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CASE STUDY: LEPRA MAHANADI EYE HOSPITAL THE PARTNERSHIP The LEPRA Mahanadi Eye Hospital (LMEH) aims to reduce avoidable blindness and restore hope and dignity to sight impaired citizens through the provision of comprehensive, accessible eye care in rural Orissa, one of the poorest states in India. The LMEH works with populations of Sonepur and Boudh districts, where sadly there is a particularly high prevalence of blindness, (1.6%) due to low awareness, extreme poverty and lack of proper eye care facilities. In the context of year on year financial deficits, LMEH looked to a partnership with Pepal to support the development of a sustainable business model for its future eye care services. In April 2010, LMEH and strategy expert Aly-Khan Jamal, attended Pepal’s ‘Innovation in India’ workshop in Delhi, delivered by Harry Barkema, Professor of Innovation Management at the London School of Economics and Political Science (LSE) to begin to map out a new business model for the eye hospital. From April to September 2010, LMEH and Aly-Khan worked together to apply business principles to resolving LMEH’s sustainability challenges. The new five-year business plan was completed in December 2010 and, in January 2011, LMEH began to implement its updated plan. THE BUSINESS PLAN The revised LMEH business plan details the steps required for LMEH to become financially sustainable and to reach its goal of being the preferred eye care hospital in Western Orissa, providing accessible, quality and affordable services to all. By 2015, LMEH aims to: • Develop the base hospital into a comprehensive tertiary eye care hospital scaling up the number and range of surgeries, increasing spectacle provision, and developing a new strategy to attract and retain a pipeline of medical staff. • Strengthen and expand outreach screening and school programmes, advocate and network with relevant government departments and extend services into neighbouring districts by 2015. • Increase revenue generation and enhance operational efficiency by introducing an enhanced user fee system and improved fee-payer services, greater use of volunteers, improved management practices, and the creation of innovative franchise models for future vision centres. It is in this latter area that Pepal has had most input with 68 % of the £1.2 million budget required to scale up LMEH’s services expected to come from increased revenue from selling services. BY 2015, LMEH HOPES TO: Expand the Base Hospital by:

Post-operative patients on their way home The Innovation in India Programme paired international participants from across the globe with skilled leaders from the non-profit sector in India. Participants worked together over a 6 month period to develop new business models to allow the Indian non-profit organisation (NGO) to have a greater impact on the communities they served. Pepal is a charitable organisation which designs and delivers life changing executive development programmes which link international corporate executives with NGO leaders to achieve sustainable social change in developing countries. LEPRA Mahanadi Eye Hospital (LMEH) was established in 2003 in partnership with international NGO, Sightsavers, to provide restorative eye care services. It comprises a base hospital, located in the district of Sonepur in Orissa, which offers surgery, eye examinations, and eyewear. Supporting the base hospital is an outreach screening programme which drives demand, provides health education and screens school children for eye problems. LMEH has one satellite vision clinic which provides eyewear and post-operative check-ups.

• Increasing annual cataract surgeries by 100% to 10,000 per annum in 2015.

Pepal’s corporate partner, Aly-Khan Jamal

• Initiating new pediatric and glaucoma surgery.

(Dalberg), is a strategy advisor who wanted to learn from working with a multi-disciplined team from a mission based NGO, challenged by geography, resources and capacity.

• Scaling up spectacle provision by 120% to 12,000 spectacles pa in 2015. Reach financial sustainability by: • Increasing the percentage of cataract surgery fee payers from 12% in 2010 to 30% in 2015 through developing facilities and a new fee paying structure. • Testing innovative models for franchise vision centres, whereby financial risk will be shared between LMEH, the franchisor, and franchisees. • Selling 3,300 spectacles per year through vision clinics and outreach screening programmes. • Retaining commission based community volunteers in order to increase the number of fee-paying cases. Develop outreach by: • Improving outreach screening through a partnership network to reach 30,000 people by 2015.

“We feel very fortunate that our Pepal partnership enabled us to work with Mr AlyKhan, a trendsetter in helping organisations to become sustainable. We acquired so much knowledge and a true understanding of our progress so far, and can now take control of the hospital’s direction. We are very optimistic about our future” - Dr Narendra Rath, Hospital Administrator

• Training 500 teachers and screening 74,000 school children.

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CASE STUDY: LEPRA MAHANADI EYE HOSPITAL A PERSONAL LEARNING The LMEH staff are extremely motivated and committed to the cause of reducing avoidable blindness in Orissa. Pepal added to this the capacity and conviction that LMEH can transform from a charitable project into a comprehensive social enterprise.“The support from Pepal involved all staff members at different levels of consultations and that has created thinking for sustainability among us at LMEH, which was not the case earlier. This programme has provided me personally an opportunity of cross-learning with the people having vast experiences in both business and development sectors. I was involved in the 5 year business plan development and in the process my learning was improved in the areas of situation analysis, needs identification, prioritising the needs and developing the actions through the team members” states Programme Co-ordinator, Madhab Mishra. Furthermore, the programme provided opportunities to draw upon international knowledge and experience in business development, significantly raising individual capacity “I improved my understanding of situational analysis and needs identification” explains Mr Rath, LMEH administrator, “Aly-Khan’s support enabled me to become personally involved in drafting the hospital’s five-year plan”. Notably, the franchised vision centre concept was drawn from the programme’s workshop. Even though the business model is yet to be implemented fully, there has been a significant shift in attitude. “Before this programme, we worked without questioning the procedures, and we did not analyse the financial operations of the hospital. The programme identified sources of revenue generation and has led to systematic changes in budget planning,” reports Deepak Kumar Dash, Finance and Administration Executive.

“I can see, I can see!” Mahadeb Sahu, 15, is the adopted son of an elderly, $1 per day farming couple. Mahadeb had not known life without the cataracts which stopped him going to school, playing in the street and leading a normal life. Neither visits to government hospitals or entire expenditure of family savings on traditional healing could remedy his situation. 1 year ago an LMEH vehicle took him to the hospital for a successful operation which, much to his parents delight, has returned Mahadeb his childhood.

PROGRESS TO DATE In April 2011, Pepal/LSE returned to Orissa to review progress to date. Although it was too early to quantify outcomes there were encouraging signs. • A spectacle grinding unit had been established at the base hospital and a technician trained, enabling same-day spectacle provision. Previously spectacles were ordered from an external provider and took over a week to arrive. Many patients were unable to return, resulting in significant revenue loss. Since its inception, spectacle sales at the base hospital have risen by 10%. • 2 commission based field workers have been hired and trained with targets to refer 60+ patients per month to the base hospital. Between January and April 2011 referrals had increased by 77%. • A ‘menu pricing’ fee paying structure had been introduced and facilities were being prepared to enable the delivery of “premium services”, to include furnishing two luxury rooms with air conditioning units. • Cataract surgery had increased by 27% and revenue from the surgeries had increased by 31% between January and April 2011.

“It was like a new life force had entered me”. Mr Badmali, both a farmer and Hindu priest saw his family’s income decrease by half when he developed a cataract in 2009. After meeting an LMEH outreach volunteer, Mr Badmali and his son travelled to the hospital and had the operation which gave him back his independence and ability to provide for his family, and “a new life force”.

ONGOING CHALLENGES LMEH has no computerised database and little or no capacity to collect financial, clinical and/or patient data, which prevents them from measuring accurately patient’s fee paying capacity and monitoring progress towards achieving their goals.

The Pepal intervention has had a clear, positive impact on LMEH’s pursuit of its mission. Significant steps have been taken towards implementing the business plan and ensuring financial sustainability. Continued support and expertise is needed to drive implementation of the business plan. In particular, LMEH need support to review their human resource policies and develop an innovative strategy to attract and retain high level clinical personnel. Human resource constraints have delayed implementation of the franchise model, a key element of the business plan.

Finally business acumen is needed to develop a new marketing and branding strategy for potential patients, local philanthropists and donors, who are currently confused by the name and mission of the hospital, ‘LEPRA’ being traditionally associated with leprosy.

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LEPRA Case Study  

Case study on the Lepra Mahandi Eye Hospital project that participants on Pepal's Innovation in India programme embarked upon in 2010.

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