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Pitfalls and stumbling blocks: the challenge to being a social enterprise (part 2)

Dr. Shelly Batra's picture
Ask anyone who has started a social enterprise what their biggest challenge would be, and I bet they would mention something about a regulatory framework. As mentioned in my previous blog, government regulations can be tedious, burdensome, and difficult to wade through. However, in addition to government regulations, there are many more challenges social enterprises face in trying to provide basic services to the most marginalized populations. For my enterprise, it was learning about the cultural stigmas associated with tuberculosis (TB), but also, learned how to truly reach the poorest populations.

In the 1990s, the WHO introduced Directly Observed Treatment Short course (DOTs), a highly effective medicine that combats TB. The issue with DOTs, is that the medicine is taken over a six month period in the presence of a trained observer, a total of 60 times. When I decided to open Operation ASHA, I learned that clinics that provided DOTs were few and far between and usually open between traditional business hours – hours when patients, especially those living in poverty, are working to earn a living. This poses a dilemma: either a patient could work for food for their families, or they could get treated. Further, there is a stigma against TB, and with the centers in well known, visible areas, their secret would get out, forcing them to lose their jobs,  their livelihoods, and their dignity.

The solution to me seemed simple enough: why not take treatments to patients, rather than the other way around? I decided to go deep into the urban slums. Find shops, temples, mosques, etc., where we could open a clinic – hidden from the general public – where we could be open for long hours, early in the morning and late in the evening. No one would have to miss work, no one would have to lose their dignity.

As with most things, this was easier said than done. Despite having provided free clinics for years, when I entered these communities discussing TB, I was no longer welcome. Doors all over were slammed in my face. These people believed that with the clinics, TB would become rampant in their communities, despite the fact that it was already present in these communities.

(c) Operatoin ASHABut as the saying goes, with every door that closes, another opens. One day, a fellow doctor slipped me a sheet of paper with the names and addresses of people he had helped. I went and met them one by one. A young man, a priest in a Hindu temple said to me, “When I had TB, no one would go near me except one. Now it is my turn to help others.” He agreed to open a DOTs center there. He took a training on how to administer the drugs and kept the medicine in the back. Prayers would begin at 6 AM so children going to school would stop by, bow their heads, and quietly take their medicine, and no one would know. Factory workers returning from late night shifts would take their medicines on their way home.

While this challenge is specific to Operation ASHA and the persistence of TB, social enterprises across the world have innovative and impactful solutions that can easily be derailed by sector specific challenges. But there are people out there who can help: social enterprises who have worked through these challenges, community workers open to new solutions, and even larger institutions and the government that can provide capacity development and provide lessons learned. The social enterprise network is growing and there are numerous lessons to be learned. 
The thing about being a social enterprise is that it is not easy. But if you have a sustainable solution, especially for the last mile, you should persevere and you will see there are people, from high level doctors, or young Hindu priests who will give you that first helping hand and help to better the lives of our fellow citizens.

Dr. Shelly Batra is the Founder and President of Operation ASHA, a health services delivery organization that aims to expand access to disadvantaged communities worldwide. She writes about the inspiration behind developing Operation ASHA and helping those most in need get access to crucial health services. This blog is a three part series about the challenges her social enterprise has faced in attempt to deliver services to the world's poorest populations.