What matters to the BoP? Quality

We are excited to welcome Rishabh Kaul on board as our newest Beyond Profit Guest Blogger. In his first contribution, he interviews Dr. G.N. Rao, a tireless advocate for access to eyecare in India.

I had pretty much made up my mind that I wanted to spend last summer getting to know the developmental sector. Narrowing it down, I chose primary health care and landed myself a four-month stint with the International Center for Advancement in Rural Eyecare (ICARE).

ICARE is the community healthcare arm of its parent organization, the L V Prasad Eye Institute (LVPEI), a World Health Organization Collaborating Center for Prevention of Blindness. ICARE is an integral part of the pyramidal structure of health care that LVPEI follows. ICARE focuses on both geographically removed as well as economically disadvantaged groups.

At the primary eye care level, ICARE provides free consultation to patients (and charges a nominal amount for glasses) and refers them to a secondary center if needed. The only revenue it generates is through the sale of these glasses, which it sells through its “Vision Centers.” The entire pyramidal structure is explained here, also, the cost incurred to provide eye care from the apex to the base per person comes out to US$ 1. They now have about 50 Vision Centers all across Andhra Pradesh, which are linked to the secondary and tertiary centers. (Full Disclosure: At ICARE, I worked on calculating the cost effectiveness of the vision centers as compared to the government primary health center’s dark rooms.)

After my internship, I got an opportunity to pose a few questions to Dr G.N. Rao, who among his many roles, is also the founding director of LVPEI and served as President of the International Agency for the Prevention of Blindness where he led VISION 2020: The Right to Sight, the global initiative to eliminate avoidable blindness by the year 2020.

I have known Dr. Rao for quite some time and what strikes me most about him is how brutally honest and up to the point he is. And while interviewing him, I was reminded of the opening paragraph of Mikhail Kalashnikov’s autobiography: “Perhaps some of you will find my bursts of word fire too long, others may regard them too brief and broken. What matters is if my words hit the target.”

Rishabh Kaul: How sustainable is the LVPEI primary eye care model (i.e. ICARE)?

GN Rao: Of all the vision centers that we have, 70% of them are self sufficient and they help in running the remaining 30% that can’t run all by themselves. So, on the whole, the entire model is quite sustainable. However, these primary (and satellite) eye care centers require linkage to a mentoring organization like LVPEI (referring to LVPEI’s Center of Excellence in Hyderabad). If the government thinks more in terms of sustainability, then our job becomes much easier. Having said this, for us to work in the remotest of areas and especially tribal areas, these programs will need external funding.

RK: There is immense competition in the nonprofit sector, how does ICARE try to differentiate itself from its competitors at the grassroots (primary eye care) level?

GN Rao: I can answer your question in three points:

• Through rigorous quality assurance systems. At LV Prasad, we make sure that we never compromise on quality. Ever. Our organization provides services based on three principles: equity, efficiency, and efficacy. All our equipment is of the highest quality and we take pride in that fact.
• Making the facilities user-friendly in all aspects. There is no point in having a facility if it’s not user-friendly. It has to be accessible by the public. For this, we have set up over 50 Vision Centers, which provide primary eye care to the public in remote corners of Andhra Pradesh.
• The trademark of LVPEI. LVPEI has been a pioneer in eye care, and its brand value is what gives people the assurance that the eye care they are receiving is of the highest quality. It has been shown that up to 70% of our total patients are from the rural areas.

RK:  What have been some of the biggest hurdles for your organization till date and how have you overcome them?

GN Rao: Recruitment of top quality people at every level has been a huge hurdle because we demand very high standards from our employees. We are trying to overcome this through regular training programs for all categories of staff.

RK: What opportunities do you see in the rural eye care sector in the coming few years?

GN Rao: 73% of India’s population is in rural areas, and this demographic is unlikely to change in the foreseeable future. Eye care services are either not available or not accessible and affordable. Where care is available, the quality is suboptimal. What we are doing is only scratching the surface.

RK:  Primary eye care doesn’t seem to get enough attention, despite it being proven that eye deformities result in substantial decreases in productivity as well as an increases in the mortality rate. What do you think can be done to raise awareness about this issue?

GN Rao: That’s right. There needs to be more emphasis on primary eye care. Three ways in which this can be achieved – building public awareness through education programs. Apart from this, there has to be an enhancement of awareness among professionals. And, of course, advocacy with policy makers is a must.

RK:  In recent years there has been a lot of talk about having market-based solutions for the poorest people in the world (mostly due to CK Prahlad’s book: Fortune at the Bottom of the Pyramid). Do you think, on its own, the market-based approach (something like Vision Spring, for example) can be sustainable for the primary eye care industry?

GN Rao: While the concept of Vision Spring is good, there is always scope for improvement. I feel Vision Spring can do much better and try to make a larger impact at the BoP. That being said, Vision Spring too requires the mentorship and help of a larger organization such as LVPEI (we do have a tie-up with them for our primary eye care models). This is because the eye care sector is really huge. As far as market-based solutions are concerned, the poorest of the poor (I believe the bottom 25% in India) can’t afford to pay for health care. It’s really that bad. Cross subsidization and risk pooling have to be applied.

RK: What other models for the delivery of primary eye care do you admire?

GN Rao: Given the time I have spent in this sector, I have come across many organizations that cater to primary eye care. While I applaud the work of many of these organizations, and I feel that some of them are doing some good work in terms of the huge volumes of people they are treating/advising, I feel that what really sets us apart is the rigorous and relentless emphasis on quality. We make sure that a gold standard is applied to whatever we do. If more and more organizations start thinking that everyone deserves healthcare of the same quality, we will see tremendous change in the health standards of this country.

Rishabh Kaul is an Economics undergraduate at BITS Pilani working with the Rural Entrepreneurship Division at the Center for Entrepreneurial Leadership there. Aside from Beyond Profit, he blogs at NextBillion as well as on his personal blog.

Photo Courtesy L V Prasad Eye Institute (LVPEI)