The Plurality of a Social Problem

A problem that affects millions cannot be merely stated as ‘A’ problem. It is in fact a complex amalgamation of a number of problems, each of which needs to be solved to deliver a comprehensive solution that addresses the multiple bottlenecks that exist across the value chain.

But sometimes social entrepreneurs define the problem quite narrowly purely based on what they think is the root cause- ‘What is the glaring issue here? Let’s address it.’

What this results in is a shallow assessment of the problem that doesn’t fully encompass its different dimensions, further translating into an ineffective solution.

So how does one get a deep understanding of the problem they wish to solve? How does one go about uncovering the multiple facets that constitute it?

The first principle is to speak to those suffering from it.

A problem cannot be solved until you speak to the one suffering from it

Speaking to the intended beneficiary is critical in getting to understand the root cause of the problem and the associated issues that need to be tackled when thinking of a solution. The deeper the insight into what the problem is and why it exists, the better the solution.

To demonstrate this, let me share a snippet from the early days of one of the most successful social enterprises in the world- Aravind Eye Care System. Aravind has been at the forefront of revolutionizing eye care having pioneered a model that provides a high volume of quality and affordable eye care services to the world’s poorest.

The Challenge

As per WHO, 39 million people in the world are blind and a shocking 90% of them live in the poorest parts of the developing world.

In more than 80% of the cases, blindness is treatable as most of them suffer from cataract, a serious medical eye condition that can be treated quickly and effectively with a simple surgery.

Yet this surgery has been out of reach for most of them due to multiple reasons, the main being the prohibitive cost of surgery.

The Beginnings

In 1976, Dr. Venkataswamy, or Dr. V as he was popularly called, had just retired from Indian government medical service as an Ophthalmologist. But instead of hanging up his scrubs, he set himself the ambitious goal of treating curable blindness.

He founded Aravind Eye Hospitals with a mission to eradicate needless blindness caused by cataract. The model was to provide high-quality and equitable treatment to all but with a focus on providing free surgeries to those at the bottom of the pyramid, as that is where he believed he could have the most impact.

He set up the first hospital at his home in the city of Madurai in South India. It had 11 beds of which 6 were reserved for patients who needed free surgery.

He began marketing his free service to the poorest in villages expecting people suffering from cataract to lap up the offer.

But the beds just weren’t getting filled.

“Why are people not coming? I am offering a life-changing surgery absolutely free of cost and yet they are not turning up? Where am I going wrong?”

He struggled to find an answer until he met a blind beggar on one of his trips to the local village. He asked the beggar why he wouldn’t come for a free surgery?

“You tell me your surgery is free, but to get to your hospital I need a bus. Once I get there, I need food and accommodation. I can’t come alone, and if my daughter comes with me, she loses the day’s wages. So, your free service costs me Rs. 100 which I can’t afford”.

Thanks to this chance encounter, Dr. V realized that the problem was not singularly limited to the cost of the surgery.

Free didn’t necessarily mean affordable.

He decided to change the model and started traveling to schools in villages where he would set up operating theatres. However, Dr. V realized that this model was costly and inefficient. Transferring surgeons and supplies was logistically complicated and expensive. Moreover, schools lacked the hygiene standards needed for surgery.

He pivoted to a new model where they performed initial screenings in villages while referring only those that needed surgery back to the hospital. Those bused to the hospital were given food, lodging, and follow-up care, free of charge.

This led to the birth of the “hub and spoke model” in healthcare.

Using data as a powerful leverage to affect change, Dr. V proved that this model had better patient outcomes and was more cost-effective than the alternatives. Soon, many hospital chains across the world started using the model and it received an endorsement from WHO.

By developing a deeper understanding of the problem, Dr. V found a comprehensive solution that not only enabled surgeries for millions of poor people but paved the way for a new model for rural healthcare delivery.

While this story is just one of many that shine the light on how Aravind became a pioneer in the delivery of equitable eye care, it demonstrates the importance of understanding the plurality of a social problem. It demonstrates that what might seem like the most glaring issue might not be the only one that needs to be solved. That it is important to understand the breadth and depth of the problem and its causes before thinking of a solution.

And to do that, speaking to those suffering from it is the necessary first step.