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Transforming Eye Clinics and Hospitals to Sustainability – The International Eye Foundation’s Social Enterprise Model

European Ophthalmic Review, 2009,2(1):8-11 DOI: http://doi.org/10.17925/EOR.2009.02.01.8
Received: February 08, 2011 Accepted: February 08, 2011

A stable but inherently unjust equilibrium exists in eye care in developing countries, causing exclusion, marginalisation and suffering for both patients with eye disease and eye-care providers who lack the authority, autonomy, resources or political power to change the situation. Patient choices include an unaffordable private sector or an inherently inefficient public system. The medical profession controls the private sector, government bureaucracy controls the public sector and donors control the charity sector, and each has different priorities.

Within the government sector, ophthalmologists can choose to remain in an inefficient, unproductive and non-autonomous system; the alternative is to leave government service for private practice because they lack the authority and investment to undertake a social enterprise. Those in private practice lack the investment power and vision to expand and include a social side. The worst-case scenario is when ophthalmologists feel that they have no choice but to leave their country of residence altogether.

Worldwide, there are 37 million blind people and 124 million people living with low vision (World Health Organization [WHO] 2002), 90% of whom live in developing countries and can only be treated when the quality of eye care is such that patients will seek, accept and be willing to pay for it. While private practitioners attract the wealthy few and the government serves the poor, the middle classes who are able to pay feel neglected because their choices are few. More ophthalmologists are needed, but addressing inefficiencies, poor quality and under-utilisation resulting from poor management and lack of financial sustainability is essential. With the world’s population growing to a predicted two billion and ageing to include an estimated 7.9 billion people above 45 years of age by 2020, simply training more ophthalmologists to work in poorly functioning institutions will not meet these needs.

The International Eye Foundation’s Strategy
In the mid-1990s the International Eye Foundation (IEF) began thinking about why eye clinics and hospitals in developing countries function at only around 40% of their capacity, lack critical resources and are dependent on government budgets and external donors. Working closely with David Green, a social entrepreneur, and the Lions Aravind Institute for Community Ophthalmology in India, the IEF developed the SightReach® Management model that could be utilised outside the Indian subcontinent. The SightReach Management model transforms eye-care institutions into social enterprises with business plans that put profit towards operational costs and growth and subsidise services for the poor. Donor funds can then be put towards areas of donor interest and services that are self-sustaining, leading to a more comprehensive service delivery spectrum. Using quality, efficiency, productivity and revenue metrics, the IEF can maximise existing resources to increase services. In 1999, with support from the US Agency for International Development (USAID), the IEF launched SightReach Management with seven hospitals in six countries in Africa, Central America and India, putting us firmly on the path to changing how eye care is delivered throughout the developing world.