidine's greater use. To develop a plan, it is essential to complete detailed analyses, study insights and motivations, and ultimately compare different possible solutions, considering efficiency and efficacy.

The content does not necessarily represent the official views of the National Institutes of Health. This case was prepared by Duda Cardoso ’16, Ashima Gupta ’16, Eric Leventhal ’16, and Robert Parsley ’16 under the supervision of Professors Kara Palamountain, Tim Calkins, and Julie Hennessy. The authors would like to thank the following people for their assistance: the Honourable Minister of Health of Nigeria, Dr. Isaac Adewole, and his team; Dr. Chuks Diji of the University of Ibadan; and Nikki Tyler ’13 and David Milestone ’06 of the Center for Accelerating Innovation and Impact (CII) at USAID. This case is based on a real situation but some of the information has been disguised or changed for educational purposes. Cases are developed solely as the basis for class discussion. Cases are not intended to serve as endorsements, sources of primary data, or illustrations of effective or ineffective management. To order copies or request permission to reproduce materials, call 847.491.5400 or e-mail cases@kellogg.northwestern.edu. No part of this publication may be reproduced, stored in a retrieval system, used in a spreadsheet, or transmitted in any form or by any means—electronic, mechanical, photocopying, recording, or otherwise—without the permission of Kellogg Case Publishing.
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