In a small clinic in the northern suburbs of Mexico City, a doctor and two nurses are bridging the gap between poor patients and their wealthy neighbours in an unusual way: instead of charging, they pay them to attend.
In exchange for government money each month, mothers come for check-ups before and after the birth of their children, receive nutritional supplements and are provided with health advice, including how to tackle obesity in a country with one of the highest rates in the world. The stipend – often used to buy books or food – continues as long as they ensure that their children are vaccinated and attend school regularly.
The unit is part of the Oportunidades network, a pioneering approach to health and social support that has expanded across Latin America over the past decade, and that more than covers its costs by enhancing the chance that participants become productive members of the workforce.
The project reflects the innovation in healthcare delivery that is taking place in fast-growing cities around the world. There is growing cross-fertilisation of ideas between urban areas in rich and poor regions alike, and between many broader aspects of urban living and those that are most obviously linked to health.
While access to health in rural areas has long been a challenge in developing countries, there is an intensifying focus on urban regions as their importance – and dangers – grows. “We cannot stop urbanisation,” says Jacob Kumaresan, director of the World Health Organisation’s Kobe Centre, which promotes innovation in public health research.
“It’s very clear that a concentration of people promotes economic growth, but that can also result in bad health, violence, crime and mental stress,” he says. “People come to cities because they feel they offer better opportunities, jobs and health. When they arrive, they do not find them and end up living in slums.”
Some countries have tried to stem the pressure on urban services caused by the flow of rural migrants to cities, including Cuba, which has balanced the “stick” of residency permits with the “carrot” of a network of neighbourhood clinics and family doctors extending far into rural areas.
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