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Public Health; Leadership; Organisational Development; Organisational Behaviour; Public Administration Management.

Postgraduate level for honours or masters programmes in courses on public health; executive leadership and management programmes; MBA level.

The case unpacks decentralisation as a means to promote and improve local decision-making and accountability through community participation and engagements. Ayanda Nkele was a programme manager in a health district in South Africa. He was faced with many challenges when trying to implement his programme, most of which were related to local authority, responsibilities and decision-making abilities at his level. This case describes briefly the South African health system. and how it functions. It describes the proposed changes to the health system and its transformation towards Universal Health Coverage. The decision space analysis as discussed in the case illustrates the types of decentralisation in the country and how this also applies to Nkele’s level.

Understanding the concepts and principles of decentralisation within the context of strengthening district health services, the re-engineering of primary health care (PHC) and rolling out a National Health Insurance in South Africa. Applying the “decision space” approach to analyse the extent of decentralisation. Grasping the requirement of leaders to be “contextually intelligent” and identify the important contextual variables to take into account when analysing public health care.

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CSS 7: Management Science.

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.

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.

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

CSS: 10: Public Sector management.

This case looks at a new start-up company, d.light Design, as it was seeking to go to market in India with its solar-powered LED lamps in 2009. Sam Goldman, founder and chief customer officer of d.light, was in New Delhi, India; his business-school friend and co-founder Ned Tozun was in China, the site of the company's manufacturing plant.

One of the key decisions Goldman and Tozun needed to make was whether d.light should focus on just one distribution channel in India, or multiple channels. The startup had limited capital, so it needed to get the distribution question right to generate revenue quickly.

The case thus combines an entrepreneurial problem with an emerging-market, or bottom-of-the-pyramid, channel design challenge. This case does not focus on product design or manufacturing challenges but rather on questions of:

• The constraints d.light faced in creating an aligned distribution channel. These constraints can have legal, environmental, and/or managerial foundations

• Demand-side misalignments in the channel structure that will occur if d.light chooses one or another of the considered channels in the case, namely, (a) the RE (rural entrepreneur) channel, (b) the village retailer channel, or (c) the centralized shops channel

• • What mix of channels—or what single channel—d.light should focus on in the Indian market

• • The financial return possible based on d.light's current cost structure and overhead expenditures in India

The constraints d.light faced in creating an aligned distribution channel. These constraints can have legal, environmental, and/or managerial foundations

Demand-side misalignments in the channel structure that will occur if d.light chooses one or another of the considered channels in the case, namely, (a) the RE (rural entrepreneur) channel, (b) the village retailer channel, or (c) the centralized shops channel

• What mix of channels—or what single channel—d.light should focus on in the Indian market

• The financial return possible based on d.light's current cost structure and overhead expenditures in India

• Assess channel benefit demand intensities for chosen target market segments

• Assess channel alignment constraints that can limit the channel designer's ability to optimize the channel to meet identified end-user demands for channel benefits

• Use these ideas to defend a choice of one or more possible channel structures as appropriate parts of a company's overall channel system

• Analyze financial opportunity in this situation, given cost parameters and possible market penetration estimates

Assess channel benefit demand intensities for chosen target market segments

Assess channel alignment constraints that can limit the channel designer's ability to optimize the channel to meet identified end-user demands for channel benefits

Use these ideas to defend a choice of one or more possible channel structures as appropriate parts of a company's overall channel system

Analyze financial opportunity in this situation, given cost parameters and possible market penetration estimates

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

Teaching notes are available for educators only.

CSS 2: Built Environment.

This case study is designed to enable students to analyze the competitive landscape of a business impacted by technological disruption; evaluate the viability of an organic growth strategy using stakeholder analysis; evaluate the revenue and cost structure of Apollo 24/7 and decide on the future investment strategy; and analyze funding strategies of traditional hospitals versus pure digital players.

To extend its reach, Apollo Hospitals Enterprise (Apollo Hospitals), a leading private sector brick-and-mortar hospital chain in India known for using state-of-the-art technology, launched a unified virtual mobile platform Apollo 24/7 in February 2020, 45 days into the COVID-19 pandemic. The management believed that the digital platform had a unique ecosystem that could not be replicated. The analysts were optimistic about the impact of the decision on the future performance of Apollo Hospitals, as it was expected to lead to higher penetration and increased revenue. They also anticipated the unlocking of value, as and when the venture capitalist (VC) would invest in Apollo Hospitals. However, with increasing operating expenses on account of burgeoning technological and marketing expenses, things did not seem to go going as planned. Three years later, in February 2022 after the Q3 of financial year 2023 results. Suneeta Reddy, the company’s managing director found herself pondering whether the digital platform could boost Apollo Hospitals’ profitability in addition to expanding its reach and increasing affordability when the company missed the analyst estimates. In India, which was then the second most populous country, “incremental access” and “affordability” were what mattered to the patients, However, for the investors and analysts, it was quarter-on-quarter performance. The change in the macroeconomic environment stalled the company’s plan of raising money from VCs.

Furthermore, the financing dilemma also plagued Reddy. She knew there was a difference between financing for conventional businesses that for digital businesses. She also had to take decide between short-term profitability with which investors were obsessed versus long-term sustainability, which involved taking care of stakeholders’ interests.

This case study is basically aimed at postgraduate courses and executive management courses.

Teaching notes are available for educators only.

CSS11: Strategy.

The year 2010 was coming to a close, and Kapil, Marketing Manager of GEF India Private Limited (GEF), was thinking about the future. He had drafted a brief (see Exhibit 1) on conducting market research to assess the health of the brand Freedom Refined Sunflower Oil, which GEF had launched in the southern Indian state of Andhra Pradesh (AP) in February of that year.1 Kapil was very happy to note that the brand had achieved good sales, in fact, significantly higher sales than the target set for the launch. This had been achieved thanks to a well-thought-out launch plan that had included considerably more above the line (ATL) marketing expenditure than any of the competing brands in the market. He was interested in finding out whether and where exactly the brand had taken root in the minds of consumers. Another important purpose of the proposed market research was to assess the effectiveness of the launch plan. Above all, he felt it would provide valuable insights when he set out to prepare a marketing plan for the coming year.

Milaap is a popular medical crowdfunding platform in India, enabling interaction between those who want to raise funds and those who want to donate. To achieve the critical mass Milaap had to increase the trust among the donors and ensure a higher success rate of the campaigns. Milaap provided two types of services: Do it Yourself (DIY), and Supported Campaign (SC). Milaap charged 5% of the raised amount from the DIY campaigns and 15% of the raised amount from the SC. Overall the chances of success were high in the SC. The case explores the dilemma of type of service to be prioritized.

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.

Teaching notes are available for educators only.

CSS: 3 Entrepreneurship.

This case is the second of a three-part series that follows the managerial, strategic, and communications decisions of the Swachh Bharat Mission (SBM) or Clean India Mission, the flagship programme of the Government of India to eliminate the practice of open defecation (i.e., not using a toilet) from 2014 to 2019. As of 2014, 550 million people in India practiced open defecation. This problem posed a massive public health hazard and economic drag for the country as well as a threat to global health. Written from an insider's perspective, the cases centre on the decisions made by a new Secretary of India's Ministry of Drinking Water and Sanitation, who was hired to manage SBM, and the team he assembled. Case B discusses the start-up challenges for SBM, including implementation in India's complex federal system, workplace culture, and the deep-rooted behaviour of open defecation in rural India and the managerial and communication strategies formulated to address them. The case concludes by framing the difficulties with slow-moving states and monitoring rigour that the leadership SBM, with a new team, strategic focus, and early momentum, faced as the mission entered its final two years.