Backround

• In 1992, David, with his nonprofit, Project Impact, established Aurolab in India. Aurolab is the first nonprofit manufacturing facility in a developing country to produce affordable intraocular lenses, suture, pharmaceuticals, and eyeglasses.

The intraocular lenses are used to treat cataract, a leading cause of blindness worldwide. Cataract surgery is the most common surgical procedure in the United States today; about half of Americans aged 65 to 74 have cataracts. In the developing world, cataract blindness and poverty often coincide. The disability increases the risk of poverty while poverty increases the probability of cataract blindness due to lack of care. Poorer patients are often unaware of treatment options or are unable to pay for them.

By using the cost and profit structure described above, Aurolab has brought the price of intraocular lenses down to $4 from the $100 they cost in the United States. Aurolab is now one of the largest intraocular lens manufacturers in the world with 7 percent market share, selling 600,000-plus units per year to 86 countries.

• One of Project Impact’s major customers is the Aravind Eye Care System, a group of hospitals in Tamil Nadu, India, that perform over 200,000 cataract surgeries annually for patients of all income levels.

In addition to supplying the hospitals with intraocular lenses, David helped Aravind become the largest eye care program in the world. David worked with Dr. Venkataswamy, founder of Aravind Eye Hospitals, to apply the same low-cost, high-volume business model to eye surgery services. 70 percent of surgeries are performed for free or below cost, and 30 percent above. This pricing structure, combined with highly efficient operations, enable the hospital to maintain a 50 percent profit margin.

Aravind Eye Hospital did a study of Indian cataract patients post-surgery to quantify the economic and community impact of their work. They found that 85 percent of men and 58 percent of women who had lost their jobs as a result of cataracts regained those jobs after surgery. This freed caregiving family members to go back to work as well.
Overall, the study concluded that recipients of cataract surgery have an average increase in household income in the first post-operative year equivalent to 15 times the cost of surgery.

• Similarly, due to David’s work with
  Lumbini Eye Hospital in Nepal, 25,000 patients per year receive sight-restoring surgery—20 percent at no cost, the majority at cost, and the remainder at a healthy margin. The hospital maintains a 35 percent margin and has $3 million U.S. in savings that is being used to expand its services. David has replicated this cost-revenue model for hospitals in Malawi, Egypt, Guatemala,
  El Salvador, Tibet, Tanzania and Kenya.
• David also directed the development and manufacture of suture (wound closure product) manufacturing at Aurolab. Aurolab has reduced the selling price of ophthalmic suture from $200 per box of suture to $30. Prior to Aurolab, only 10 percent of suture—a critical medical technology—was sold to developing countries. Aurolab’s suture products are also CE Mark Certified (European regulatory standard) and U.S.F.D.A. approved.
• Was awarded an Ashoka fellowship in 2002
• Serves on the faculty of the Johns Hopkins Wilmer Eye Institute
• Serves on the International Council of Ophthalmology on the Task Force of the International Agency for the Prevention of Blindness
• Provided technical assistance and guidance in the development of the largest eye hospital for the Middle East and Africa
• Advises Seva Foundation, ChristoffelBlindenMission, International Eye Foundation, Fred Hollows Foundation, and Orbis International to help make their eyecare programs economically self-sustaining

Project Impact’s Affordable
Hearing Aid Project (AHAP)

Hearing impairment is the most common birth defect in the world. The World Health Organization estimates that at least 250 million people in the developing world have a hearing impairment, 32 million of whom would benefit from a hearing aid. Only 6 million hearing aids are currently produced annually and, of those, only 12 percent go to the developing world, many of them of poor quality.

Untreated, hearing loss impairs an individual’s quality of life, decreasing independence, prospects for employment, and opportunities for education. In children, hearing impair-ments can stunt education and cripple social development. In developing countries, the hearing impaired are more likely to live in poverty—the disability adds to the risk of poverty and lack of education and nutrition increase the risk of hearing impairment.
Project Impact recently developed and brought to market Impact 1, a low-cost, high-quality digitally programmable hearing aid for distribution in the developing world and to the poor of the developed world. Digital hearing aids cost, on average, $1,500 in the United States. Project Impact has brought AHAP’s cost down to $45. The hearing aids are sold for up to $200, including a solar battery charger, using David’s multi-tiered pricing strategy. Impact 1 was designed to minimize component costs while maintaining excellent performance. Costs are further controlled through Project Impact’s partnership with Aurolab, where manufacturing costs are minimized.

In the developing world, Impact 1 is distributed at the community level through socially franchised partnerships with other non-profit organizations already working in the area of healthcare and disability. Localized distribution provides access to local expertise, faster market penetration, expanded reach to intended beneficiaries, increased job creation, and expansion of the project’s ability to raise start-up funds from a broad base of stakeholders.

As a result, Project Impact is able to meet its high-volume and low-margin objectives. Distribution has begun in the United States and India and plans for distribution
in several other countries are in the works. Impact 1 has both C.E. Mark and U.S. F.D.A. approval for sales in Europe and
the United States, respectively.

To date, Project Impact has raised $2.6 million and used the money to:

• fund product development
• purchase components
• set up initial manufacturing
• establish first distribution sites
  and inventory for 11,000 hearing aids
• run four clinical trials
• develop training programs for local distribution sites
• manage legal and regulatory issues
• support overall management and fund-raising efforts

Sales have begun and soon AHAP will become economically self-sustaining.

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