IXL Social Enterprise Case Studies Chronic Diseases October, 2013 | Page 14

Improving Chronic Disease Care in Slums by 2019

Solutions for chronic diseases in slums
are not a priority for governments,
the private sector or NGOs
Governments see slums as illegal habitats and focus on emergency care
Governments are responsible for providing infrastructure and rule of law.74 Unfortunately, slums are
in flux and often not recognized as legal places of habitat with legal protection and security.75 As
a result, nominal efforts are made by governments in slums to provide roads, schools, electricity,
water and security. Moreover, many governments see urbanization as a problem and put more
effort in rural development to slow urbanization. Most governments ignore slums or threaten
residents with eviction.76
Additionally, the type of aid that governments do traditionally provide is often designed to attend to
communicable or infectious diseases. Governments have spent billions of dollars in aid for malaria,
HIV and tuberculosis.77 Among aid provided by the United States government, almost 50 percent
of global health dollars was spent on HIV alone.78 This focus on HIV creates a global mentality
of reactive care from epidemic flare-ups, but it does not address the growing problem of noncommunicable disease education, prevention, diagnosis, treatment and care.
The formal private sector is unable to provide market solutions for chronic diseases in slums
There is a thriving informal private sector — low-cost, low-quality healthcare market — in urban
slums. These informal providers and medicine shop-keepers often lack training or formal education
in healthcare and operate outside the purview of regulation. Though they provide affordable and
accessible healthcare opportunity for slum dwellers, they are also a threat due to higher risk of
getting proper diagnosis and treatment. On the other hand, the formal private sector may have
difficulty building a profitable business in slums because it is harder to provide complete, consistent,
quality and affordable services and still maintain significant margins.79 The formal private sector, in
general, has had difficulty implementing pricing models that work in slum environments.80
There are some formal private entities existing in slums, however, most of them are still quite
expensive for the average slum dwellers’ limited budgets. Clinics are also hard to monitor and lack
transparency that is critical for ensuring appropriate accountability across the value chain.81
NGOs focus on healthcare challenges related to communicable and infectious diseases
Non-governmental organizations (NGOs) have become major contributors to social development
in recent decades. Some NGOs focus on rural areas and provide relief aid. Others work in urban
areas and focus on development. However, NGOs have challenges in funding, program continuity
and customer perception.82 As a result, their impact has been nominal and at times even negative.83
The last decade has shown that non-communicable diseases are a growing concern for the
developed and the developing world.84 Significant research is being done not only on these
chronic di