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The central lesson to be learned from studying the case is to understand the challenges and constraints posed by contextual conditions in designing contracts in public–private partnerships (PPP) for financing and delivering health care in emerging economies such as India.

Perverse incentives, along with contextual conditions, led to extensive opportunistic behaviors among involved agencies, limiting the effectiveness of otherwise highly regarded innovative design of the program.

India’s “Rashtriya Swasthya Bima Yojana” or National Health Insurance Program, launched in 2007 provided free health insurance coverage to protect millions of low-income families from getting pushed into poverty due to catastrophic health-care expenditure. The program was implemented through a PPP using standardized contracts between multiple stakeholders from the public and private sector – insurance companies, hospitals, intermediaries, the provincial and federal government.

Teaching Notes are available for educators only.

CSS: 10 Public Sector Management.

Organisational behaviour; Leadership; Organisational development; Public–Private partnership; Health care management; Public health.

Masters students in Business Administration, Post Graduate Diploma, Clinical Training of Medical Professionals, Health Leadership Programme.

Prof Jannie Hugo, the protagonist in the case, was considering his dilemma of aligning the multiple partners involved in public health care. A high level of collaboration was required of a multitude of stakeholders in developing the Daspoort clinic into a pilot site for the Tshwane district’s implementation of the National Health Insurance system. In addition, the re-engineering of primary health care with the focus on the patient and community orientated approach were launched on this site.

Gaining insight into international and national landscapes and principles of health care systems. Critically analyse the role of technology in delivering innovative health and social services. Present judgment of Prof Jannie Hugo’s contextual leadership effectiveness in enhancing collaboration between the multiple stakeholders and recommend next steps.

2 × DVDs on Vimeo, Slides and teaching plan with discussion or exam questions with model answers.

CSS 7: Management Science.

The subject area is entrepreneurship.

Graduate and executive education level in leadership, entrepreneurship and strategic management are used to discuss leadership, entrepreneurship and strategy in health services.

This case talks about the passionate journey of a pediatrician practicing in the Mumbai city of India, who as an individual private practitioner is contributing to the fulfilment of the global health agenda and the fourth Millennium Development Goal (MDG) – “reduce child mortality”. His vision is to make quality and affordable expert pediatric care accessible to all the individuals, right from pre-birth to adulthood. Surya Mother and Child Care Hospital (SMCH) is being strengthened as a nation-wide network of mother and child hospital offering patient/consumer-centric integrated collaborative quality care, and it needs to be seen how this model can be made sustainable as it enlarges in scale for the future.

The case is structured to achieve the following learning outcomes: to understand about effectuation as a logic for entrepreneurial success through the lens of Dr Avasthi and his venture SMCH; To understand and apply Porter’s Principles of value transformation that essentially focus on outcome-driven cost-efficient work practices in a collaborative integrative fashion, where transformation must come from within (some practices suggested can be applied to the Indian Healthcare Services Delivery systems); to critically analyze the overall strategic position of SMCH as an organization and its competitive environment; to discuss the factors influencing health-care delivery capacity build up, given the MDGs 2015, Every Newborn Action Plan and Indian Newborn Action Plan framework, as applicable to India; and to discuss and analyze mechanisms for future sustainable service delivery options for SMCH. Although each of these principles is important, possibly, the instructor could emphasize and encourage more discussions on potential models of shared partnerships that can help quality health-care services reach the unreached and the incorporation of technology in achieving this. The learning process can also facilitate discussions about leadership qualities in the creation of health-care entrepreneurs, for the “Change That They Would Want To See”.

Teaching notes are available for educators only. Please contact your library to gain login details or email support@emeraldinsight.com to request teaching notes.

CSS:3 Entrepreneurship.

This case study would enable students to understand the concept, process and advantages of mergers and acquisitions as a growth strategy with respect to 1mg. Also, the students would be able to use the threats, opportunities, weaknesses and strengths matrix to map 1mg’s strengths, weaknesses, opportunities and threats.

This case study analyses the transformation journey of 1mg to Tata 1mg, one of the most trusted internet pharmacies in India. This case describes a small start-up that was launched in 2013 and had made many acquisitions since then. This case revolves around Tata Digital’s purchase of 1mg. The case starts out by explaining 1mg’s financial situation and why the company was acquired. This case study focuses on how the integration helped Tata Digital and 1mg realize their respective missions. Furthermore, the case study illustrates the benefits and difficulties of this integration.

This case study is basically aimed at postgraduate management students; it can be used in strategic management and health-care courses. Students can understand the concept of diversification and acquisition with the help of this case study. Students can also gain an insight into the organic and inorganic diversification as a growth strategy.

Teaching notes are available for educators only.

CSS 11: Strategy.

This case uses the concept of social entrepreneurship to analyze the entrepreneurial journey of Mr Suraj Prakash and his social enterprise, the Swasth Foundation. It further deepens our understanding of strategic decision-making by exploring the successful use of pivots.

The case was primarily developed through a series of interviews with the leadership team over a year. Secondary sources included literature about Swasth Foundation available on the internet and those shared by the founder.

In 2008, Suraj Prakash left McKinsey & Company after six and half years in the health and development sector as an engagement manager. Along with his friends, Aman Paul and Ankur Sharma, he established Swasth with the goal of building an ecosystem that delivered high-quality, affordable and accountable health services to low-income communities in India. Right from its inception, Swasth went through many fundamental shifts in terms of its business model, team composition and even the nature of its existence; however, this did not deter Suraj from pursuing his goal.

The case brings into focus the health-care system of India, especially in the context of the urban poor and the challenges they are facing, followed by the initiatives taken by Swasth Foundation and the impact it is trying to create. The remainder of the case delves into Suraj’s entrepreneurial journey and the three pivotal decisions that changed the course of his organization over 11 years. It will also provide a transpicuous view of the entrepreneurial decision-making process through the lens of pivoting. As Suraj and his team are trying to bring about the required changes through the third pivot, there remain some challenges that need to be addressed for a successful implementation.

The case is written for business management students and can be used in general management, entrepreneurship and strategy classes. The case can be used for discussions on leadership, social entrepreneurship and strategic decision-making. It is suited for both undergraduate and postgraduate levels.

Roger Osayende, a former management consultant, must advise the Ministry of Health of Ektu, a fictional country in Central Africa, on how to implement a new point-of-care diagnostic test for infants with HIV. In Ektu, mothers often transmitted HIV infection to infants during pregnancy, delivery, or breastfeeding due to inadequate resources to invest in prevention efforts. The existing procedure to diagnose infants with HIV required collecting dried blood samples at more than two hundred healthcare facilities around the country and transporting them to a central laboratory in the capital for testing. This process was characterized by significant delays due to long transportation times, batching of samples in transportation and processing in the lab, and concomitant congestion in the lab. This delay resulted in loss to follow-up, that is, lost patients due to mothers not collecting their infants' results. A new point-of-care device was about to be introduced, which would obviate the need for this centralized processing and the resulting diagnostic delay. The key decision under consideration is where to place the devices to maximize their effectiveness.

Understand the importance of making public health decisions based on a data-driven, logical framework   Uncover the link between operational performance of the healthcare system and health outcomes at the population level   Appreciate the relevance of operational decisions in enhancing or diminishing the effectiveness of a medical technology   Use process analysis concepts to characterize various components of delays

Corporate social responsibility, specifically nonprofit business collaborations from a nonprofit’s perspective.

Graduate level programs in nonprofit management, corporate social responsibility and development management; it can also be used for executive education.

Social enterprises and nonprofits at present increasingly look to corporate firms for grant funds to finance their activities and assets. This case features the experiences of one of the largest nonprofit eye care providers in India, LV Prasad Eye Institute based in Hyderabad in accessing corporate financial support in the form of corporate social responsibility funding. The case deals with the organization challenges, stresses and strains that arise in a nonprofit–corporate partnership. Specifically, it focuses on the strategic and operational challenges that emerge from the partnerships. The partnerships reviewed in the case pertain to rehabilitation.

After solving the case, the participants will be able to understand the stages in developing collaborations between nonprofits and businesses for corporate social responsibility. They will also be able to understand the internal implications for nonprofits operations and strategy from such collaborations.

Teaching notes are available for educators only. Please contact your library to gain login details or email support@emeraldinsight.com to request teaching notes.

CSS11: Strategy.

Strategic Marketing Management. This case is also relevant for discussion in other courses like brand management.

Postgraduate Management students.

Just before the official launch of “no-negative” news edition by Dainik Bhaskar Corp. Ltd, there was widespread speculation that the group was risking too much by going against the set convention of the newspaper industry. The common belief in the industry was “If it bleeds, it leads” and “good news is no news”. While endeavoring to do away with this perception, the management needed answers to questions like “Would it really be an attractive proposition for the readers?”, “Was the group compromising the role and responsibilities of press in presenting the truth to the world?” and “How would it add value to the brand?” The entire debate was pivoted around the sustainability of positive marketing strategy and “Is it a good idea to go forward with No Negative?” For decades, Dainik Bhaskar was known for its strategy of capturing untapped markets or denting into monopolistic markets and become a leader. This case is an odyssey of moving away from the “me-too” to category (positive newspaper) positioning. The main objective of this case is to build the concept and rudiments of positive marketing in practical perspectives using the backdrop of the Hindi newspaper industry and its largest player breaking the myth “only negative news sell”. Besides this, the case also evolves the process of institutionalizing positive marketing in organizations.

The primary objective of teaching through this case is to make students aware and understand the emerging strategy of positive marketing and its ability to break through the present clutter in the market. It also elaborates on how companies can use this tool for differentiating themselves from others.

Teaching Notes are available for educators only. Please contact your library to gain login details or email support@emeraldinsight.com to request teaching notes.

CSS 8: Marketing.

The broad teaching objective is underpinned by the themes of purpose and partnerships. This is taught through application of business model innovation for sustainability where the value proposition is broadened to social and environmental, and multi-stakeholder partnerships in a time of crisis. Students will be expected to analyse the above concepts through a meso (sustainable value), micro (business models) and macro (ecosystems) lens. Upon completion of the case study discussion, successful students will be able to better understand the three features that support sustainable value, explore how a global pandemic can create new business models and partnerships to create social value and analyse how business ecosystems operate against the 6 C framework.

Discovery Holdings Limited is a leading financial service organisation in South Africa, and its Digital Health division is responsible for the platform which delivers telemedicine offerings to doctors and patients. The case highlights the development of the telemedicine offering and the period that is covered spans from the launch of the Discovery DrConnect platform in 2017 to April 2020. Adrian Moss is the protagonist in the case. He is a manager in the Special Projects, Digital Health team of Discovery Health, responsible for the DrConnect project. His challenge is how to raise more awareness of the DrConnect offering and how to enhance uptake from doctors and patients. COVID-19 and the lockdown in South Africa in March and April of 2020 presented an opportunity for both doctors and patients to use telemedicine as a new way of engagement and treatment.

This case is appropriate for masters, MBA and executive education students focusing on the fields of study of environment of business, strategy, business model innovation and social entrepreneurship.

Teaching Notes are available for educators only.

CSS: 11 Strategy.

The case is based on data collected from in-depth interviews, and from company, third-party and regulatory–agency documents. In addition to prior conversations over several years between the company founders and the lead case writer, there were several rounds of interviews in 2023 with the surviving founder and in-depth interviews with eight of the company’s key managers. Company documents reviewed included bylaws, organization charts, profit and loss statements and staffing statistics, all from founding to sale. Also reviewed were documents and evaluations of company operations and performance produced by the merger & acquisition firm that handled the company’s eventual sale. The company owner insisted on complete disguise of the company and all its members and prohibited disclosure of detailed proprietary financial data.

At the strategic level, this case is about how the unique, complex and changing healthcare environment created opportunities and threats to which a women-owned and run start-up company, Aloe Health (AH), had to respond to become and remain successful. At the personal level, the case illustrates what it takes for an entrepreneur and leader having clinical but no real business acumen to start, expand and turn around a company and ultimately position it for a successful acquisition, continually learning and adapting along the way.

The case describes how two women who were friends for many years started up a home healthcare company later in their lives and grew it into the largest women-owned business of its kind in the USA. Based in the Southwest USA, an area with many factors conducive to success, they navigated the many complexities of US Medicare regulations to create a fully-integrated home healthcare company providing unskilled personal care, medically skilled homecare and end-of-life hospice services to thousands of clients. The case provides background on the founders and the home healthcare industry context, and details the steps taken to start up and build the company into a fairly successful enterprise; one of the largest of its kind in the region. The (A) case ends with one of the founders facing a crisis brought on by the death of her co-founder and the revelation of some significant organization dysfunctions, leaving her unable to profitably exit the company and unsure of whether she would be able to turn things around. The students are tasked with making recommendations for what she should do next.

The (B) case brings events up to fall 2023, describing the steps the surviving founder took to transform her leadership style and the company’s systems and culture, and to navigate the due diligence process associated with preparing for an (ultimately very successful) acquisition. It also shares the owner’s “lessons learned,” and briefly notes the current state of the acquired company and the many AH employees that it continues to employ.

The case provides ample information for students to appreciate the company’s strategy and the challenges of operating in the highly regulated health care industry. However, it is probably even better suited to illustrating the “soft” issues of new-venture management, such as the tendencies of founders to overload themselves by micro-managing their growing venture and not adapting to expansion, and for those with clinical backgrounds to focus on caring for patients and employees while overlooking business essentials and organization systems. It also illustrates how business partnerships among strong-willed individuals can produce dynamics in the founding team similar to a “marriage,” with affection and complementary talents, yet also tensions. It further illustrates the process of a successful turnaround strategy, and the “due-diligence” challenges of preparing for an acquisition.

This case has a range of course applications at multiple education levels. Although it is probably best suited for graduate and executive-level programs, it can also be selectively used in undergraduate classes, particularly if populated by upperclassman. It is ideally suited to courses on entrepreneurship and on healthcare management. For an entrepreneurship course, it could be positioned mid-way through the semester, after covering topics relating to the entrepreneurial mindset, founding teams and business models. It can be used to get the class focusing on competitive issues and the challenges of starting up a company in a highly regulated environment, on entrepreneurial founding-team characteristics and management tendencies (e.g. micro-management control tendencies), on transition issues from start up to growth stages and on exit strategies.

We believe this case is also well suited as a teaching exercise for students pursuing healthcare management studies in baccalaureate and graduate programs (MBA, MHA, MHS) in which instructors wish to broaden student exposure to a real-world scenario that focuses on entrepreneurial behavior in a healthcare setting (a topic of increasing interest to healthcare practitioners and managers given the current trend toward provider formation and ownership of health facilities). Here, the case may be used to focus on the complexities of the healthcare industry, the key differences between various healthcare service business models and on the challenges that technically (clinically) trained professionals often face when trying to manage a healthcare business. Ideal placement of the case would be in a capstone course, after students have been introduced to their functional coursework in topics such as introduction to management, organizational behavior and leadership, financial management and strategic thinking. The case also challenges students to apply knowledge obtained in specialized coursework in healthcare systems and policy, industry regulation, as well as healthcare reimbursement methods.

The case also may be used in organization behavior courses to focus on team, cultural and leadership issues and in strategic management courses to focus on strategy implementation. In addition, there are enough family business themes in the case (even though Aloe is not actually a family business) to use it in a course on managing family businesses.