The case revolves around “Sistema Ser” (SSer) (1), a private health care organization that serves the base of the pyramid (BOP) in northern Argentina, and its founder and director, Argentine gynecologist Dr. Jorge Gronda. In the late 1990s, Dr. Gronda had begun to serve the poor—particularly women in the remote Puna region—on an unpaid, voluntary basis. Eventually, the initiative developed into a formal network of organizations comprising CEGIN (a private enterprise and medical center offering preventive and primary gynecological services); a number of affiliated physicians and other health care providers (e.g., pharmacies); and Fundación Ser (FSer), a foundation that coordinates the affiliation of network providers and markets SSer among potential members. The SSer network is financially self-sustaining and, at the same time, able to provide affordable services to its patients from the BOP. SSer is based on a system of membership cards and a network of providers that offer high-quality services at a price 40- to 60- percent lower than that of other private providers.
For more than 15 years, SSer has been delivering primary health services, which cover 80 percent of the most common low-cost and non-complex health problems, mainly to people at the BOP and within San Salvador, the capital of the province of Jujuy. Recent developments have led Dr. Gronda to consider options for scaling his organization’s impact. He wonders whether he should geographically expand the delivery of SSer’s existing service portfolio in order to reach BOP communities outside of San Salvador, or whether he should extend SSer’s service portfolio by delivering additional services in San Salvador.
The case illustrates the development path of a social innovation born of a volunteer initiative and transformed into a sustainable structure. One of its main objectives is to make students aware of key factors that need to be considered in regard to scaling decisions in general and those at the base of the pyramid in particular.
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