| Context: While there have been many successful global health pilots and initiatives that have been implemented, often organizations struggle to scale interventions that have proven efficacy and effectiveness. Within the global health literature, there are limited studies that examine the strategies health services organizations employ to advance delivery for disadvantaged populations in lower-and-middle-income countries.;Objectives: The objectives of this thesis are three-fold. First, the thesis provides in-depth case study analysis of an organization that has successfully scaled its operations for the bottom of the pyramid populations in multiple countries in Africa. Second, the thesis analyzes strategies private sector organizations use to achieve scale in lower-and-middle-income countries. Third, the thesis illustrates how value chain integration strategy advances scale up of health services delivery in resource-poor settings.;Design: We use a qualitative research methodology to provide rich nuance about empirical phenomena by extending prior research on scaling up health services delivery and applying strategic management frameworks to analyze the phenomenon. While we predominantly employ qualitative case study methodology, we supplement our analysis using exploratory statistical analysis.;Results: Many health services organizations operating in lower-and-middle-income country contexts struggle to achieve goals of scale, sustainability and inclusion. Using value chain integration as a framing logic, this research demonstrates that organizations should not try to do everything themselves, especially activities where other actors in the ecosystem have superior skills and positions. We identify three main mechanisms for using value chain integration strategy to scale up health services delivery: identifying mutual dependency with partners, creating an efficiency core and building a strong set of four types of management skills, including financial skill, quality management, supply chain management, and client relationships.;Conclusion: The novel contribution of this thesis emerges from the use of a strategic management conceptual framework (i.e., value chain integration) to analyze a health services research context and problem (i.e., health care delivery by an NGO in Africa). Further mixed-methods research, which includes disconfirming or negative case sampling, is needed to examine whether and how health services organizations in resource-constrained environments deploy value chain integration strategies to achieve expansion and deliver services to disadvantaged populations. |
