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For discussion of social entrepreneurship in middle-income economies, emerging markets generally and Africa, specifically, Quali Health presents interesting questions about entrepreneurial funding, scaling and the interplay between social entrepreneurial activities and the informal sector.

South Africa’s primary health outcomes do not correspond to the country’s spending on public health, with South Africa ranking among the worst globally in the incidence of tuberculosis, HIV prevalence, infant mortality and life expectancy. In part, this poor outcome can be explained by high inequality in access to healthcare, which reflects South Africa’s grossly skewed income and wealth distributions, with the bulk of the country’s population reliant upon an underfunded, inefficient and poorly managed public health system. This substandard service for the working poor in South Africa’s townships with high population densities offered a profitable entrepreneurial opportunity to provide affordable and effective primary care with vast gains in quality and outcomes improved dignity for patients. After receiving her MBA, physician and entrepreneur Dr Nthabiseng Legoete self-funded the launch of Quali Health in 2017. The business model set out to disrupt healthcare delivery for South Africa’s poorest citizens. Drawing patients from the working poor in Diepsloot, Quali Health’s inaugural site was cash flow positive within five months when the facility hit only 30% of installed service capacity. With quick success, Dr Legoete faced the strategic question of how fast to scale and finance the expansion. She also considered a new micro-insurance product for her clientele.

For discussion of social entrepreneurship in middle-income economies, emerging markets generally and Africa, specifically, Quali Health presents interesting questions about entrepreneurial funding, scaling and the interplay between social entrepreneurial activities and the informal sector.

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CSS: 3 Entrepreneurship.

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.

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CSS: 10 Public Sector Management.

This case was developed from secondary sources. The secondary sources included company websites, social media and news reports. This case has been classroom tested in multiple executive master of business administration (MBA) courses on business model innovation and entrepreneurship.

The case traces the entrepreneurial journey of Dozee, a remote patient monitoring system in India. Dozee was manufactured by Turtle Shell Technologies Private Limited, cofounded by Mudit and Gaurav. The primary customers of Dozee’s offering were households with elderly citizens and health-conscious individuals who sought preventive health care. The cofounders identified the unmet need for a convenient and user-friendly contactless health tracker. Dozee team built a thin sensor-embedded sheet and module that can be placed beneath the mattress to track sleep patterns and health vitals. They also provided data analysis and data interpretation services. After four years of conceptualization, Dozee launched its product and service in 2019. Although the initial response was lukewarm, the onset of the COVID-19 crisis led to significant changes in the health-care industry. Demand for virtual assistance and contactless monitoring devices became increasingly important elements of COVID-19 treatment. Unlike other sensor-based fitness trackers, the sheet could be easily placed under the patient’s bed to capture health vitals. Choosing to pivot from a home-based individual customer segment to a medical-grade device provider for hospitals could significantly increase the scale and scope of the offering for Dozee, but it would also place Dozee in direct competition with other health monitoring devices from different business categories.

This case is appropriate for MBA and executive-level courses related to entrepreneurship and business model innovation. The case explores issues such as digital disruption and how start-ups can design a go-to-market strategy. The case works well in the classroom, even if people are unfamiliar with the health-care industry. Participants can certainly relate to the concept of adopting artificial intelligence–enabled devices for monitoring their health. The instructor should be able to quickly engage participants in a lively discussion about Dozee’s vision and the opportunities and challenges in adopting digital solutions in health care.

This case study was developed using data from secondary sources. The data was collected from the organization’s website, annual reports, press releases, published reports and documents available on the internet.

According to the International Energy Agency’s (IEA) World Energy Outlook (WEO), 775 million people worldwide would not have access to electricity even by 2022, with the majority of them living in sub-Saharan Africa (SSA) (Cozzi et al., 2022). In SSA, energy poverty had been a serious issue over the years. According to the IEA, 600 million people lacked access to electricity in 2019, while 900 million people cooked with traditional fuels (Cozzi et al., 2022). A World Bank report from 2018 said many SSA countries had energy access levels of less than 25% (Cozzi et al., 2022). Energy poverty in SSA hampered sustainable development and economic growth.

Despite significant efforts to address this poverty, Africa remained the continent with the lowest energy density in the world. Although solar and other energy-saving products were appealing, their adoption rates were modest, and their distribution strategies were not particularly effective. The lack of electricity exacerbated a number of socioeconomic problems, as it increased the demand for and use of wood fuel, which caused serious health problems and environmental harm.

While working in Uganda, Katherine Lucey (Lucey) saw that having no electricity had negatively affected women’s health in particular because it was women who were responsible for taking care of the home. These effects were both direct and indirect. The women’s reliance on potentially harmful fuels for cooking, such as firewood and charcoal, resulted in their suffering from respiratory and eye problems, in addition to other health issues. Furthermore, the distribution of energy-saving and renewable energy items was seen as the domain of men, and there was an inherent gender bias in energy decisions. Women were not encouraged to participate in energy decisions, despite the fact that they were the ones managing the home and would gain from doing so. In addition, because there was no light after dusk, people worked less efficiently. Lucey saw the economic and social difficulties that electricity poverty caused for women in rural Africa. She also witnessed how the lives of a few families and organizations changed after they started using solar products. This motivated her to start Solar Sister with the mission of achieving a sustainable, scalable impact model for expanding access to clean energy and creating economic opportunities for women.

Solar Sister collaborated with local women and women-centric organizations to leverage the existing network. Women were trained, provided all the necessary support and encouraged to become Solar Sister Entrepreneurs and sell solar products in their communities and earn a commission on each sale. To provide clean energy at their customers’ doorstep, the Solar Sister Entrepreneurs received a “business in a bag” – a start-up kit containing inventory, training and marketing assistance.

Solar Sister’s business model empowered the women in SSA by providing them with an entrepreneurship opportunity and financial independence. Also, the use of solar products helped them shift from using hazardous conventional cooking fuels and lead a healthy life. The children in their households were able to study after sunset, and people in the community became more productive with access to clean energy.

The COVID-19 pandemic outbreak, however, had a serious impact on Solar Sister. It found it challenging to mentor and encourage new business owners due to restrictions on travel and on group gatherings. The Solar Sisters were unable to do business outside the house either. Their source of income, which they relied on to support their families, was therefore impacted. The COVID-19 outbreak also slowed down the progress achieved by the community over the years and made household energy purchasing power worse. Furthermore, the organization was also grappling with other issues like limited access to capital, lack of awareness and infrastructural challenges. Another challenge lay in monitoring and evaluating the organization’s impact on the last mile.

In the absence of standardized measurement tools and issues in determining the social impact of Solar Sister, it would be interesting to see what approach Lucey will take to measure the impact of Solar Sister on the society. What measurement tool/s will Lucey implement to gauge the social impact of Solar Sister?

This case is intended for use in PG/Executive-level programs as part of a course on Social Entrepreneurship and Sustainability.

Need for preventive health care: To comprehend the contribution of preventive health care in improving the health quotient. Sri Sathya Sai Sanjeevani Hospital (SSSSH) and its initiative is an apt example of the wonder which preventive care can bring in the context of rural health. Community participation: The case can be instrumental in showing the pathway to encourage community involvement in mainstream health by promoting the holistic model of SSSSH that understands mothers and children's health profile and needs, especially in the unreached rural segments of an emerging economy like India. Importance of healthy childhood: World Health Organization (WHO) promotes the school health programme to prevent health risks among children by inculcating healthy behaviours during childhood. The successful SSSSH model proves that it is implementable by integrating comprehensive health education modules in the existing institutions for medical care.

The challenge of a healthy childhood is inadequate availability and accessibility of quality care. Non-awareness of the parents is also a significant reason for the children who miss the benefit of a happy childhood. While much is planned by the Government and some part of it being executed, this case highlights the effectiveness of the maternal and child health programme executed by the Sri Sathya Sai Sanjeevani Hospital (SSSSH). This initiative fulfills the dire need of ensuring the preventive healthcare component leading to safe motherhood and safe birth of healthy children. Further, the case is also the culmination of pin-pointed innovative awareness activities such as school health screening and the Divine Mother and Child Health Program (DMCHP). It opens up the discussion on the current model of health care followed by SSSSH, Raipur, and its impact in the local areas to decide on its expansion across the country for nationwide implementation.

Bachelors in Business Administration, MBA, Executive MBA, Post Graduate Diploma in Healthcare Management

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CSS 2: Built Environment.

Marketing: New Service Launch; Relationship Marketing; Direct Marketing.

This case could be taught in marketing management, services marketing or strategy courses, in the product development or service launch modules at the graduate level; alternatively it could also be used in the promotion module for the illustration of direct marketing (DM) tool application; and it could also be used as a capstone case for the introductory Principles of Marketing course at the undergraduate level.

The case examines the launch of a new air ambulance service in Karachi, Pakistan; a venture of Akbar Group Jet services; Princely Jets (Pvt) Ltd. The case describes the first mover advantage of the service and the marketing strategy recommended by the Chief Executive Officer (CEO), Mr Ghouse Akbar. The major concern is whether the strategy is forceful and compelling enough to secure approval from the board. The major issues include the role of DM processes and relationship marketing tools to encourage a value-added premium service which had no precedence of demand and practice. Concepts to thrash out in class also include customer profiling and segmentation along with how best to create awareness and generate a sustainable basket of customers for the high-price value-added low-use service.

Discuss and illustrate the importance and benefit of market research information for making a decision; how to create awareness and customer recognition and cultivate demand for a new and unsolicited service; identify appropriate and effective promotion tools to achieve required customer demand, brand recognition and customer value; how to launch a premium priced unsolicited service in a niche market?; and exhibit the synthesis of the four P's in a new product launch marketing strategy.

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Public Sector Management.

MBA or postgraduate program courses in public policy and management. MBA or postgraduate program courses on social innovation, social entrepreneurship and public or collective entrepreneurship. Management development programs for public policy professionals, non-governmental organizations and social enterprises.

Despite several country-wide campaigns to improve sanitation levels, India continues to be the country with the highest number of people, over 600 million, practicing open defecation. This case outlines the Sabar Shouchagar Project (Toilets for Everyone) undertaken by the District Administration of Nadia District in West Bengal that transformed the region into the first open-defecation-free district in India. The case begins with providing the context of the problem of open defecation, why it has been hard to eliminate and how undertaking a project to eliminate open-defecation-free practices has myriad institutional and economic challenges. The case then details the conceptualization and execution of the complex Sabar Shouchagar Project which involved a loose coalition of various state programs and civil society organizations. The case ends with questions on the continuity of this project beyond the tenure of the current District Magistrate and on the replicability of such an ambitious project in other parts of the country. The setting of this case, a government agency, is different than most cases and provides an opportunity for students to talk about a state agency and its interstices with civil society. This case explores how to create change through large government machinery and allows the student to explore aspects of social mobilization, social change and social innovation. If taught within a postgraduate or MBA program, the case would serve well to dispel stereotypes and biases about government bureaucracies (such as slow timelines, limited efficacy of projects and so on).

After discussion and analysis of the case, students will be able to: appreciate how administrators within a large government bureaucracy address an ambitious and complex public health issue in a developing world context. Understand the on-the-ground challenges that arise when a change agent pursues a worthwhile goal. There are difficulties such as getting resources beyond what a government office has access to, getting alignments between different key actors within the local community and forging coalitions. Understand initiatives for social transformation within a developing country context. Specifically, the case unpacks the cultural, political, economic contexts that determine how social innovations may be pursued. Understand capacity-building and change management. Evaluate efforts required to sustain social change efforts and the challenges and pathways with respect to replication of successful social change projects in other geographies. Appreciate the design of civic engagement practices in public policy implementation.

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CSS: 10: Public Sector management.

The learning outcomes of this case study are to understand the business-to-business (B2B) consumer outlook on mental health care in emerging markets; analyse the challenges faced in creating a need for mental health care in Indian workplaces; explore the business attractiveness of the B2B model and understand the business potential of the B2B segment at heyy,; and contemplate different innovative strategies that could change consumer mindset on mental health care in emerging markets.

Ankit, the founder and CEO of heyy, was facing a conundrum. “heyy,” was built on normalizing mental well-being at workplaces. His mental health-care app heyy, had crossed 50,000 subscribers within a few months of launch. The mobile app was designed to spread mental health awareness and provide various levels of mental well-being interventions. Business-to-consumer and B2B customer segmentation had been targeted by this start-up. The B2B space consisted of employees working with partner organizations. The adoption rates of employees using the features of heyy, declined after the initial app download. The employees had yet to fully become acclimatized to the features of heyy,. Exploring the business potential and investigating the business attractiveness of the B2B segment were the focus of the present study. Ankit contemplated various strategies he could adopt to increase user adoption of “heyy,” services by employees in his partner organizations. The case study strives to address the question – “What are the risks faced by organizations when entering the mental health-care industry in emerging markets like India, where mental health care is still not openly discussed?”

This case study is designed to be taught as part of the “entrepreneurship development” and “strategic management” courses for undergraduates, postgraduates and students of executive programmes in management. Students need to be aware of basic strategic management concepts such as BCG matrix, SWOT analysis and business canvas before working on this case study, so they could dissect the case from multiple perspectives to get a comprehensive outlook on the case.

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CSS 11: Strategy.

This descriptive case study applies economic concepts to an issue of public policy, and helps build students’ critical thinking, analytical and quantitative skills. The case addresses a variety of topics typically taught in microeconomics and public economics courses. Topics most prominently represented in the case include elasticity of demand and supply, tax policy, tax incidence and negative externalities. Theoretical basis for each topic is laid out in the discussion section of the instructors’ manual, along with insights from student responses. The core nature of the concepts covered in this case study allows it to be integrated with common economics textbooks.

This descriptive case is based on critical economic analysis of secondary sources.

This case study focuses on the imposition of the controversial “soda tax” on sweetened beverages in the City of Philadelphia in 2017 and considers the economic lessons that can be learned from Philadelphia’s experience with the tax. The tax was proposed as a way to raise the city’s revenue while reducing obesity. After the tax was enacted, the sales of sweetened beverages declined in the city, but increased outside the city’s borders. The receipts from the tax have been below projections.

Learning outcomes covered by the case are typical for a microeconomics, public economics or managerial economics course. The appropriate course levels range from the principles to the MBA level of the economics and business curriculum. Discussion questions may be selected to fit a specific course focus and level. The instructors’ manual outlines question sets suitable for various types of economics courses.

Social entrepreneurship, Business Strategy.

MBA/MS.

The case discusses about Evans Wadongo, a Kenya-born engineer and social entrepreneur, and his efforts of lighting up the rural communities of Kenya through his MwangBora solar lanterns. Wadongo through his social enterprise Sustainable Development for All-Kenya (SDFA-Kenya) economically empowered women, educated children and empowered youth by creating employment opportunities for them. By 2012, SDFA-Kenya had successfully impacted the lives of 1,20,000 people, benefited more than 60 community groups and set up around 30 economic ventures.

Concept of social entrepreneurship, business model innovation, product innovation, bottom of the pyramid as a market, sustainable development, triple bottom line.

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