Michael Adamson CBE on Wavelength's Power of Purpose programme

Case Study – a story of eye care in India

by Michael Adamson CBE

Spiritual inspiration, McDonalds-like efficiency and global systems change - a story of eye care in India

Imagine losing your sight from cataracts in rural India. This can be equivalent to a life sentence, unable to work, unable to move around easily. But it does not have to be this way and Aravind Eye Care have set a global standard for how this can be addressed. I have just had the privilege to spend a study week in Tamil Nadu – guided by the excellent Wavelength team – seeing their amazing work on the ground.

Each year, Aravind reach over 4m people through  community outreach work and hospital walk-ins, screening for cataracts and other eye issues, and assessing who needs immediate surgery and who needs glasses.  They then undertake over half a million surgeries, of which the majority are cataract removals, and fit glasses, to many more. All this is provided either free or at low cost for paying patients. And in parallel, they have taken 12% of the global market share in manufacture of high quality intra-ocular lenses and work in 29 countries to build capacity as part of an active open learning network. Extraordinary.

How do they do this? By embracing the legacy and principles of their founder Dr Venkataswamy – known as Dr V. – a visionary social entrepreneur who established Aravind in 1976. His approach to achieving his mission to “eliminate needless blindness” can be captured in some of his words –

  • Modern technology combined with spiritual consciousness is the need of the day
  • Intelligence and capability are not enough. There must be the joy of doing something beautiful
  • Aravind will draw from outside organisations but not become dependent and cherish its capacity to make its own decisions and
  • We are not just repairing eyes, it is ourselves we are helping, it is ourselves we are healing.

They have embraced rigorous process design and standardisation combined with high volumes, all organised from a patient perspective. That drives down unit costs and enables low price or free services. Surgery is same day or next day and paying patients (but still much less than other providers) subsidise the free patients – the split is about 50/50. Compassion and kindness are part of the culture and built in from the moment people are in touch with Aravind.

I don’t think I have ever come across a social purpose organisation that is so aligned and so relentlessly curious about best practice. McDonalds inspired the rigorous focus on efficiency after a visit by Dr V to the USA. When Aravind became frustrated at the price of intra-ocular lenses – used to replace the lens in the eye with cataracts – they went and researched the global market and found that the existing manufacturers were operating with enormous profit margins. As one of their Board members, Mr Tulasiraj, said – “there is no point in complaining, you just have to figure it out”.  So they went and found technology partners in the US and started a manufacturing operation of their own – Aurolab. This now has 12% of global market share reaching 160 countries and a much higher market share in developing countries. Their lenses have been independently shown to be of an equivalent quality to their commercial competitors.

This determination to discover best practice wherever it might be found has extended into manufacturing eye drops and surgical equipment, warehousing and supply chain and innovation.

And because they are committed to eliminating needless blindness everywhere, they have given free training to hundreds of practitioners from around the world and are working in active capacity building partnerships with eye care institutions in 29 countries sharing their methodology and approach for free. They estimate that the resulting productivity improvements have an enabled an additional 750,000 cataract surgeries.

It is a remarkable demonstration of a particular type of system leadership: role- model excellence; disrupt the existing players and replicate.  They have declined various commercial partnerships with big pharma because they want to stay in control of their own destiny and follow Dr V’s vision.

This was a really inspiring visit – and, for me, to see an extraordinary social enterprise offering real systems leadership. Dr V would be very proud to see his values and principles still being put into action and re-invented as each decade passes and new possibilities emerge.

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