Addressing health equity through healthcare social enterprises: a qualitative multiple case study of service delivery strategies in Malaysia

Persistent inequities in healthcare access continue to affect underserved populations in low- and middle-income countries, including Malaysia. While social enterprises are increasingly recognised for their contributions to healthcare delivery, their role in addressing systemic service gaps and promoting equity remains underexplored. This study examines how healthcare social enterprises in Malaysia develop and operationalise approaches intended to reduce access barriers related to affordability, service availability, and distribution within the country’s dual-tier health system. A qualitative multiple case study approach was employed, involving seven healthcare social enterprises in Malaysia. Data were collected through semi-structured interviews with key informants comprising the founders or chief officers of each social enterprise, from September 2021 to June 2022. Cases were selected using purposive sampling based on active involvement in health service delivery, with inclusion criteria: 1 registered SEs; 2 offering direct health-related services. Interview transcripts were analysed using thematic analysis to identify cross-case patterns in how SEs address health inequities. Four key strategies were identified. First, community-driven models tailored to local needs helped expand access and reduce affordability barriers. Second, social enterprises managed resources strategically by investing in human capital, applying cross-subsidisation, and adopting hybrid revenue streams. Third, partnerships with government, civil society, and private sector actors supported resource mobilisation and service expansion. Finally, digital platforms and mobile tools were used to improve healthcare access, continuity, and outreach, particularly in underserved areas. Collectively, these approaches highlight how social enterprises operate as adaptive, mission-driven entities that respond to structural healthcare gaps through innovative and inclusive service delivery models. Healthcare social enterprises in Malaysia employ practical strategies to reduce disparities in healthcare access, affordability, and service distribution by integrating community responsiveness, strategic resource management, and technological solutions. Their hybrid approaches offer a complementary role to public health systems. However, sustained progress toward health equity will require stronger institutional support, including policy alignment and tailored financing mechanisms.