Social enterprises are the flavour of the season. We are now not only talking about newer enterprises, but also getting back to the older, iconic institutions and checking out whether they fit into the new nomenclature. Earlier, they used to be called non-profits or charitable institutions. Clearly, times have changed. The book on Sankara Nethralaya is written with passion and admiration. What started off as a not-for-profit affordable eyecare hospital has been retrofitted into a new framework of social enterprise — “retrofitted” because the authors write with passion and compassion but forget to bring out the “enterprise” aspect of the organisation clearly.
What do I mean by the enterprise aspect and how are social enterprises different from plain charities and non-profits? That is for a larger debate, but one way of defining a social enterprise is to look at how close it is to a business model in operations and how far away it is from the accumulative tendencies of a for-profit. This is a difficult test to apply, but worth engaging with. If we were to engage with this debate, the book would disappoint because it does not talk in detail about the revenue model of the enterprise. Tucked away somewhere in the text is the fact that most of its investments and expansions are funded by philanthropic sources while the organisation is self-sustaining in its operations. We also get to know from the book that cleanliness, hard work, a punishing work schedule and discipline drive the hospital. However, we do not get to know much about the operating philosophy, the management structures and the internal models that make this enterprise tick.
That said, the book is eminently readable, with many anecdotal details. It is also very innovative in its presentation. It is divided into nine chapters, starting with the origins of the idea, how it grew in the initial phases, its lifelong relationship with the patients, impacts, initiatives and a peek into the future. Each chapter is accompanied by a section that brings out the specific achievements of the hospital in the context of the chapter, and is followed by a brief but delightful expert commentary by some leaders who have known Nethralaya — including people like Prathap Reddy, A M Naik, Deepak Parekh, Gopalkrishna Gandhi and Rahul Bajaj. It is an innovative format and brings a bit of the outside perspective to the narrative.
Having said that, there is always an expectation from such inspirational books: to understand why such enterprises tick, what drives them and why they are sustainable. Unfortunately, the book provides neither a framework nor an analysis to understand Nethralaya. It doesn’t provide any insights into the management processes, the revenue model and the overall operating philosophy about Nethralaya. This is quite unlike the case of Aravind Eye Care, where the overwhelming personality of Dr V and his vision are clear.
I am sure Dr Badrinath of Sankara Nethralaya has that sort of vision and systems in place, but the book does not capture it in great detail. The introductory part tells us that the authors wanted to write a biography of Dr Badrinath, the person behind Nethralaya, but the doctor insisted that they write about the hospital rather than himself. There was a point in this, since it provided the opportunity to look beyond the passion of the promoter. Unfortunately, the authors fail to provide that perspective in their enthusiasm to paint a great picture of the promoter.
For instance, while talking about cataract operations, the book says that although performing 50 cataract surgeries is the norm among opthalmologists, the doctors in Nethralaya are happy with around 20 surgeries. We know that Aravind Eye Care thrives on large numbers because it argues that the best way to spread the capital costs on costly equipment is to ramp up the numbers so that the cost of individual surgeries is brought down. Why 20 is a good number is not clearly argued in the book, from the point of view of either economics, hygiene or effectiveness. This is stated as a fact, and the rest of the argument trails off to dwell on the simplicity of life and not being ostentatious. This laudatory and idolatory approach of the book is its main failing.
I am sure there is much more to Nethralaya than the patient endorsements, industry endorsements, achievements and so on that are listed in the book. There is something for enterprises in this space to learn from the experiences of Nethralaya, much the same way we have learnt from Aravind. This learning would have been possible had the authors distanced themselves from the position of admirers and become students of organisations. Their need to tell the story is greater than their need to understand why Nethralaya works. That is the undoing of a rather informative and delightful book.
The reviewer is a visiting faculty member, Indian Institute of Management, Bangalore
Sankara Nethralaya’s Passion for Compassion
VV Ranganathan, George Skaria and Meera Prasad
Lone Tree Books, 2012