Preservation and Restoration of Vision:

Vision for the Future, Part 2: Economic Benefits of Ophthalmologic Care: The Effect of Cost Recovery on Program Development

The development approach embodied in the concept of financial sustainability is a difficult one for PVOs and NGOs to embrace because of their historical dependence on donations to sustain field programs.

Very often NGOs are tied to a charitable model of raising funds from donors who usually respond to an appeal made on behalf of those who are "helpless."

When an organization is invested in the charitable mentality for fundraising appeals, it often lacks the skills and mentality necessary to earn money from the sale of a product or service; it also lacks basic business planning skills necessary for development of cost recovery models.

Organizational structure and program character and direction are often determined by the source of fundingóhow eye care is funded affects service delivery more than any other aspect. Those who control the expenditure of resources, control program planning and direction.

With external funding, program direction often remains in the hands of the donors and not the project; and spending often occurs with little thought to the desired result. This is in contrast to earned income, which is difficult to obtain, and often more wisely spent.

When a program begins to earn its own income, staff attitudes change as a program begins to generate its own resources: staff become more empowered and motivated when there is ownership.

Linking decision making to income generation and management of financial resources leads to the development of program planning skills: those who are performing the work know their business the best and become better managers when they are in control of decision making which affects financial viability and program sustainability.

Emphasis is placed on satisfying customers and being accountable to the clients. As in any business, if the client is satisfied, the business thrives. This is in marked contrast to service delivery settings which are ostensibly ëfreeí where there is no monetary exchange between the client and the provider - if the patient doesn't have to pay for services, very often the provider doesní't feel accountable for the result.

The simple act of charging a fee for service introduces accountability into the patient-provider equationóproviders strive to satisfy the customer to gain loyalty and reputation in the market place. Consumer behavior and expectation regarding quality and satisfaction transforms service deliveryóthrough their choice of eye care provider, consumers become program planners as they force providers to provide quality and affordability.

In almost every developing country in the world, there is a tremendous backlog of blindness due to cataract, which accounts for 50% to 80% of blindness and visual disability.

Top-down planning approaches have been unsuccessful in ameliorating the problem of cataract blindness in any significant way. The bottom-up, market-driven approach fostered by cost recovery planning approaches will hopefully transform service delivery such that surgical volume increases as quality cataract surgery becomes affordable and is sought after by the poor who otherwise would not be able to afford cataract surgery at present market prices.

By embarking on the path to cost recovery, organizations begin the transition from utilizing organizational resources for operating costs (re-inventing cash flow each year from donations to continually pay for operating expenses) to resource utilization for capital expenditures, new developments and, most importantly, expanding service delivery to the truly undeserved.

The "Sustainability Model" is a good example for donors and governments to see how they can use their precious resources for start-up costs (which are least attainable in a developing country) instead of for operating costs (which are attainable in most areas of the developing world).

Next: Relationships among Collaborators