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The learning outcomes are to understand the definition of public value and the strategic drivers behind public value creation, understand the nature of social innovation in the public sector, identify the critical opportunities and challenges involved in sustaining innovation in the public sector and identify the role that non-profit organizations can play in supporting and sustaining social innovation.

This case puts participants in the shoes of a global health innovator’s leadership team as the organization approaches a funding crisis. The organization, VillageReach, is on a quest to expand across the public health system of Mozambique and experiences a funding dilemma. The case reveals the challenges of working with governments to achieve large-scale, systemic change. It explores the conundrum of using international donor funding to embed new practices in government service delivery. Ultimately, it asks participants to choose between the pursuit of new, small-scale innovative projects and the large-scale rollout of a national programme.

This teaching case is written for courses focused on social entrepreneurship, social innovation and social change. It can also be used in courses focused on non-profit management and public sector innovation. Specifically, the teaching case is suitable for two audiences: social enterprise and non-profit managers focused on strategy, development and operations (the case focuses on an enterprise that relies primarily on donor funding) and health-care managers and administrators. Generally, the case is suitable for undergraduates in their final year of study as well as graduate-level business and public administration courses, including MBA, MPH, MPA, EMBA and Executive Education courses.

Teaching Notes are available for educators only.

CSS 3: Entrepreneurship.

The case and discussion questions posed will allow the instructors the opportunity to introduce critical strategic concepts from strategic, nonprofit management and social enterprise literature. Specifically, (1) strategic transformation: countering drift and anticipating future trends and crises; (2) types of leadership: transactional versus transformational; (3) hybridity and mission drift; and (4) nonprofit funding models, the starvation cycle and the overhead myth.

Both primary and secondary sources have been used to prepare the case. The first two authors had the opportunity to interview Thomas Tighe, Direct Relief’s (DR) President and CEO in July of 2019. The interview lasted one hour and was transcribed by one of the authors and reviewed by the other two authors for accuracy. In addition, the authors conducted nonparticipant observations in DR’s headquarters in Santa Barbara (California). Given the longevity and media exposure of the organization, extensive internal and external archival data was also available for the analysis.

This real and undisguised case is based on DR, a +70-year-old humanitarian $1.2bn nonprofit organization headquartered in California (USA). From its headquarters in Santa Barbara, DR responds to emergencies and delivers medical support for vulnerable people affected by poverty, natural disasters and civil unrest in all 50 US states, six US territories including Puerto Rico and US Virgin Islands, and in more than 90 countries.

The case presents Thomas Tighe, DR’s President and CEO, reflecting in late 2018 on the transformation and growth that the organization had experienced since he started his tenure in 2000. Specifically, he is considering the most effective way to allocate an unrestricted recent cash donation. Should DR spend that money on traditional fundraising, reducing its efficiency rate, or should DR take a long-term approach and use the funds to build long-term capabilities? In addition, the case outlines the history and evolution of DR over its more than 70 years of existence, the CEO’s background and motivations, as well as a detailed description of the organization’s revenue portfolio. Students will have an opportunity to learn about a unique nonprofit named among “the world’s most non-for-profit organizations” by Fast Company; DR was also included in the Charity Navigator’s list of the “10 Best Charities Everyone’s Heard of.” In addition, in January 2009, DR was designated as a Verified-Accredited Distributor by The National Association of Boards of Pharmacy, which placed it as the first nonprofit to receive this designation to deliver prescription medicines to all 50 US states. Throughout Tighe’s tenure, DR had been lauded for its fundraising efficiency. The unique distinction to DR’s efficiency is its tradition of adopting new technologies and modern business practices for humanitarian purposes.

Students will learn how DR, under the leadership of Thomas Tighe, reinvented and reinforced the organization’s traditions to retain high levels of efficiency in the face of an ever-larger organizational scale, public scrutiny and demand for humanitarian support across the world. Students will witness many strategic and operational tenets that they may be more familiar with from the for-profit world. The case also will help students to understand the concept of hybrid organizations and different nonprofit funding models.

The case has been written to be used in graduate Nonprofit Leadership Management and Social Entrepreneurship courses. Given the scope and implications, the case could also be used on an upper-level strategy course. To maximize students’ learning, the case should be introduced halfway into the course after students have a solid understanding of what nonprofits are and how they operate. If students are not familiar with some of the concepts introduced in the analysis, the proposed readings will prepare them for a more fruitful discussion.

Entrepreneurship; Strategy.

The case is meant for Undergraduate and Postgraduate students pursuing entrepreneurship and management with specializations in strategy. It can be also used for Entrepreneurship and Management Development programs for generating an insight into strategic planning, organic growth of enterprise and the formulation of a future road map. The case can be used in courses like “strategic management”, “female entrepreneurship” and specialization courses like “Start-up: Ideation, Launching, Managing and Growth”.

Simran Sahni and Sachin Sahni, the owner and co-founders of health, beauty and slimming center are currently running centers in Lucknow and Ludhiana. Although as of now there is no operational franchisee provided by Health Zone in any of the other cities across the country, the owners have a vision to open around 100 franchised and company owned centers across the country. At this juncture, both the co-founders, who also happen to be husband and wife, look forward to understanding and revisiting the operations and strategies at Health Zone to formulate the road map for the future.

The participants will be able to identify key challenges for service organizations and will learn ways to meet these challenges. The participants will be able to identify motivation and retention strategies applied by the co-owners in their organization. The participants will be able to have an insight on the key elements of the Business Model of a service organization based in the wellness industry. The participants will be able to analyze the opportunities available for new startups in the wellness industry drawing their conclusions from experiences and business development and expansion of Health Zone in its overall journey. Participants will be able to devise models for the enterprise so as to help it grow and expand its operations nationally.

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 was based on both primary and secondary data. In-depth semidirected interviews were conducted in 2021–2022 after receiving the institutional research board approval. The interviews took an approximate time ranging from 90 to 120 min. They were recorded and transcribed. A thematic analysis was undertaken to identify the most relevant themes for the case. The secondary sources used included various websites, scholarly and trade journals, as well as specific databases, such as Statista.

The case exposes students in multiple disciplines to the challenges created by the COVID-19 crisis at Yale School of Medicine (YSM). It describes its remarkable effects on organizational and community members as they struggled to reimagine more inclusive and supportive spaces. As one of the most severe crises humanity has ever witnessed, COVID-19 exacerbated the existing struggles of the underrepresented communities, creating a double pandemic. It has also amplified inequities among marginalized groups including black, indigenous and people of color; women; immigrants; lesbian, gay, bisexual, transgender, queer/questioning; people with different abilities; working parents; single parents; religious minorities; and people with low income. When COVID-19 hit in 2020, Yale University School of Medicine (YSM), like other pioneering schools in the field of health care, doubled their efforts to face both the public health crisis and the substantial social turmoil (racial tensions after the death of George Floyd, food insecurity, vaccine resistance, social inequalities, etc.). Professor Marietta Vazquez, MD, who was the first Latina to be named Associate Dean for Medical Students Diversity at YSM, launched with Dr Latimore (Chief Diversity Officer) and her other colleagues many strategic initiatives aiming at improving the diversity, equity and inclusion of organizational and community members.

The case is an invitation to graduate students and students in executive education programs to reflect on the grand challenges leaders faced at YSM as well as in other institutions across the nation and the globe. It is also a call to reimagine ways leaders can accelerate the pace of change in their organizational ecosystems.

This case was written for use in graduate-level courses, including executive education dealing with Diversity, Equity, Inclusion and Belonging, Leadership and Change, Health-Care Equity/Policy, Health Sciences, Human Resource Management, Organizational Behavior, Crisis Management, Sustainability, Business and Society, Social Issues in Management, Strategy, etc. Faculty members can easily adapt the case to fit the content of the course they teach, the students’ context as well as the specific learning outcomes to be achieved.

The learning objectives have been prepared following Bloom’s taxonomy (Bloom et al., 1956). After completing the case study, the students will be able to identify and recall the prerequisites necessary for establishing a pathology laboratory. (knowledge); analyze the micro- and macroenvironmental factors considered by Mr Sabihul Haque in the development of the strategic plan for Healthcare Laboratories (HCL) (knowledge and application); explain the key components of the Porter’s value chain and their significance in the operation of HCL (comprehension and evaluation); use the TOWS analysis to map the internal strengths, weaknesses, opportunities and threats of HCL (application and synthesis); and analyze the challenges faced by protagonist in managing HCL and generate suggestions for addressing the challenges (analysis and synthesis).

HCL, an enterprise established in 2018 in Sahdeo Khap, Gaya, Bihar, India, aims to provide high-quality pathological diagnostic services in semi-urban and rural areas. This health-care initiative is pioneering, offering pathology services to make high-quality, low-cost diagnostic services accessible in rural India. In rural settings, numerous health-care hurdles make it challenging for individuals to access the care they need. Since its inception, HCL has expanded its reach to connect more areas, facilitating diagnostic services for people in remote regions. The establishment of laboratories in semi-urban areas aims to reduce patient travel time, costs and health risks by bringing services directly to their doorstep. Haque, the chief executive officer of the lab, grappled with multiple challenges, including selecting an appropriate location for the lab, recruiting and retaining skilled workforce, managing logistics supply, collaborating with local health-care providers, dispelling the stigma among the population that superior services are only available in cities and enhancing health literacy in rural communities. Following numerous meetings with Ms Ummati Naiyyer, head of operations, they worked collaboratively to address these challenges, developing a blueprint and future plan to operate services in rural areas. This case study provides insights into the obstacles faced by HCL striving for success in rural areas. It elucidates the beneficial application of the Porter’s value chain, along with an analysis of macro- and microenvironmental factors. Unique challenges such as societal stigma and mistrust are specifically emphasized. Students engaging with this case study will enhance their problem-solving skills through brainstorming and providing recommendations, contributing to potential solutions for HCL’s difficulties.

The teaching notes for the HCL case is designed to enhance the learning experience of undergraduate and graduate students within the context of the course. This case study serves as a valuable teaching tool, allowing students to apply theoretical knowledge to real-world scenarios in the health-care industry. The notes provide a framework for instructors to facilitate discussions, encourage critical thinking and promote a deeper understanding of key concepts related to establishing diagnostic laboratories in rural areas.

Teaching notes are available for educators only.

CSS3: Entrepreneurship.

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.

Impact investing, Social entrepreneurship.

MBA, EMBA, Executive Education.

CareCross Health describes the impact due diligence leading up to an investment into CareCross Health by impact investor Palm Capital. The case follows the protagonist, Caitlin Stevens, CEO of Palm Capital, as she identifies CareCross Health as a potential investment target, performs an initial screening of the company and visits the company and its sites as part of an in-depth impact due diligence.

By the end of this case, the student should be able to consider the critical steps associated with conducting an impact due diligence; understand the challenges associated with conducting an impact due diligence, with a particular focus on due diligence in an emerging market scenario; analyse a potential impact investment, in this case CareCross Health, and make a preliminary recommendation on whether the investment is viable from an impact perspective; identify the trade-offs between private sector and public sector provision of services to low-income groups, and consider unintended consequences in analysing the impact of a social enterprise; and prepare possible scenarios and weigh the potential outcomes of various arrangements to ensure alignment of investor objectives.

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 1: Accounting and Finance.

Teaching objective 1: Students are able to identify and apply characteristics of a social entrepreneur, and social enterprise, as defined by Dees (2001). Teaching objective 2: Students are able to identify and apply the four tensions identified by Smith, Gonin and Besharov (2013) that manifest in social enterprises. Teaching objective 3: Students are able to apply Institutional Theory to social entrepreneurship. Students are able to explain legitimacy and the influence of context on the social enterprise. Teaching objective 4: Students through using the Change Canvas, are able to distinguish between profit and purpose characteristics of the organisation; and are able to make recommendations based on the process they have followed.

Kovin Naidoo is the CEO Of a multi-national social enterprise, Australia-based The Brien Holden Institute. The case explores Naidoo's journey as a social entrepreneur, and the partnership forged with Brien Holden as they built their multinational social enterprise. Naidoo is catapulted to the position of CEO after the sudden death of his friend, and is trying to balance the competing pressures of profit and purpose. The case introduces the foundational characteristics of social entrepreneurship, before exploring Institutional Theory and the Change Canvas as a tool for managing tensions between profit and purpose.

This case study is aimed at students of entrepreneurship, social entrepreneurship, corporate social investment, development studies, innovative health-care systems, sustainable livelihoods and asset-based development. It is written at an Honours / Masters level and is therefore also appropriate for use in customised or short programmes.

Videos (including a TedX by Naidoo), Web materials and a book chapter are included in the supplementary materials list.

CSS 3: Entrepreneurship.

The years 2011, 2012, and 2013 witnessed both significant developments and setbacks in global polio eradication efforts. On the positive side, January 13, 2012, marked a full year since India had detected a case of wild poliovirus. On the negative side, polio continued to be endemic in three countries-Pakistan, Afghanistan, and Nigeria-and in those countries the goal of eliminating polio seemed more challenging than ever. Between December 2012 and January 2013, sixteen polio workers were killed in Pakistan, and in February 2013, nine women vaccinating children against polio in Kano, Nigeria, were shot dead by gunmen suspected of belonging to a radical Islamist sect. In addition, after a 95 percent decline in polio cases in 2010, the number of cases in Nigeria rebounded in 2011. Recognizing that polio was unlikely to be eliminated in these countries in the near term, the Global Polio Eradication Initiative moved its target date for eradication from 2013 to 2018.

These setbacks sparked a debate about the appropriate strategy for global eradication of polio. Indeed, some experts believed that recent setbacks were not caused by poor management but were instead the result of epidemiological characteristics and preconditions that might render polio eradication unachievable. These experts argued that global health efforts should focus on the control or elimination of polio rather than on the eradication of the disease.

This case presents an overview of polio and the Global Polio Eradication Initiative and recounts the successful effort to eradicate smallpox. The case enables a rich discussion of the current global strategy to eradicate polio, as well as the issue of whether eradication is the appropriate global public health objective. More generally, the case provides a concrete example of a particular type of global public good, namely infectious disease eradication.

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

• Understand the nature of a global public good

• Perform a back-of-the-envelope benefit-cost analysis of polio eradication

• Discuss the appropriate strategy for eradicating an infectious disease

• Apply game theory to analyzing which countries would be likely to contribute funds toward global polio eradication

• Discuss the role of private organizations in the provision of global public goods

Understand the nature of a global public good

Perform a back-of-the-envelope benefit-cost analysis of polio eradication

Discuss the appropriate strategy for eradicating an infectious disease

Apply game theory to analyzing which countries would be likely to contribute funds toward global polio eradication

Discuss the role of private organizations in the provision of global public goods

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.

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 7: Management Science.