Finding your feet in constrained markets: How bottom of pyramid social enterprises adjust to scale-up-technology-enabled healthcare delivery

Scaling social impact is a challenge that innovative social firms operating in resource-constrained Bottom of Pyramid markets must address while also ensuring profitability. However, how scaling occurs is scarcely understood. By building on the case studies of two healthcare social enterprises located in India, we make four important contributions to the understanding of the scaling up process. First, we demonstrate that entrepreneurial adjustments are guided by whether social firms prioritize alleviating their internal constraints or those faced by customers. Second, we show how such dynamic prioritization of constraints influences how firms mobilize resources and use operating routines from inception to market establishment. Third, we illustrate how, by pursuing resource mobilization strategies and operating routines, firms generate a ‘deep’ impact by expanding the number and type of their activities or a ‘broad’ one by increasing their membership base and/or geographic area. Finally, our findings show that the prioritization of internal or customer constraints leads firms to establish different sequences of elements of institutional legitimacy—i.e., normative, regulatory, and cognitive ones. We conclude by presenting the development of a process model for scaling-up social firms, by developing our propositions and by discussing the implications of our findings.