Towards social enterprises that digitally engage citizens for integrated people-centred health services: Organisational case studies and a framework analysis of community health alliances

Globally, social enterprises are being explored for their potential to act as socially responsible, privately-owned providers of community-focused primary care. In this study, we tested a framework on how social enterprises could use digital health and citizen engagement to actualise the WHO strategies for integrated people-centred health services (IPCHS) using case studies of two Community Health Alliances (CHAs) in Sydney, Australia. We constructed cases studies of two CHAs using a combination of documentary analysis (57 documents), and semi-structured interviews (14 participants) that were coded using both inductive and deductive approaches. Case study findings were used to conduct a framework analysis to test, validate, and revise the framework, based on a recommended approach for organisational case study research. Our case analysis demonstrated that CHAs use digital health and citizen engagement to co-produce services in ways that actualise the IPCHS strategies. Framework analysis demonstrated that enterprise, digital health, and citizen engagement enable each other and co-create IPCHS. The framework was revised to reflect novel observations. Findings indicated that the CHAs we studied do not yet operate as social enterprises, with ongoing challenges related to value capture, their ownership model, and their formalisation as independent entities. Stakeholders attributed CHAs’ operational challenges to the early stage of maturity. To address this, our future work will develop a maturity model and toolkit to implement and evaluate social enterprises that use digital health and citizen engagement to co-produce IPCHS. • Our case analysis demonstrated that CHAs use digital health and citizen engagement to co-produce services in ways that actualise the IPCHS strategies. • Framework analysis demonstrated that enterprise, digital health, and citizen engagement enable each other and co-create PCHS. • While the two CHAs we studied do not yet operate as social enterprises, this may be attributed to their early stage of maturity. • Stakeholders provided varying perspectives on whether and how CHAs could operate as social enterprises, with identified challenges being related to how they might capture value from the integrative functions they perform, their ownership model, and their formalisation as independent entities. • We will consider these when developing this framework into a maturity model to guide the development of social enterprises that use digital health and citizen engagement to co-produce IPCHS.