Financing Social Entrepreneurship Efforts David Green Creating a Different Economic Paradigm • Examples of sustainable eye care that serve all economic strata, where free is the lowest price • The interplay of affordable technology combined with cost-effective and affordable eye care service delivery • Social enterprise business models with the right control and governance to ensure fidelity to social mission • Financing to bring about the revolution Our “Calling Card” • Over 300 eye care programs are self financing and serving low income • Eye care, more than any other medical specialty, has proven that primary, secondary and tertiary care can be self financing and serving the poor • Lessons learned in eye care need to be applied to other medical arenas Aravind Statistics 2011-12 Charity Pays: Aravind in Kerala Initial situation Activities Result Paying patients • Only 2% of Aravind’s paying patient population was coming from Kerala • Aravind held over 40 outreach camps in 12 months • One year later, over 25% of Aravind’s paying patients came from Kerala Word of mouth generated by doing affordable care is sufficient to drive paying volumes; cannibalization doesn’t occur Aravind Has Helped 285 Eye Hospitals Become Sustainable Other Countries: Bangladesh Bulgaria Bolivia Botswana Cambodia China Egypt Indonesia Kenya Malawi Maldives Nepal Zambia Zimbabwe Guatemala El Salvador Tanzania Tibet Nigeria Sri Lanka Lions (SF) Sight Savers CBM - 112 - 53 - 21 WHO,ORBIS,IEF,RTS Seva, others - 45 Total: 231 Participants: 1148 80% of these eye care programs have become profitable while serving the poor Grameen Eye Hospitals Surgeries: 47,000 70% pay $33 20% pay $78 10% free Profit $222,222 Lumbini Eye Hospital, Nepal AlNoor Magrabi Eye Hospital Egypt Year 2005 2006 2007 2008 2009 Expenditure Revenue Profit/loss 5,492,345 5,870,038 377,693 8,026,917 8,373,917 347,000 10,007,394 10,617,815 610,421 9,936,205 9,946,984 10,779 13,349,988 16,611,784 3,261,796 Total % Free % Free Cataract Cataract Total All All Surgery surgery Surgeries Surgeries 4727 49% 6,138 41% 4260 60% 5,435 51% 4447 58% 6,208 47% 6859 41% 9,330 33% 6356 43% 10,147 31% Annual Data of Shenyang He Eye Hospital Chitrakoot- Sadguru NC Exams & treatment Surgeries Surgery free or below cost Percent free or below cost Surplus revenue 2011-12 411,774 100,691 86,719 86% 8% Visualiza : Public and Private Together Waiting room private Waiting room Social Operating theatre PACIFIC VISION FOUNDATION EYE INSTITUTE San Francisco USA Humanizing Capitalism • Use profit and production capacity to serve • Profit is good; it’s how you use it that makes a difference • Profit is a means to an end and not the end itself • Maximize distribution while being profitable VS Maximizing return on investment • Use pricing to change the competitive landscape in favor of the consumer Finance from the Customer Policy Implication for INGO’s • Instead of re-inventing cash flow each year to pay for programmatic operating expenses: –Make programs self financing from user fees –Use freed-up finance for start up or expansion of new service delivery Create and Use Market Forces • Change the competitive landscape by providing accessible high quality services • Consumers become program planners • Stimulate industry development by converting need into demand and proving that markets exist Aurolab Interplay of technology, disruptive pricing and compassion 14 million eyes regained sight through affordable Aurolab products 8% global market share of intraocular lenses 1.9M annual volume Products sold in 120 countries: 60% to nonprofits; 40% Volume commercial Aurolab Price USD Competitor Price CE Mark for most products, FDA for suture IOL Suture Pharma 1,337,901 1,173,953 1,675,122 $4.50 $100+ $1.10 $10 $1.50 $60 Aravind’s Growth and IOL’s Total procedures over time 350,000 300,000 250,000 200,000 150,000 Aurolab 1992 100,000 50,000 0 Paying Free Source: “Restoring vision to Millions – underlying management concepts” a presentation by Aravind Executive Director Thulasiraj, 2010 Humanize Capitalism-Product Development 1. Demystify product development, manufacturing and regulatory costs 2. Control technology/IP to be in control of manufacturing, distribution and pricing to insure affordability to end users 3. Engage extreme technical competence – find people who already know what they are doing 4. De-construct supply/distribution chain to cut out unnecessary margin 5. Take the help of IP lawyers • Aurolab Humanizing Capitalism- Distribution 1. Create novel channels that remove non-value-added margin 2. Use pricing and quality to change competitive landscape 3. Create companies that transform their industry and are in favor of lower income people 4. Convert great unmet need for lower income populations into demand 5. Sculpt costs and margins to result in affordability, while achieving reasonable returns 6. Create novel, disruptive supply chain ecosystems that reach middle class, lower middle class and poor Technology Development Formula • Find individuals with extreme technical competence • Build company around them • Low cost product development • Short product development cycles- typically 2 years Sculpting Costs & Margins to fit Reality Comparing Apples to Apples • Figures for 2007 IOL's Price Volume Revenue Cost of goods Manufacturing Aurolab Major competitor $2-30 ($4) 1M $5M $2.50 $1 $50-400 ($130) 7M $920M $32 $1 Manufacturing costs may be the same but margins and distribution are vastly different SoundWorld: Hearing in 30 Minutes Attach to Ear Quick test User adjustable $2000 vs. $100-$200 Quantum Catch Fundus Camera • Fully automated operation • Field of view about 55 degrees in diameter (mosaic) high resolution • Separate images under near-infrared, red, and green retinal illumination • All images are stereo pairs • Price not yet set but far lower than existing cameras Glaucoma Detection • RAPDx is a pupillograph utilizing a highdefinition, machine-vision. • Hopkins Study Conclusions: A prototype pupillography device appears able to discriminate glaucoma from normal with relatively high specificity and sensitivity. Non-Invasive Blood Glucose Monitor Aqueous Humor Light We measure optical properties of the aqueous humor related to glucose concentration Concept: shine light into eye, measure output; correlate to blood glucose level, all in a hand-held device for home use Change Competitive Landscape with Pricing • India market growth in cataract surgery after Aurolab 1992-2002: • 2 companies grow to over 10 • Commercial companies compete with Aurolab on price and quality • Market grows from 800,000 to 5 million cataract surgeries per year • Big Co vs Aurolab /Indian Govt. – Aurolab forces competitor to reduce pricing for suture from $240/ box to $23 using competitive pricing as the weapon Changing the Competitive Landscape with Finance • Financing as tool of influence to tilt an industry in favor of the poor • Criteria by which funds are invested changes competitive landscape • Engineered financial instruments are needed to grow social enterprise as an asset class Eye Fund 1 Deutsche Bank – IAPB - Ashoka Investors • Storebrand Livsforsikring , Norway • SPP Livförsäkring AB , Sweden • Agence Francaise de Developpement, France USA Investors • Overseas Private Investment Corporation • The Bernard A. Newcomb Foundation • Deutsche Bank Americas Foundation • COFRA Foundation, Switzerland • Janet A. McKinley Investments: • China • Nigeria • Paraguay $14.48 million $2.3 million Senior Debt Investor Protections: • 84% first-loss protection to commercial socially motivated investors provided by Deutsche Bank, foundations, and development agencies • 1% loan loss reserves • 6-month interest reserve $10.18 million Subordinated Loans $0.5 million Subordinated Debt $1.5 million Equity IAPB Capacity Building: $1.5M to 8 Institutions to Provide Training to 37 Eye Fund Two • • • • $50M affordable debt Presently accessing demand Regionalize Combine with grants and possibly equity fund Enhancing Organizational Effectiveness Raise $10-20M to support creating sustainable eye care: • Strengthen organizations providing sustainability planning, consultation and training services with clients in their region • Create IT infrastructure to support all activities, including monitoring and reporting to donors; demonstrating results • Take lessons learned in creating sustainable eye care and apply to other medical specialty arenas. • Apply lessons learned in developing countries for creating more equitable and cost-efficient eye care service delivery in developed countries. For-Profit Social Enterprises • Development of a new asset class to facilitate financing for social enterprises – For profit social enterprise that can leverage off of increasing valuation of assets vs. non profits, which can’t – Go beyond Corporate Social Responsibility to use assets and core competencies to be socially transforming “Middle-Way” of Capitalism • Philanthropy is not sustainable and often does not reach the beneficiary • Strictly return on investment commercial sector does not address problem in it’s full public health magnitude • Need for “Middle-Way” of capitalism that maximizes distribution while being profitable • Socially transforming vs. CSR • Service to others ‘baked’ into the organizational DNA Fight All Forms of Blindness • Physical Blindness • Blind to the needs of others • Empathy with the blind and visually challenged and our desire to do something about this. • IAPB – we are small but powerful in our collective quest to serve others and ameliorate human suffering Dr. V and Systems Change Guiding Philosophy “… Spirituality allows the divine force to work through each of us for a greater good