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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 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.

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.

It is January 2014, and the case protagonist, David Milestone (senior advisor at the Center for Accelerating Innovation and Impact at the U.S. Agency for International Development's Global Health Bureau), is preparing for a meeting of global stakeholders and pharmaceutical manufacturers who are interested in reducing mortality caused by childhood pneumonia and are prepared to donate $10 million to support this effort.

Milestone's goal is to propose a strategy to address childhood pneumonia in Uganda, toward which the $10 million donation would go. In addition to effectively and sustainably reducing childhood pneumonia deaths, the plan must align the interests of various stakeholders behind the problem. A successful strategy in Uganda could be a model for interventions elsewhere. The United Nations Commission on Lifesaving Commodities for Women and Children recently identified Uganda as a “pathfinder” country, meaning it could serve as the example for other countries wrestling with the same issues. This is a remarkable opportunity to change the lives of children in Uganda—and all around the world.

After reading and analyzing the case, students will be able to:

• Perform a stakeholder analysis

• Appreciate the challenges involved in improving public health, especially in developing countries

• Create a patient journey and use it to identify potential impact points

Perform a stakeholder analysis

Appreciate the challenges involved in improving public health, especially in developing countries

Create a patient journey and use it to identify potential impact points

GE Healthcare was on a continuous lookout for investing into new and innovative super value products for the Bottom of the Pyramid markets in India. After launching its first successful super value ECG machine Mac 400, GE had recently launched its twenty-fifth super value product a PET CT machine. Serving the BOP markets has its own unique challenges that may be different for each product that is placed in the market. However, GE has so far successfully sailed through all the challenges and developed a steep learning curve about BOP markets. However, it is now facing the challenge of ensuring sustainability of product pipeline. The company is also keen to exploit the opportunities for reverse innovation that super value products have provided. The company also wants to assess the disruptive impact of these products in domestic medical device markets as well as markets outside India.

In the 1960s thalidomide, a popular new drug considered to be safe and effective, was revealed to cause severe nerve damage and birth defects in newborn infants, prompting health officials to ban the use of the drug and tighten overall restrictions on new drugs and drug use. Twenty years later, after recognizing the positive effects of thalidomide when treating patients with leprosy and its potential role in the treatment of certain types of cancer and cases of HIV/AIDS, the Celgene corporation would be forced to contend with stringent FDA regulations, liability concerns, public skepticism, and poor mass media portrayal in order to secure the drug's approval.

To illustrate how regulators are subject to political pressure, which companies much recognize and consider when making business decisions.

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.

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.

Teaching objective 1: To flourish and explore the current business model to get socioeconomic benefits from organic farming compared to conventional farming; in the context of hill farming. Teaching objective 2: To explore and design innovative entrepreneurship opportunities in the field of organic farming and how these opportunities can be seized by using managerial skills. Teaching objective 3: To analyze the economic benefits of organic farming compared to conventional farming.

Manj Gaon is a small village in the Tehri Garhwal district of Uttarakhand. This village serves as the Uttarakhand Organic Commodity Board’s training facility. Organic farming was the primary source of income for farmers in the late 1970s, but the Green Revolution in India had a negative impact on agriculture, the environment and the economy of the country. After the Green Revolution, the agriculture sector was completely dominated by conventional farming, and the use of chemical fertilizers, pesticides and insecticides affected the village to some extent. But farmers like Bhagchand Ramola paved the way for other farmers to grow and shine through organic farming. The organic farming model developed by Ramola was helping farmers and society in several aspects, such as the economy, health and the environment. A self-developed organic farming model had been generating fair revenue for the farmers and uplifting their socioeconomic status as compared to conventional farming. Complete adoption of organic farming in the village requires an analysis in terms of sustainable economic growth. However, there was a certain dilemma that was stifling the growth of the newly adopted business model because farmers were dependent only on Japanese buyers and input providers. So, there was a huge need to tie up with other consulates across the country. Secondly, expanding a business model requires more input and output in terms of manpower and revenue, so persuading conventional farmers to adopt the organic farming model was quite a challenge for Ramola.

The case can be taught to the MBA-level students.

Teaching notes are available for educators only.

CSS 11: Strategy.