The Aadya Initiative
It is estimated that 1.1 billion people suffer from vision loss globally right now. 12 million of those that are blind or visually impaired, live in India. Without significant investment, 1.7 billion people will be impacted globally by 2050. Low and middle-income countries account for 90% of all vision loss, with women and girls being disproportionately affected. 80% of blindness and visual impairment is treatable or preventable with access to basic eye care, including screening. Of the 154,000 people the Aadya project has screened to date, 98% have had no access to eyecare ever. For many in rural communities, access to basic eye care is limited by access, culture and a sheer lack of qualified technicians.
“The World Health Assembly endorsed the global targets for effective coverage of refractive errors and cataract surgery to be achieved by 2030 - namely, a 40 per cent increase in coverage of refractive errors and a 30 per cent increase in coverage of cataract surgery[1].“ The World Health Organization has estimated that the lack of eye-care in low-income countries costs the global economy more than $200 billion annually in lost productivity.
The secondary and tertiary impacts due to large scale vision impairment within rural and remote villages in India are:
High poverty rates within families as a result of caring for someone with a disability.
Underemployment as a result of people forced to leave the workforce due to vision impairment.
Low rates of educational access for family members, who are taken from school to be caregivers and assist vision impaired parents or relatives.
High rates of accident and injury among the vision impaired.
High rates of lost productivity from those who are working age, but visually impaired.
Decrease in overall health for those that are vision impaired and their families.
Limited or no access to community due to mobility.
High rates of mental health issues among vision impaired individuals.
Lower life expectancy among the vision impaired.
Lower mobility, fine and gross motor skills among people with a vision impairment.
Vision loss isn't just about restoring sight to one individual or many. The ripple effect which occurs once sight is restored to one person is far reaching. When done on a large scale, individuals, families, villages, communities and society as a whole will benefit from the change.
Combat Blindness International (CBI) attempted a new way of increasing access to eye care during the COVID-19 pandemic. It became clear during this time that eye health services needed to evolve and find new ways to bring equitable eyecare into remote villages. Traditional eye screening camps (that were common practice before this time) needed to be replaced. No longer could we gather together those most in need, in one place, and provide them eye care screenings as a group. Together with our partner, Dr Shroff’s Charity Eye Hospital, we trained 8 local technicians and deployed them into remote villages, to go door-to-door, screening patients. These densely populated villages and towns suffer from poor amenities and limited access to centralized health care services. From this, the Aadya Initiative was born.
The Aadya Initiative is a scalable and sustainable business model to reduce preventable blindness in rural communities in low-income countries. By training a workforce of skilled female technicians and deploying them back into their own communities, we provide eye health screenings and treatment. We then capture and use the data collected via an integrated mobile data collection and referral platform, and provide it to key stakeholders to ensure the sustainability of eye care provision for that community, into the future.
The Aadya Initiative has 6 major components:
Selecting and employing a local female workforce of skilled eye health technicians from rural and remote communities.
Training and deploying these eye health technicians back into their own villages and communities, to go door to door, screening the entire village.
Utilizing real time smartphone data collection and portable eye health technology to help diagnose and treat every patient.
Offering treatment to patients found to have eye health condition by providing consultation, glasses, or a referral for further follow-up/ surgery at partner eye hospitals.
Creating sustainable change for rural communities using the Aadya data. Providing our data and statistics/recommendations to local partner eye hospitals, health clinics, local and state governments. In this we enable appropriate services to be set up in the most advantageous locations to continue serving these remote communities post Aadya.
Becoming financially self-sustaining, within one to two years, from sales of spectacles, and referrals to secondary vision centers; thus creating a replicable model that can be implemented in other regions or countries across the globe.
For the many in India who have never had an eye health exam, the Aadya Initiative offers screening 27-times more efficiently than traditional ‘eye camps’ (an eye camp is a 1-day event held in a community where specialists in eye health are brought and the population line up to be screened one by one for vision issues. It is a ‘self reporting’ model; meaning only those people in the village who think they may need help choose to attend).
Each eye health exam through the Aadya Initiative takes between 6-9 minutes per person, door to door, throughout a village. Each patient has their sight tested and this data is recorded with mobile technology, into a smartphone and simple database. The results are offered immediately to the patient and the Aadya Initiative technicians then offer treatment solutions for patients in need. Glasses, transportation to and from home for further consultation/ examination/ treatment are also offered if needed, along with surgery (if required), hospital stays, post treatment followup and insurance assistance (if available).
Aadya eye health technicians are employed within their own communities, supervised, and deployed in pairs. Using our mobile smartphone technology, each technician is able to screen and assist 87 people per week on average. Data collected throughout this model is then used to engage local, state and federal healthcare services as well as partner hospitals and local organizations in ongoing service provision for communities. Aadya technicians provide regular feedback on the program, data recording and best practice in the field as well as insights on how to engage rural communities.
The Aadya Initiative's target population is rural and remote communities in low-income countries. At present, the Aadya Initiative is delivering services in Saharanpur, Uttar Pradesh, India, where the latest population estimate is 3,911,158 people. We estimate that over the next 1-5 years, in Saharanpur alone, the Aadya Initiative could provide eye health services to over 1,000,000 people, of which 60% are rural women and girls.
Currently in India, the population is underserved in relation to eye care in numerous ways:
Access to eye care is non-existent in many communities, with over 98% of people screened by an Aadya technician reporting they have no access to, and have never had, any eye health checks or treatment.
There is approximately 1 ophthalmologist per 100,000 population in India; therefore seeking an appointment or treatment for rural and remote patients is limited.
Traditionally, women in India have limited decision making power in the family and low social economic opportunities. They will often forgo their own health needs for that of their children or other family members.
The current model of eye health checks for rural and remote communities is via ‘eye camps’. This outdated model is inequitable and inefficient, leaving the most vulnerable patients once again missing out on healthcare.
At present, limited services of any kind reach these remote communities and villages. There is very limited reliable data available as to the current populations in these regions, and even less on their healthcare needs.
The Aadya Initiative will bring:
Access to eye care to all people living in these remote villages and communities.
Trained community members to provide this service, door to door, for everyone.
Culturally compatible eye care provided by women, to all.
Diagnosis and treatment for all those screened at limited/ no cost.
Privacy for patients in the process, screened at home at their convenience.
Realtime data on the eye health needs of remote and underserved villages.
Access to ongoing eye-care into the community into the future, through provision of the data collected to local agencies to inform local healthcare needs.
The impact on these villages:
Following assistance from the Aadya Initiative, not only is an individual’s sight restored, but people who regain their vision go on to generate 1,500 percent of the cost of their cataract surgery in increased productivity within their community, during the first year after their surgery.
An increase to the social and economic empowerment for those rural women employed as Aadya eye health technicians. In Uttar Pradesh at present, Aadya health technicians receive training and ongoing employment, earning $100 USD (7,265 Rupees) per month for their work, screening those within their community. This is 149% more than the average rural female monthly income, bringing with it increased health, educational opportunities and increased quality of life for them and their family.
Sustainable access to eye care into the future. The Aadya Initiative data will be accessible to both public and private, local and state stakeholders. This will ensure strategic data-driven decisions about the health needs of communities post-Aadya screening. This ensures that the most needed services are provided into communities with the most up to date data possible on each population.
Ability for local government or non-government agencies to conduct strategic modeling, planning and decision making into the future; with regards to population growth, density and current and future health care needs for these communities.
- A positive impact on the secondary and tertiary ripple effects within these communities, which occur from large scale vision impairment.
For 38 years, CBI has been on the forefront of partnering with local hospitals and healthcare systems to provide innovative solutions to alleviating blindness and elevating individuals, (particularly women) in marginalized communities. Long-term local partnerships in 17 countries and 4 continents to date, have resulted in 2.85 million vision screenings for refractive errors and cataracts and 385,000+ sight restoring cataract surgeries performed in partnership with CBI.
We work with our in-country partners to help them identify their needs based on the population they serve. CBI has long-standing partnerships with the Aadya Initiative partners Dr Shroff’s Charity Eye Hospital (SCEH) in Delhi, India and the University of Wisconsin-Whitewater (UWW). Both these partnerships provide CBI with technical and social sector expertise in rural eye care interventions and entrepreneurship respectively.
CBI understands the eye health needs of rural and remote communities in India at present, by using various data points. The following set informs the development and evolution of the Aadya Initiative; India:
Narrative/ feedback from ‘eye camp’ participants and community members,
Statistics on gender, age, throughput and diagnoses from ‘eye camps’,
Observations from partner hospital staff, local in-country ophthalmologists and patients on the efficiency and ongoing sustainability for communities of ‘eye camps’, and
Data on care & follow-up from ‘eye camp’ patients as well as those who are not served.
During the COVID-19 pandemic, CBI and our partners in-country used the above data points to design the pilot phase of the Aadya Initiative. Screeners from the target communities were selected and trained, then deployed back to serve their own community. Our design is informed by the community, uses local partners, employs local people and serves local villages sustainably.
The Aadya Initiative is currently in its 3rd phase of design and implementation, where the collection of narrative feedback, statistics, observations and analysis of the data continues with our partners and employees, to inform how the program is performing, and whom it is serving.
- Employ unconventional or proxy data sources to inform primary health care performance improvement
- Provide improved measurement methods that are low cost, fit-for-purpose, shareable across information systems, and streamlined for data collectors
- Leverage existing systems, networks, and workflows to streamline the collection and interpretation of data to support meaningful use of primary health care data
- Provide actionable, accountable, and accessible insights for health care providers, administrators, and/or funders that can be used to optimize the performance of primary health care
- Balance the opportunity for frontline health workers to participate in performance improvement efforts with their primary responsibility as care providers
- Growth
CBI is applying to this challenge as we are experts in the field of data gathering, analysis, eye health and treatment. Our impact to date through the Aadya Initiative has been limited by various barriers:
Financially limited reach into rural and remote communities. The Challenge will allow us to:
Fund transportation for Aadya staff into and out of some of the most remote regions of India.
Identify and select women from these rural communities, to become Aadya health workers.
Train and employ these local women to assess the eye health of their own local communities.
Capture real-time data on eye health in these remote regions and measure improvement of access to these regional healthcare systems.
Choose the communities we can best serve based on need.
Handle geographic boundaries of communities which are already receiving local eye care by existing health services.
Address the barriers (transportation and support) to our low conversion rate between referral for surgery and surgeries completed.
A cultural barrier to accessing remote communities and patients exists at present in Uttar Pradesh, India. The Aadya Initiative seeks to overcome this by:
Researching and respecting cultural norms within each region (for Eg. In India, women are respected within different communities, at differing ages) before selecting and deploying technicians there.
Partnering with regional established eye hospitals/ health care providers and sharing strengths/learnings with them.
Increasing access to eye health for women, by identifying, training and employing local women from target communities appropriately, as Aadya eye care technicians, then deploying these women back into their own communities.
Retaining local knowledge about eye health within these communities (for the future) by employing local people.
Market barriers exist at present for rural patients to follow through on their referral for cataract surgery. We seek to overcome this by:
Providing a confirmed appointment date and time (at the time of their eye health exam) for the cataract surgery.
Provide transportation for a family member to bring the patient to the surgery and accompany them on their return home.
With this local/ regional data, Aadya will further seek to decrease this barrier by identifying rural locations for regional eye health service placement, by government and non-government bodies.
The Aadya Initiative is limited by the number of technical issues at present. The challenge will allow us to:
Increase the number of eye care technicians we deploy and remote communities we can serve at any one time.
Overcome the limited number of low-tech devices we can deploy with Aadya eye health technicians.
Continue to expand our ability to collect data “offline” and drive strategic decision making moving forward.
Move through the integration constraints of the eye screening software we use, and our data recording.
Increase staff training and simplify data capture to ensure 100% of the data is recorded accurately in our data management software.
Ensure standardized training for Aadya health workers on eye health screening, data collection and recording, for the most accurate picture of eye health across India.
Provide the opportunity for us to design a professional progress pathway for Aadya workers through employment, review and promotion.
Increase our knowledge of regional eye services/ hospitals, to form partnerships for the sharing/ provision of real-time data on their most vulnerable populations.
CBI’s Aadya Initiative is a significant improvement on the traditional ‘eye camp’ model of eye health in rural communities and low-income countries. Our solution also ensures that the data we capture, is used to benefit the community for the future. The Aadya Initiative will be catalytic for individuals and communities in low-income countries in 7 significant ways:
The Aadya Initiative goes door to door, connecting with everyone in every home within rural and remote communities and providing free eye exams and treatment for all. This approach is gathering more accurate, real-time data via smartphones, than traditional eye camps. Thus eliminating the unpredictability and inaccuracy of attendance and data collected (on paper) during an eye-camp (eg. people don't show up if they don’t believe they need help, or aren't available due to work, responsibilities, lack of mobility etc.).
The Aadya Initiative is 27 times more efficient than traditional ‘eye camps’. Eye camps have become standard practice for NGOs to address eye health in rural and remote villages. These camps are transient, consume a multitude of resources, need access to an ophthalmologist and on average only screen around 115 patients at each camp. With various small organizations able to prepare and deploy around 50 camps per year, the total population screened is therefore only around 5,750 people per year. The Aadya Initiative has screened over 154,000 people for eye health in one year alone. This is a 2700% increase in patients screened.
The Aadya Initiative identifies, trains and employs local women from small rural and remote villages, then deploying these women back into their local village/ region to gather data and administer eye health exams. This approach allows for cultural sensitivity and additional trust in any diagnosis given to individuals, as their exams are conducted by local trusted women. It also enables these rural and remote villages to have qualified women living within their community, skilled in eye health and local.
The Aadya Initiative doesn't rely on the availability of an ophthalmologist in order to conduct simple eye health exams. The Aadya Initiative deploys trained technicians to conduct eye health exams, thus bringing screening opportunities to communities and individuals much more frequently and efficiently than eye camps.
The Aadya Initiative empowers local women through training and employment as eye health technicians. The Aadya Initiative is having a direct and positive impact on these women’s futures, their families and their communities. Since becoming Aadya screeners, we have seen an increase in the confidence of these young women, an increase in their cultural standing in their family and community, delay in marriage for many and continuity of employment even after marriage.
The Aadya Initiative is a private experience within each family's home. A significant step forward in caring for individuals and families with compassion and privacy, this solution allows for individuals and families to understand a diagnosis in private, ask questions, share concerns and understand their medical needs in a one-one environment.
The Aadya Initiative’s real-time data will allow local government and non-government services to get an accurate picture of current on-the-ground health conditions within remote communities/ regions. Funding/governing bodies will then be able to use our data and respond accordingly to community needs/ health issues. Key stakeholders will be better able to optimize the performance of their health care resources with real-time data and statistics. Individuals and communities will gain local and sustainable health services, specific to their population & the ability to project the future direction that services need to take, to respond to changes in the needs of the population.
Given the 2700% increase in remote patients receiving eye care (outside of the traditional eye camp model), CBI expects a shift to similar models of eye health assessment and healthcare in general, in rural and remote communities worldwide. The impact this approach will have on improving eye health, and reducing poverty and inequalities, will be extraordinary.
The Aadya Initiatives impact goals are centered around the UN Sustainable Development Goals (SDG’s):
SDG #1: No Poverty (Target: 1.1 and 1.2 )
- In the next year, we plan to restore sight to those who are blind or have low vision, giving people the opportunity to work, earn an income for their family or engage in education.
In the next 5 years, we plan to increase eye health screenings and treatment, and raise the poverty level in rural India by expanding the Aadya program into new geographic regions.
SDG #3: Good Health and Well-being (Target 3.c and 3.d)
In the next year, we will promote eye health and make eye health screening available to all women, men, and children in some of the most remote villages in Saharanpur, Uttar Pradesh
In the next 5 years, we plan to ensure all previously screened Aadya communities have ongoing access to eye care, as well as new Aadya communities continue screening the entire population of rural villages.
SDG #4: Quality Education (Target 4.3 and 4.5)
In the next year, we will provide technical training, professional skills and financial literacy to women employed as Aadya eye health technicians as well as some eye health education to the patient population as a whole.
In the next 5 years, we plan to provide micro-financing training and ensure quality education from selection to professional development and ongoing employment for Aadya technicians, as well as eye health education available locally in each past Aadya community.
SDG #5: Gender Equality (Target 5.a and 5.b)
In the next year, we plan to recruit and train a workforce of women, to serve their own communities.
In the next 5 years, we plan to continue employing women into Aadya positions and deploying them into their communities. We also plan to assist Aadya workers to move on to become trainers, entrepreneurs and mentors within and external to the Aadya program.
SDG #8: Decent Work and Economic Growth (Target 8.5 and 8.6)
Within the next year, we plan to provide the opportunity for Aadya eye health technicians to become the primary wage earners in their families.
Within the next 5 years, we plan to show economic and productivity improvements within previous Aadya communities.
SDG #10: Reduced Inequalities (Target 10.1 and 10.2)
Within the next year, we plan to bring much needed eye care to rural communities who lack basic access to care and increase women’s cultural standing within their community.
Within the next 5 years, we plan to improve women's quality of life, and ensure that access to basic services within rural communities such as eye care is readily available.
SDG #17: Partnerships for the Goals (Target 17.6, 17.7 and 17.8)
Within the next year, we plan to continue partnering with a local hospital and local women, to provide eye care to remote villages in Uttar Pradesh.
Within the next 5 years, we plan to partner with various hospitals and healthcare systems to replicate the Aadya Initiative and provide innovative solutions to alleviating blindness and elevating individuals, particularly women, within marginalized communities.
A multitude of indicators are used to measure our progress in relation to our goals:
SDG #1: No Poverty
a. Increase in average income of women in rural areas
b. Ability to earn a living by patients who have been treated through Aadya
c. Income continuance
d. Household Income
e. Household expenditure
f. Household per-capita expenditure
SDG #3: Good Health and Well-being
a. Number of residents
b. Numbers of patients screened
c. Number of communities serviced
d. Number of geographic regions serviced
e. Number of consultations provided to improve vision health
f. Number of patients receiving surgery or treatment
g. Number of patients receiving glasses
h. Number of previous Aadya communities with continued access to eye care.
i. Number of people referred for further treatment and/or surgery
j. Number of glasses provided
k. Nutritional intake
l. Obesity level
SDG #4: Quality Education
a. Number of Aadya technicians recruited
b. Number of Aadya technicians trained
c. Number of Aadya technicians
d. Number of children returning to school following treatment
e. Number of children returning to school as a result of care for a family member who was visually impaired.
SDG #5: Gender Equality
a. Marriage age for Aadya technicians
b. Number of technicians who continue working after marriage
c. Self confidence level of Aadya workers
d. Number of women achieving socio-economic independence
e. Number of women vision technician groups/teams seeking to become independent business owners
f. Number of Aadya technicians who have moved into management positions
g. Increase in eye health screenings for women in the community
h. Percentage of eye health screenings for women is equal to the population density of the region
SDG #8: Decent Work and Economic Growth
a. Wage level of Aadya technicians above national average
b. Number of Aadya technicians
c. Number of Aadya technicians deployed
d. Number of Aadya technicians retained
e. Number of Aadya technicians in management positions
f. Cost of living within Aadya communities
g. Number of Aadya workers who have returned to work.
h. Purchasing power within Aadya communities
i. Unemployment levels
j. Labor force participation
SDG #10: Reduced Inequalities
a. Prevalence of blindness and visual impairment in the community/region
b. Number of women blind or visually impaired
c. Age of patients
c. Gender of patients
d. Religion of patients
e. Income
SDG #17: Partnerships for the Goals
a. Number of local partnership within individuals and communities
b. Number of global partnerships
c. Number of localities we are working in
d. Number of governments and NGOs we shared data and analytics with.
e. Number of sustainable businesses/ independent self-sustaining eye care services developed following Aadya community intervention.
The Aadya Initiative is built around 2 primary target populations, patients in need of eye health in remote underserved communities and a workforce of locals (women) who we train to become eye health technicians. The short term impact of the Aadya Initiative on an individual, can be scaled to return a long-term self sustaining impact for visual health programs in underserved communities. The Aadya Initiative builds on established research and is validated by pilots conducted by the Aadya team.
There is a proven linkage between our activities and the UN SDGs. In a breakthrough article by Justine Chang et. al. published in The Lancet in March 2022, the authors “identified 29 studies that reported direct links between eye health services or interventions and their largely beneficial effects on SDGs related to poverty (SDGs 1, 2, and 8), education (SDG 4), equality (SDGs 5 and 10), and sustainable cities (SDG 11).”
According to the article “eye health services included cataract surgery, free cataract screening, provision of spectacles, trichiasis surgery, rehabilitation services, and rural community eye health volunteers. These findings provide a comprehensive perspective on the direct links between eye health services and advancing the SDGs. In addition, eye health services likely have indirect effects on multiple SDGs, mediated through one of the direct effects.” (Chang et. al. 2022)
The pilot phase of the Aadya program gave us evidence and numerous insights into our target populations and impact via our first impact evaluation. Our pilot program trained 8 eye health technicians over a 10 days period. They were then deployed and were able to conduct over 2800 patient screenings within their own community. The target community had a positive short term impact of increased health service delivery, while the Aadya eye health technicians experienced increased income and educational opportunities.
Subsequent phases have demonstrated that the Aadya Initiative model of door-to-door screening is a more effective and efficient way to provide eye health in rural communities compared to the traditional eye camp model. This is supported by a study by AK Sil, where they found the ‘eye camp’ model of service delivery for communities can only deliver an estimated 12,839 screenings per year compared to the Aadya model where we have screened 154,000 patients in one year. (Sil, A, 2006)
Source Cited:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1705640/
https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(21)00351-X/fulltext
The Aadya Initiative has strategically combined technologies and tested different apps in each of our phases of our program development, to solve problems facing the eye health technicians, and the communities we strive to serve.
The core technology the Aadya Initiative uses is:
A survey based mobile app that can support “offline” data collection in remote villages and communities.
An additional supportive mobile app to collect data, that become inputs to the core data collection system.
Eye screening evaluation tools via smartphone.
Our innovative approach lies in the modular approach we have taken with the technology. Now that we have validated the core technology we are starting to layer technologies that will enable us to support the entire workflow including Recruitment, Training, Deployment, Vision Screening, Eyeglass Sales, Referrals (including appointments), Transportation and Surgery Follow-up. This core technology then gathers the data for us, ready to share with local government and non government systems, allowing us to build sustainable eye care in each community, for the future.
As the project evolves and scales our technology roadmap will continue to add modules to address the needs of each stage of the Aadya workflow. The Aadya platform will enable organizations to access data and analytics, helping them to make key decisions for communities.
- A new business model or process that relies on technology to be successful
- Software and Mobile Applications
- 1. No Poverty
- 3. Good Health and Well-being
- 5. Gender Equality
- 8. Decent Work and Economic Growth
- 10. Reduced Inequalities
- 17. Partnerships for the Goals
- India
- India
- Kenya
Primary Health care data is collected by our team of Aadya eye health technicians using our unique mobile based screening tool. In brief:
Aadya eye health technicians are employed by us and paid for their work.
The Aadya Initiative will work with partners and local experts in eye health, but wont require these already stretched front line workers to collect the data.
They deployed in groups of 2, into their local community and surrounding villages to go door to door, providing free eye health exams and logging the resulting data.
Aadya technicians record every patient's results via our smartphone platform, on the spot, in real time.
When an Aadya technician encounters someone with vision issues, additional data is collected on appointment times/ logistics to assist the patient further. Any treatment or followup is also recorded (provision of a referral or glasses etc.).
Any patient needing follow-up has their Aadya screening records validated at the vision center they were referred to upon arrival.
Incentives for Aadya eye health technicians include:
Aadya staff are employed with a good salary and ongoing position.
Aadya staff receive training in the medical field within a well respected local eye hospital and a supervisor for the duration of their employment.
Provision of a cell phone and training in mobile technology and data capture.
Bonus payments to any Aadya workers whose referrals for treatment/ surgery, results in followthrough from those patients in obtaining the treatment/ surgery.
Aadya technicians receive a bonus payment for meeting their target screenings per month or if they exceed their target.
Aadya technicians receive a bonus payment for each pair of glasses sold.
Intrinsic motivation in being deployed into your own community, to do the best for your local community, families and friends.
- Nonprofit
The leadership team for CBI and the Aadya Initiative includes women and men between the ages of 35-86 who are of various education levels, nationalities, cultural backgrounds and religions. In addition, we find local personnel in each region and country, ensuring we are hiring locally for project managers and staff thus increasing the diversity of CBI and our projects.
CBI works globally with local partners to ensure eye care for all. The Aadya Initiative is a multinational, multicultural effort. We not only embrace diversity and inclusion, we live it. By design, the Aadya Initiative is meant to support marginalized populations, empower women and work collaboratively with the local community to achieve our goals.
The design of the Aadya Initiative is based on our need to create a self-sustaining model. We quickly realized from our pilot that an innovative use of technology was the key to achieving this from the program.
Below we have outlined the Social Business Model Canvas to clearly convey each key component of the Aadya Initiative. Based on secondary research (Chang et. al. 2022, Sil. A. 2006) and our pilot, the need for eye health services is significant in rural communities. Our innovative business model also addresses the need for an increase in work opportunities for young women in rural communities.
In the Social Business Model Canvas below we have addressed the Market, Implementation, Finance and the Social Value Proposition. We are providing two versions of the Social Business Value Canvas for review – one visual and the other addressing details for each component of the canvas.
MARKET;
Customer Segments
Young women from rural villages in India - to become Eye Health Technicians (A)
Families in remote villages in need of vision health and beyond (B)
Remote communities in need of eye care (C )
Macro Economic Environment
Need for gender equity, employment and improvement of community health
Easy access to mobile technology
Reduction of Poverty,
Quality Education, Decent Work and Economic Growth
Competitors
Paper and pen approach
Data collection using volunteers
Clinical research projects
Eye camps
SOCIAL VALUE PROPOSITION;
This project targets those populations most vulnerable to vision loss, women and girls in rural areas of low-income countries. The model is unique because it empowers women to help women in a cultural context that often excludes them from medical intervention. Having a local, sustainable, and culturally compatible program will positively impact these marginalized communities.
IMPLEMENTATION;
Partners
Dr. Shroff Charity Eye Hospital (SCEH)
University of Wisconsin-Whitewater Enactus (UWW Enactus)
Delivery
Community-based solution
Eye health technicians recruited and trained from the community with a focus on empowering young women
Mobile technology integrated with web platforms for dashboard, administration and analytics
Regional Vision Centers created
Sales and Marketing
Recruitment
Village representatives
Regional Vision Centers
FINANCE;
Cost of Delivery
$184 - Cost of recruiting, training (1 month) and deployment of eye health technicians
$115 - Average monthly cost of each eye health technicians
Eye care screening platform and mobile technology
Management and supervision of technicians
Other infrastructure costs
Revenue
Sale of eyeglasses - Average $1 for each eyeglass
Patient Referral - $1
Patient follow-up after surgery - $1
Bonus and advanced procedure referral - $2
Surplus
All surplus revenues will be used to recruit and train eye health technicians. Higher levels of surplus resulting from program expansion will be redirected to program improvement and expansion.
- Individual consumers or stakeholders (B2C)
The Aadya Initiative brings in revenue from:
Selling glasses at a very low cost, to those who require them.
Gaining service contracts from the Indian government, for every referral we provide to a patient in need of a cataract operation.
With the scale at which Aadya is able to screen patients, these 3 factors alone will allow us to become financially sustainable within 1-2 years.
We have raised $135,000 in investment capital to date and are using this at present to continue along the road to financial sustainability.
We expect to continue to apply for grants/ funding in the future to grow the program, however this won't be necessary to sustain the program.
Future revenue streams include adding other health service questions during our screening, based on community need and new partnerships (eg. diabetes).
The financial sustainability of the Aadya Initiative is achieved through minimal investment funding and increased revenue. The primary revenue is the sale of glasses and referrals of patients to eye hospitals for those in need of cataract operations. Our successful revenue model allows for the Aayda screener to earn a salary of 4- 5’s times what she would earn in her village.
The Aadya team adheres to the Lean Startup methodology approach to projects and initiatives. We wanted to use the methodology to develop a self-sustaining visual screening program for remote underserved locations. To shorten product lifecycle and quickly validate the business model we embarked on a series of “business-hypothesis-driven experimentation, iterative product releases, and validated learning” in June 2020.
Phase 1: Pilot Stage - March 2021 to May 2021 (Investment of $25,000 by CBI)
Problem and Hypothesis - Is it feasible to recruit, train and deploy young women from villages to become eye health technicians? Will the mobile based technology support the data collection by the vision technicians while supporting the workflow? Can the sale of eyeglasses and referrals support the salaries of the vision technicians?
Solution and Findings - 10 day rapid training and deployment of 8 vision technicians in Mohammadi area of Uttar Pradesh, India resulting in 2800+ screenings in two weeks. 267 Eyeglasses sold and 531 referrals made. This first impact evaluation of our model, training, deployment and technology demonstrated that a well-run program with the right combination of technicians would allow for a visual screening program that is highly efficient, scalable and financially sustainable. But a few more experiments were needed.
Phase 2: Feasibility Stage - October 2021 to May 2022 (Investment Funding $75,000 from CBI)
Problem and Hypothesis - Can we expand the Aadya Initiative to multiple locations? Expand the program and streamline the training and expand the technology platform? Can the technology platform collect data seamlessly in “offline mode”? Can each vision technician use the technology to screen between 800 to 100 individuals every month?
Solution and Findings - Phase 2 was launched in the region of Saharanpur (Uttar Pradesh) using between 20 to 34 technicians. We started with three villages in the Saharanpur region and have now been working with 11 villages. In this phase we screened over 86,000 individuals but also learned that eyeglass sales and referral conversion rates needed to be improved. The data collection technology needed to become modular to include other aspects of the initiative. Specifically transportation and patient follow up needed to be addressed in future phases. The conversion rates have become the key to financial sustainability.
Phase 3: Growth Stage - Since May 2022 - (Investment Funding $35,000 from CBI)
Problem and Hypothesis - Can we increase conversion rates for eyeglass sales and patient referrals? Can we use the Aadya platform to continue to collect data in a modular way and share data, analytics and findings with partners? Can the data support all decisions in the workflow?
Solution and Findings - The data continues to help drive decisions to improve conversion rates. The team has been able to gather other costs of the initiative and gained better insights on the financial sustainability of the program. In Phase 3 based on our total screenings of over 154,000 the program is financially sustainable. The key to the success of the program is to manage conversion rates and workflow management.
President & Executive Director