The case essentially describes the evolution of healthcare delivery model developed by Jan Swasthya Sahyog (JSS), a non-profit organization established in 1999 with the mission of providing affordable health care to the poor in the tribal and rural areas of Chhattisgarh state, one of the poorest states of India. The case begins with an overview of the demographics and background material on the healthcare sector in India, with particular reference to the gaps in health outcomes between rural and urban India and brings out clearly, the poor state of health of the rural population, even in comparison with some of the low- and middle-income countries (LMIC). This is followed by a detailed description of the initial efforts of the founders of the JSS - Dr. Raman Kataria and his team to locate and establish the clinic at Ganiyari village in Bilaspur district belonging to Chhattisgarh state. The case also demonstrates that it is not sufficient to just establish the clinic, but stresses the importance of developing the ecosystem to enable the population to seek and receive health care and take advantage of the facilities. These include development of a referral network, training of local volunteers and educating the public about the importance of seeking health care at the right time. The case also brings out the infrastructural limitations and difficulties encountered in providing even the most basic health care in remote rural settings. This is followed by an overview of the operations at the Ganiyari facility and provides a detailed description of the innovations developed and implemented to minimize the costs of healthcare delivery. It also provides a discussion of the costs and revenues and of JSS operations highlighting its dependence on external funding through donations and grants to keep the organization solvent.

There are change efforts, and there are change efforts. Edna Adan Ismail, referred to in the Western press as the Muslim Mother Teresa, created a small revolution when she founded the Edna Adan Maternity Hospital in Hargeisa, Somaliland. From securing buy-in and permissions from Siad Barre's government, acquiring land and struggling to keep it, and designing and constructing a new building, to educating a health care workforce, attracting physicians, and attending to the health care needs of a poor population, the case sets the stage for an analysis of change management. As Edna Adan Ismail feels the impact of globalization and the demands of global standards of care from the developed world, she faces some complex problems. How would she continue to add and improve hospital operations, educate the local population of health care providers and patients, and meet the objectives and standards of international actors? The material in this case presents complex problems around efforts to innovate and implement change on a grand scale.