Symposium 4 Social entrepreneurship & eye care Role of Social Entrepreneurship in Eye Care: Up-scaling and Sustainability

WHO, 2010 “As the world grapples with the combined challenges of economic slowdown; the increasing globalisation of the economic system and of diseases; and growing demands for chronic care, the need for universal health coverage (and a strategy for financing it) has never been greater” Despite best intentions, governments still grapple with: −Where and how do they find the financial resources? −How can they protect people from the financial consequences of ill health? −How can they make optimum use of resources?

GLOBAL POVERTY STATISTICS Almost half the world (over three billion people) live on less than $2.50 a day.

Disability and Poverty 82% of the 600 million people with disabilities worldwide live below the poverty line (Khanna, Raman & Rao, 2007) 64% of those with disabilities were not in poverty prior to the onset of their disability (Gooding, 2006) Households affected by disability: −3x more likely to enter poverty within one year of onset −Lower probability of leaving poverty → increased costs and reduced earnings Disability Poverty

Public sector Social enterprise Private sector Reaching the 7 billion

For Profit Social Enterprise Not for Profit Social enterprise Socially minded Revenue generated = +

Social enterprise is not: Traditional fundraising Grant money Gifts/donations A “quick fix” in a time of a crisis For everyone Social enterprise is: Creating sustainable revenue streams Engaging market forces Devise new ways to leverage existing assets Decreasing dependence on the external funding Utilisation of business methods

Eye health and income generation Can conflict with universal health coverage Can be controversial −e.g. sale of reading glasses

Social enterprise strategy Experience in URE Not all activities to conducive to income generation −Health systems integration Human Resource Development

Mission Centric SE Most eyecare NGOs will have a mission centric social enterprise Primary purpose  to advance the social mission Social programs and business activities have a significant effect on each other

Risks of establishing/converting to a social enterprise Erosion of core values Investor dictated agenda Governance challenges

Should your organisation undertake SE or undertake other earned income activities? Is your organisation risk averse? Does your organisation have the organisational capacity to start and run an enterprise Will a separate business provide the best opportunity to meet your goal Y N N N Y Y Earned income activitiesSocial enterprise

Initiating a social enterprise Expand what you already do −Commercialise something your organisation already does, e.g. creating a fee for a service model within an existing program −Develop a new aspect of something your organisation already does e.g. expanding services to a new population Start something new −Create a new commercial product or service −Or do something totally new

Attracting investment

How can we source start-up funding? Conventional modes of funding −Donor/government −CSI −Crowd sourcing/Online platforms −Local governments −Business Angles −Philanthropy −Foundations −Social Investors

Cautions Distraction from your mission Donor cannabilisation Inadequate resources Diversion of resources Cultural difference creates tension between NGO and enterprise staff Cause of financial losses Conflicting stances among board Risk of failure - reputation and morale Depoliticising of social problems “Let governments off-the-hook”

Opportunities for social enterprise in eye health

The dilemma! Some eye health activities often sit squarely in the public domain while others are best served in a commercial format Many social entrepreneurs have successfully built Hybrid organisational structures Non-profit with entirely owned business subsidiaries

Licensing Basic & Applied Research Collaborative Research & Product Developme nt Public Health Commercialisation Ophthalmic Research Institute Vision and Eye Health Vision Myopia and Presbyopia NGO Uncorrected refractive error Licenced 2 technologies from Vision CRC to ATI ATI Developing breakthrough solutions and surgical products ATA ComX ISO Certified Culture The Brien Holden Vision Institute Not for profit Commercialization - For profit

Get the correct message across: Sustainability is more than just financial

Vivian Greene