Drishti Eyecare: A Social Enterprise in Search of Scalable Service Models

Introduction:
Parvathamma, 60 years, a weather-beaten 'home-alone' woman lives alone in her mud-house in
Hosahalli village 16 Kms from Chennapatna, a town famous for adorable colorful lacquered wooden
toys. She makes her living on income from her land which she had leased out for agriculture.
Parvatamma is losing her vision since the last few years. The nearest eye hospital is Drishti Eye
Hospital (Drishti) at Chennapatna. But the town is not well connected by public transport. Going there
even for a consultation would take her the whole day. Also, she would have to seek the support of a
willing neighbor who is familiar with the town. All of her five children are married and lived with their
families quite some distance away. Anyway, they would not find time enough to accompany her for
treatment, especially if she has to be admitted for surgery in the hospital. She has considered, but
postponed her eye check-up many times; she could still recognize people and objects at some distance.
In any case, like many others of her age in the village, Parvatamma is illiterate – so she doesn’t have
to read. But when she heard the dandora that an Eye Screening bus (Mobile Clinic) from Drishti was
visiting the village next day, she decided to get her eyes checked.

By noon, Drishti’s mobile eye-camp had screened around 80 people of the village. After the initial
screening tests, Elizabeth, the Optometrist at the camp told Parvathamma that she had developed
Cataract in both her eyes. Anil, Manager Outreach Camps, counselled her at length that she had to get
operated to regain her vision. Parvathamma complained about her knee pain which affected her
mobility and that she was alone, and wouldn’t be able to make it for the surgery. But she was also
worried that the rains were fast approaching, and then the harvest season would start, and then none
from her village would chaperon her for the surgery during such times. She consented when Anil
pointed out that nine more persons from her village, including her panchayat ward-member, had
decided to undergo cataract surgery and were going to be transported to the hospital at Chennapatna
in the same bus when it returned to the hospital in the afternoon. She felt reassured that she could also
join the same group after one week for the post-operative check-up.

Parvathamma paid Rs.2000 as advance amount and registered for the surgery. Anil said that she could
not make use of the Yeshaswini insurance coverage since she was not a registered member of the Agri-
cooperative. She could pay the balance INR 2000 after the surgery. Parvathamma rushed home to
pack her clothes to join the other patients - they would all be staying two nights at the Drishti Eye
Hospital at Chennapatna.

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Background:

By mid-2018 Drishti Eye Hospital in Chennapatna completed 3 years of successful operation and had
conducted about 3000 ophthalmic surgeries. Anandampillai Kiran (Kiran) and his team had set up the
super specialty hospital in the district headquarters and attached to it a tele-medicine center (TMC) set
up in the nearby small town Maddur and a mobile eye clinic (MC). These three facilities – the base
hospital, TMC and the MC - together as a cluster, was envisaged by Kiran as a vertically integrated
eye-care delivery model. When such clusters were replicated to other districts i.e., a horizontal
expansion, Kiran believed, it would help address the avoidable blindness problem of the people at the
bottom of the socio-economic pyramid (BoP) in rural India. The Chennapatna cluster could reach
around 30 of the total 146 villages in the Taluka. Similar clusters were already in operation in three
more districts of Karnataka. Some of the clusters didn’t have a TMC, but included a Vision Centre (VC)
i.e., an eye clinic with ophthalmic consulting and screening facility. In all, Drishti had set up three
Hospitals, two vision centers (VC), two tele-medicine centers (TMC) and two mobile eye-screening
clinics (MC).

Even though he had reasons to be satisfied with the financial performance so far, which he ensured by
closely monitoring units in each cluster, Kiran grew skeptical regarding his expansion plans as well as
the impact Drishti had made in the avoidable blindness space. Along with financial returns Drishti had
to demonstrate high scale of social impact, both of which presupposed faster growth, in order to attract
further impact-funding. The key to creating high social impact was, Kiran believed, to penetrate deeper
into the remote underserved and unserved villages through the vertically integrated healthcare cluster
he had already tested in Chennapatna. But, a horizontal expansion with just hospitals located in district
headquarters, seemed to accelerate expansion also fetching better financial returns. Kiran had to choose
between sticking to Drishti’s initial vision and viability.

The cluster model with three integrated eye-care facilities was already facing several challenges.

First, very few patients walked into the TMC. Even those who did, had reservations against tele-
consulting, and many left the center without consulting the doctor online. Second, while each VC
attracted around 40 patients per day, recruiting and retaining optometrists as well as getting consulting-
doctors, even on alternate days, for these small-town locations were proving hard. Third, Drishti could
only cover a small proportion of the villages in a district. The MCs could be held only within a radius
of 30-40 kms from the base hospital as the bus had to return to the hospital with patients for cataract
surgery by afternoon. Better coverage of villages called for more MCs; more resources to be spent.
Fourth, changing the consumer behavior and perception towards eyecare demanded persistent and
persuasive efforts to create awareness among the villagers. Social inhibitions and logistic bottlenecks
confounded these efforts. Kiran wondered if the patient walk-in numbers – of VC as well as TMC -
could be improved, or even sustained, without such rural marketing efforts. Kiran’s ambitious goal of

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covering all the villages, around 1000 of them in one district, before moving to the next district appeared
daunting.

Kiran began to harbor doubts about the practicality of the cluster model. At the same time, he knew that
patient referrals from VCs and TMCs was critical for the optimal utilization of the base hospital – a
surgical facility with a capacity of 300 surgeries/month.

The valuation committed to the venture capitalist, and Drishti’s founding mission to make a significant
impact on AB at the BoP, weighed on Kiran’s mind.

Kiran was deliberating on how to expand Drishti’s reach.

Drishti Hospitals

Envisioned as a for-profit Social Enterprise, DISHA Medical Services Pvt. Ltd. was established in 2011
by a team of three techno-entrepreneurs Anjali Joshi, Dr. Rajesh Babu and Kiran. Their mission was
“to deliver affordable eye care in underserved markets”, through a network of facilities branded as
Drishti Eye Hospitals (Drishti). Drishti was seed-funded by Lok Capital, a social impact venture capital
fund.

The founders believed that serving the healthcare needs of the 1.2 billion people at the base of the
pyramid demanded viable business solutions, and not merely philanthropy. Therefore, Drishti was
funded and managed like a commercial enterprise with the primary social objective of delivering
affordable eye care solutions to address the problem of avoidable blindness.

Kiran was of the firm opinion that Drishti must aim at three goals - speed, scalability and the
sustainability of its business model. Kiran summed up the criticality of scale, speed and sustainability:
“Drishti model is based on low price and high volume. It is a matter of how much time is required to
reach that volume. We have set of fixed costs, which gives us certain capacity to deliver services. As
long as we get the capacity utilization up, our business model is going to work. It is a question of how
much time - how quickly, we take to reach that volume level and sustain it”. Just in the previous 12
months the Chennapatna hospital had conducted about 1082 surgeries of which 80% were cataract
cases. The contribution of each of the constituents of the cluster to the total surgeries is given in Exhibit-
1.

The Indian Healthcare Milieu1

As per an Essilor estimate, more than half of India’s population needed some kind of vision correction.
Most of this need was in the villages – over six lacs of them, across more than seven hundred rural

1
(https://timesofindia.indiatimes.com/india/India-loses-37bn-because-of-poor-eye-vision-Study/articleshow/20367747.cms .

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districts of the country. India ranked among the lowest on public healthcare spending at a dismal 1.3%
of the Gross Domestic Product (GDP), a little over a third of China’s. This deficiency of the government
sector in healthcare led to the rapid rise of the for-profit private sector which came to own about 93%
of the hospitals in the country, 70% of which were concentrated in the cities. But 70% of the Indian
population and 78% of those in bottom of the socio-economic pyramid (BoP) lived in rural India, with
just about 1% of them under any medical insurance coverage. Therefore, healthcare was way beyond
the means of most in rural India. The low purchasing power coupled with poor infrastructure and the
absence of institutions for market formation and efficient operations, rendered rural India totally
unattractive for the mainstream private commercial hospitals. Therefore, the availability, accessibility
and affordability of quality healthcare was a major problem in rural India, and a humongous challenge
for the BoP.

The eye care challenge in the country was far more daunting. About half of the population needed some
kind of vision correction. The country was home to about 12 million blinds, 80% of whom were
classified as avoidable blindness and hence could be cured. But the majority of the blind belonged to
the BoP in rural India. There was only one ophthalmologist for every 60,000 people in the country and
the ratio was worse in the BoP market. Moreover, the quality and reliability in eye care services
demanded expensive diagnostic and surgical facilities and highly skilled manpower, rendering eye care
services costly. In a typical urban hospital, consultation fee was over ₹300, prescription glasses cost
around ₹1000 a pair and an eye surgery over ₹10,000. These affected the availability, accessibility and
the affordability of eye care to the BoP segments. It was in this bleak scenario that the founding team
of Drishti sensed economically attractive opportunities for delivery of affordable eye care solutions that
would have a significant impact on the scourge of avoidable blindness.

Design of a sustainable eye care model for the BoP market

The Drishti founding team felt that extending the urban model of large multi-specialty eyecare hospitals
would not be suitable for the rural BoP market. So, they adopted a hub-and-spoke model as depicted in
the image below.

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A mid-size base- hospital at the district headquarters with surgical facilities, mainly for cataract
operations, would serve as the hub, and TMCs and VCs set up within 70 Kms of the base-hospital would
serve as the spoke. The base hospital would receive referrals for cataract surgeries from TMCs and VCs
as well as from MCs conducted within a radius of 30-40 kms from the base hospital. Non-cataract
surgery cases would be referred to other multispecialty eye hospitals.

The rollout started in November 2012, with the setting up of the first base hospital at Devanahalli, of
Bangalore Rural district, about 60 kms north of the Bangalore city. The hospital had 20 beds and could
conduct about 300 surgeries in a month. The services included Comprehensive Eye Examination,
Refractive Error Services, Cataract Surgery with IOL Implantation, Glaucoma Evaluation, Uveitis and
Ocular Immunology, Diabetic Retinopathy, Childhood Eye Diseases, and Community Eye Care.

Both Kiran and Anjali had worked in telecommunication industry for more than a decade and believed
that telecom technology could transform the rural eyecare scenario. To extend the reach of the base
hospital, Tele- Medicine Centers (TMC) were commissioned first at Vijayapura about 12 kms from the
base hospital, and then in Bagepalli- a taluk headquarters 60 km away in the neighboring
Chikkaballapur District. The TMCs were staffed with qualified optometrists who, after the initial
screening of the patient, would upload relevant data and pictures, which a doctor in the base hospital or
at any remote location could study. The doctor would then advise the patient on the treatment through
a seamless video consulting facility.

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According to Mr. Vivek who promoted the TMC, “The technology is so effective that even a doctor on
a family vacation in Goa could advise a patient real-time.” However, due to poor patient walk-in, the
first TMC at Vijaypura had to be shuttered down.

In 2013, Drishti set up its first Vision Centre (VC), an eye-clinic with screening and consultation
facility, in the neighboring Chikkaballapur, the district headquarters, as a spoke of the Devanahalli base
hospital. The center soon began attracting around 40 patients daily of whom, on an average, 6 to 8
patients who needed cataract surgery were referred to the base hospital at Devanahalli. Non-surgical
eye ailments were treated by the consulting ophthalmologist at the VC whereas Glaucoma and other
more complicated surgeries were referred to multispecialty eye-hospitals in Bangalore city.

The first Mobile Clinic (MC) was commissioned in 2013, which operated within a radius of 40 kms
from the base hospital at Devanahalli. The MC, a bus customized and equipped to conduct basic eye
check and also to prescribe and dispense spectacles, extended Drishti's reach into remote villages of the
district. In a month, a fully utilized MC could cover about 15 villages and screen around 3000 villagers
through about 22 outreach camps. Since the team for the MC, including the doctor and optometrists,
was sourced from the base hospital, staff availability determined the actual number of MCs held.
Patients screened at the MC accounted for as much as 80% of the surgeries conducted at the base
hospital. From his experience Kiran knew that only 3 to 5 out of 10 persons advised to visit the hospital
would actually visit the hospital for further consultation. Kiran found that unless a reasonable number
of about 50 people visited the MC, it would be unviable. To ensure healthy footfall to the MCs Drishti
collaborated with women health workers (called ASHA workers) who conducted door-to-door
campaign for the MC two days before the camp.

In June 2015, Drishti expanded into Ramanagaram district setting up its second base hospital in
Chennapatna, the district headquarters, located 70 kms south of Bangalore city. Six months later, Drishti
set up its third base hospital in Chitradurga, the headquarters of the eponymous district, 200 kms north
of Bangalore.

In March 2016, the VC under the Chennapatna base hospital was set up at Kanakapura- 40 kms away
towards south-east. The following year a TMC became functional at Maddur, another small town 23
kms towards west of Chennapatna base hospital. Another modified bus was added to the Chennapatna
base hospital in 2017 itself. Kiran was in the process of setting up a VC and TMC for the Chitradurga
base hospital. The goal was to have a base hospital along with its VCs, TMCs and MCs in each of the
30 districts of Karnataka before moving to other states of the country.

Exhibit 2 details the facilities required for each unit in the hub-n-spoke model and corresponding
demand generation efforts. The major milestones and events at Drishti are given in Exhibit-3.

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Many city-based hospitals, especially in south India, regularly conducted mobile clinics in poor urban
localities as well as villages situated within about 50kms of the hospitals2. But the Drishti’s MCs had
important differences. Since Drishti’s base hospitals were located in district headquarters outside
Bangalore city, the MCs conducted by Drishti reached several villages beyond the reach of any city-
based hospitals. Also, the VCs as well as the TMCs located in talukas and small towns functioned as
spokes of the base hospital and no other eyecare hospital could have the deep rural penetration that the
cluster model of Drishti could achieve.

Pricing of Drishti Services

Drishti charged its patients a consultation fee of INR 100/-, but waived it off for deserving patients.
Prescription glasses were priced from ₹300 onwards based on lens and frame design, and the cost of
cataract surgery was around INR 4000 while depending on the quality of the intraocular lenses the cost
could vary. Drishti provided free consultation to the patients attending its MC camps that were
sponsored by donors. Free cataract surgeries were performed for poor patients over 60 years old not
covered under health insurance.

Kiran explained about Drishti’s pricing policy: “We want to be an affordable eye-care player. For any
service or product, we offer, we have a minimum price. We don’t offer anything free, but affordable for
those who self-select themselves and walk into our Vision Centers or hospital. The logic is that if a
patient self-selects, then he or she is willing to pay….”

Kiran felt that this model of eye care delivery would be economically sustainable only if Drishti could
scale up rapidly to achieve higher volumes. The initial investments and the recurring fixed overhead
expenses of the units of a typical vertically integrated cluster is available in Exhibit-4. Cost structure
for a typical cataract surgery at Drishti hospital is given in Exhibit-5.

Patient Behavior (Market Opportunity versus Go-to-Market challenges):

According to Anjali the BoP patient did not feel the need for preventive healthcare. Their behavior
denoted a kind of grudge-consumption. Besides, the villagers considered wearing spectacles, especially
if worn by girls, a sign of physical disability. Some behaviors and beliefs salient to rural consumers
observed by Anjali are given in table below.

Disease- Distance correlation: Villagers avoided medical consulting as they had to travel
cover some distance to reach the nearest hospital. Only when an illness became unbearable,
they approached a hospital. A few families that owned an automobile would consult a doctor
in the bigger city and would stay loyal to that doctor rather than meet a doctor in nearby town.

2
The hub-and-spoke model is not new to the Indian market. The most celebrated example is the Aravind eye
hospital located in the city of Madurai in the neighboring state of Tamilnadu. Aravind also had VCs and MCs.
But the difference was that while Arvind operated in and around a large city Drishti had no presence in large
cities.

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 Distance-Cost correlation: To meet a local doctor in nearby small-town villagers
carriedINR.300/-. To consult at a hospital in the district headquarters they carried about INR.
1000/- or more and to a city hospital they would carry more money as they had to spend on
food and accommodation for themselves and for an accompanying neighbor who was already
familiar with the city.
Technology acceptance and Brand credibility: Beyond 30 kms of the Drishti hospital there
was little credibility for Drishti brand. Only those patients who were already familiar with
Drishti hospital brand were ready to walk into the tele-medicine centers and consult with the
doctor remotely. Other patients who walked into the TMC facility would return without
consulting the doctor online. Patients did not feel that they got a complete eye consulting service
over telemedicine. Also, not all doctors, even in Bangalore city, were comfortable with tele-
ophthalmology treatment.
Cataract Prominence: 85% surgery cases identified in the rural were cataract cases. Mostly
elderly people visited the Mobile eye camps. If held on a holiday, 3-4 kids also visited the MC.
Aesthetics: Even rural patients expected improved procedures and decent looking glasses. The
Modi-procedure3 for cataract was not accepted by many villagers because of the “soda-glass”
they had to wear after surgery or for vision correction.
Elderly: Old people were left in apathy regarding health matters. Their children would own a
fancy two-wheeler but would not spend INR 3000 on their parent’s eye-treatment. Due to this
indifference, one-night stay in hospital after the cataract surgery was mandated by Drishti for
the elderly patients.
Income and Age information: Women in villages didn’t report their age. No one reported
their actual income class. There is income hierarchy in the villages. The well-to-dos had access
to a personal doctor in the city and did not visit local physicians.
Peer/hierarchy influence: Opinion leaders had strong influence on the rural patient behavior
especially with regard to undergoing surgeries. MCs would be held with the
support/permission of the village panchayat (administration) heads. After diagnosis of cataract
during the camp, the patient would be counselled by the Drishti ophthalmologist for a surgery.
Their consent for the surgery often depended on the fact that there were also others from the
village undergoing the same surgery.
Group behavior: There is fear of travelling alone to hospitals. If patients are formed into
groups and a leader is assigned, there is greater readiness to travel for surgery and for follow-
up. If something goes wrong with the treatment villagers collectively demanded money as
compensation.
Disinterest in follow-up: There is drastic drop in mandatory post-operative follow-up. Only
those suffering from a post-operative problem would ever come for a follow-up.
No Felt need: Elderly in the rural were mostly illiterate and therefore had little reason for minor
vision corrections. School going kids were found to be more forthcoming for an eye-screening.
Role of Agri-cooperatives: People who are registered members of a milk-federation or Agri-
federation were the first to know of mobile camps to be held in their village. By virtue of their
membership, they were also eligible for insurance schemes like Yeshaswini4.
Seasonality of demand for treatment: While summer season saw high demand for eye-care
other seasons especially harvesting/festival seasons like Diwali and Dussehra were lean
periods. The demand for healthcare is also low during the sowing seasons.

Collaborating for Value Creation

3
A popular cataract treatment project conducted by Dr. Murugappa Channaveerappa Modi in rural India. The
treatment was very successful and he conducted about 500,000 surgeries. However, many patients disliked
the thick glasses (nicknamed “soda glass” ) given after the treatment for vision correction.
4
Yeshasvini Scheme: A health insurance scheme introduced by the Government of Karnataka for the Co-
operative farmers of Karnataka that covers about 823 defined surgical procedures to the farmer cooperators
and his family members.

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For the peculiar healthcare related behaviors and for the low-income levels of the rural poor, Kiran
believed that tough demand creation measures would be necessary. Drishti sought the partnership of
other social enterprises and NGOs who were familiar with the rural context and had complimentary
capabilities. Drishti collaborated with Accredited Social Health Activists (ASHA5 workers) who went
door-to-door educating the villagers about the need for preventive eye-care. These workers knew the
local communities, hence were acceptable for the villagers. They conducted initial screening and
qualified people for the mobile eye camps to be held in the village. These workers also followed up on
the regular use of spectacles given to children. The ASHA workers thus provided continuity for
Drishti’s efforts and served as the critical link between the villagers and Drishti. Kiran commented
about ASHA: " I am trying to reach the grassroots. I don't think it would be possible to reach them
without the support of collaborative partners like this".

Drishti partnered with Heads Held High (HHH), a social enterprise with a focus on skill-training rural
youth for various kinds of employment. HHH would mobilize the youth and Drishti would train them
in eye-screening. The youth could sell spectacles to those in need and make a commission. Customers
who were diagnosed by these youth with an eye problem were referred to Drishti's hospital for further
treatment. The association with an eye hospital like Drishti was expected to enhance the credibility of
these youth.

Drishti also collaborated with the 2.5 New Vision Generation (2.5 NVG), the social impact division
of Essilor International S.A., a global leader in ophthalmological solutions. This guaranteed an assured
supply of high-quality lenses for even the cheapest spectacles dispensed, helping Drishti meet its goal
of providing affordable quality eye care. 2.5 NVG partially funded the specially fitted bus used by
Drishti for conducting MC. After screening for cataract, the bus transported patients who needed
advanced treatment or surgery to Drishti's base-hospital. Drishti arranged to deliver 2.5 NVG’s glasses
to patients' door-step, solving the challenge of last-mile connectivity in the delivery of the eye care
services. This partnership also contributed significantly to 2.5NVG mission, as summed up by its Vice
President, Saugata Banerjee:

"We have to create new vision- people who are not wearing glasses, should get access to a pair of
glasses. In India we have 550 million people who need a pair of glasses, but don't have. It is a Herculean
task. 2.5 NVG’s Eye Mitra Optician (EMO) program, has trained and created 2,500 rural youth to be
opticians in their villages in three years. 2.5 NVG plans to take the number to 10,000 by 2020”

Drishti's collaboration with the CSR division of Titan Industries ensured the supply of high-quality
frames through the latter's procurement department. The then Managing Director of Titan launched the
Titan CSR initiative of covering every school and village in Chikballapur for eye care. Rotary

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A trained female community health activist. Selected from the village itself and accountable to it, the
ASHA workers are trained to work as an interface between the community and the public health system.

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International, a global NGO, collaborated with Drishti in setting up the surgical wing in the Devanahalli
Hospital and in launching the VC in Kanakapura. This collaboration helped Drishti subsidize the free
cataract surgeries of the poor patients.

While the collaboration with 2.5 NVG progressed as the company promised Drishti to commit funds
for more mobile clinics in newer locations that Drishti would expand, other collaborations confronted
hurdles. HHH looked at more rewarding avenues for training and placing the rural youth; For e. g.,
Training for organized retail sector in the cities and towns rather than for selling spectacles for Drishti
in remote rural areas. ASHA workers were not active in all the districts of the state.

Organizing for The Rural Market

Drishti had to grapple with the challenge of recruitment and training of optometrists for its facilities
located far away from the urban centers. Kiran was looking forward to the partnership with Minto
Hospital, a respected government hospital in Bangalore, with a large ophthalmology and optometrist
training facility, that could help Drishti overcome the staffing problem. Kiran managed to recruit
doctors for hospitals which were located in the district headquarters. But getting doctors for the VCs at
the taluk towns was very difficult. For instance, the VC in Kanakapura taluk town had a doctor who
travelled from Bangalore. This not only increased the cost of operations of the facility, but also raised
doubts about the willingness of the doctor to bear the stress and strain of travel for a long time. Kiran
had tried, without much success, a small format VC staffed with one optometrist, persuading him to
believe that patients would like to consult with only a doctor. Without the assurance of the availability
of qualified doctors, opening new VCs was not be feasible.

As scaling up the VCs becoming hard, Kiran turned to well-established general practitioners (GPs) in
villages. Drishti provided the screening devices required at the GP’s clinic. The proposed arrangement
was that the GP would refer the ophthalmic cases to Drishti hospital for which a fee would be paid by
Drishti. With the GPs treating this new opportunity as secondary, Drishti failed to receive sufficient
referrals.

TMCs were considered an alternative wherever VCs were not feasible. But the TMC in Maddur
received only about 6-8 walk-in patients in a day. The slow pace of acceptance of TMCs among the
semi-urban and rural patients could mean a long wait for Drishti.

A Way Forward

Kiran found himself at the cross-roads as he was contemplating the strategic options to expand Drishti.

He could set up hospitals in many more district headquarters as availability of doctors and paramedics
in district HQs was better than in small towns. Given the size of the eye-care market in these district
HQs, demand for non-cataract surgery could also be an opportunity Drishti could exploit by adding

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 facilities to these hospitals in future. Patient walk-in to these hospitals could be augmented through
MCs and local promotions. The advantages of this semi-urban focused horizontal expansion strategy
would be larger scale in a shorter time span, and attractive financial returns. Drishti could thus become
a chain of multispecialty eye hospitals operating in all district HQs which meant a chain of hubs but no
spokes. Without the spokes that helped Drishti expand vertically with the VCs, TMCs and MCs in the
remote villages, deeper rural penetration and corresponding high social impact would be impossible.
Drishti had learned from its experience that vertical expansion required ecosystem building efforts in
collaboration with many other social enterprises, and those collaborations could sometimes fail.
Investors wanted both impact as well as financial sustainability. Kiran had to decide.

Exhibits

Exhibit-1: The contribution of each unit of the eyecare cluster to total surgeries (Kanakpura
cluster)

VC Kanakapura 104 cases or 12%

MCs conducted by Kanakapura VC team 151 cases or 17%
TMC Maddur 37 cases or 4%
MCs conducted by Maddur TMC team 55 cases or 6%,
Base hospital Chennapatna 527 cases or 61%.
MCs conducted by Chennapatna base hospital 10% of the 527 surgeries
Table created by authors using data supplied by the company.

Exhibit-2: Components of the Drishti model of Eyecare delivery

Component Facilities and personnel Demand activation programs

Base Hospital *2 to 3 Ophthalmology surgeons specialized in *Mobile clinics conducted in rural

(located in a district cataract. areas by the staff of the hospital.
headquarter)
*Facility to conduct about 20 cataract * Accredited Social Work Activist
surgeries/day and provide post-operative care (ASHA) workers conducting door-to-
facilities. door promotion in the neighborhoods
of the hospital
*An outpatient department (OPD) equipped with
all diagnostic devices.

*Facility for dispensing spectacles.

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Vision Centers *An ophthalmologist along with 2 optometrists in *Accredited Social Work Activist
(located in a taluka a state-of-the-art clinic facility providing only (ASHA) workers conducting door-to-
town and provides OPD services. door promotion in rural villages.
secondary eyecare)
*Facility for dispensing spectacles.

Tele-ophthalmology *State-of-the-art clinic facility equipped with *Promotional Booths set up in busy
centers (located in screening devices as well as tele-consulting shopping areas and other public
smaller towns of a devices. places e.g., parks where elderly
taluk) persons come for regular morning
* Two Optometrists conducting initial screening
walks.
of patients and facilitating their consultation with
the ophthalmologist located in nearby city.

Mobile clinics *2-3 Optometrists in a modified bus equipped *Drum announcement 2-3 days before
(operates in villages with devices for diagnosing cataract cases. the camp
within 30-40 kms
*A camp organizer and a driver. * Banner put up at a public place in
distance from the
the village and leaflets circulated to
base hospital)
each family in advance. S

VC at General *Drishti gives screening devices to be used by the GP’s own efforts in his/her locality.
Practitioner’s clinic physician in case he comes across patients with
(located in small eye problems.
towns)

Table created by the authors based on field observations and interviews with company executives.

Exhibit-3: Events at Drishti

Nov 23, 2012; Drishti in operation with its main center in Devanahalli along with two vision
centers- in Bagepalli in Chikbalapur and Vijaypura. Hosts about 10 eye camps
a month in semi-urban and rural areas.

Jan 7, 2013, Drishti Eye care secured funding from Lok Capital. Lok one of the largest
dedicated funds in India for business focused on serving BoP made its first
investment in healthcare segment in Drishti.

Aug 7, 2013 Oscar nominee Bombay Jaishree put together India’s first children Carnatic
choir. The proceeds were for funding surgeries conducted at Drishti.

October, 2014 Drishti and Essilor organized a rally in Doddaballapur for world sight day.

October 24, 2013 Rotary Drishti Surgical wing was sent up in the Devanahalli Hospital

Dec 14 2013 Drishti Chikballapura was opened by Smt. Arundati Nag. She also launched the
first mobile eye clinic.

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 Dec 16, 2014 First camp with the mobile eye clinic was held in Addagallu in Chikballapur

Dec 26, 2014 Titan MD, Bhaskar Bhat, launched Titan CSR initiative of covering every
school and village in Chikballapura for eye care

Jan 16, 2015 Drishti super specialty eye hospital was launched in Chennapatna.

Feb 13, 2015 Health minister of Karnataka launched 2.5NVG & Drishti Mobile eye clinic

July 23, 2015 Launched school screening program in Chennapatna taluk in association with
Essilor Vision Foundation.

Aug 14, 2015 Drishti shortlisted in top 5 social impact startups by the Economic times

Dec 13, 2015 Drishti hospital launched in Chritradurga

March 13, 2016 Launch of Rotary Drishti Eye Hospital in Kanakapura

June23, 2016, Nandan Nilekhani invests in Drishti. Drishti will expand its reach to six more
districts in Karnataka in the next phase of expansion, after infusion of fresh
funds by Nilekani

Table created by the authors based on data from company website.

Exhibit-4: Investments and the operational expenses

Unit Monthly Recurring Expenses Initial investment in Leasing,

including salaries, Rent, office Interiors and equipment
and maintenance.
Base Hospital 5,00,000 1,20,00,000

Vision Center 2,00,000 18,00,000

Telemedicine Center 1,20,000 10,00,000

Mobile Clinic 1,00,000 30,00,000

Table created by the authors based on data supplied by the company.

Exhibit-5: Cost structure of a cataract surgery service

Revenue INR 4000/ SURGERY (Surgical charges:60% +

Hospital stay)
Variable expenses 35%

Contribution 65%
Table created by the authors based on data supplied by the company.

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