This chapter explores social enterprises as an alternative addition to traditional entrepreneurial ecosystems. It reviews the substantial social enterprise literature in order to identify the myriad of competing tensions that constrain the development and success of social entrepreneurial ecosystems in areas of significant poverty and economic deprivation. Following this, the findings of several contemporary and novel studies are discussed. These collectively evidence the ways in which social enterprises are overcoming the seemingly immutable constraints that they operate under. In particular, the Social Enterprise Places initiative has been highly effective in supporting the development of flourishing social entrepreneurial ecosystems in many locations in the UK. However, the growth of social enterprises, both in number and economic importance, presents further challenges that social enterprise owners and managers will have to contend with. Consequently, these organizations and their allied ecosystems require continued structural, financial and skills support.

Providing low-income consumers access to transformative services such as healthcare is an ethical challenge of vital importance to marketers. However, most consumers at the base of the pyramid are excluded from the market for such transformative services because of financial constraints due to poverty. In this paper, instead of focusing on the micro-interplay between firms and consumers, we examine the macro-interplay among firms, consumers, and public policy in addressing the ethical challenge of market inclusion at the base of the pyramid.Specifically, we examine how the Vietnam government used a policy of free and universal health insurance for children under the age of six as a means of lowering affordability barriers and fostering market inclusion in the healthcare market. Overnight in 2005, all children under the age of six living anywhere in Vietnam became eligible for free health insurance. Using this policy intervention as a natural experiment, we compare market inclusion outcomes of children under the age of six with older children who were ineligible before and after the program was implemented. We show that lowering affordability barriers through public policy (1) increases access to target services, (2) increases consumers' overall out-of-pocket spending, and (3) increases access to complementary services. By adopting a macromarketing lens, this study makes a strong case for collaboration among firms, governments, and communities in addressing the ethical challenge of system-wide market inclusion in base-of-the-pyramid markets.