Yesterday’s NPR broadcast featured a fascinating story about the Aravind Eye Care System, a not-for-profit organization in south India that is working to prevent cataract blindness. This subject matter is of particular interest to me—my mother is an eye surgeon who works on strabismus and cataract patients in rural Peru—but more importantly gives us a powerful case study on how to balance economic needs with health equity.
Cataract blindness is one of the most widespread preventable problems in the developing world. Like many other issues in health equity, cataracts develop more often and more quickly in the most structurally disadvantaged sectors of a society. The WHO writes,
“Worldwide, approximately 18 million people are blind as a result of cataracts, and, of these, 5% of all cataract related disease burden is directly attributable to UV radiation exposure.”
Thus, a farmer who spends all day working in his field without eye protection faces an increased risk of cataract blindness. The problem is also self-perpetuating, from an economic standpoint: blindness is highly debilitating in manual labor, so many of those who become blind are forced into retirement early. This leads back into a cycle of poverty, a chain which can be broken by a simple and relatively inexpensive procedure. The surgery itself is simple. A surgeon makes a small incision on the edge of the cornea and removes the natural lens, which has become opaque. He or she then inserts a new, synthetic lens in its place and sutures the incision. The problem? Synthetic lenses are expensive, and out of the income range of the people who most need the surgery.
Aravind’s founder, Dr. G. Venkataswamy, has approached this problem by blending business strategy with a charitable mission. This technique can be seen in many NGOs worldwide, to some degree, but what sets Aravind apart is its ability to vertically integrate the process of eye surgery—that is, to control every aspect of the process, from lens production to actual implantation. The organization even owns a lens manufacturing plant in India, called Aurolab. Accordingly, every step along the way is treating like a business, aimed at maintaining an operating surplus.