Creating and Sustaining Livelihoods through Franchising Eye Care Delivery

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Creating and Sustaining Livelihoods through Franchising Eye Care Delivery

United States
Project Summary
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Scojo Foundation creates market-based solutions to the problem of distributing reading glasses to the nearly one billion people around the world who have blurry near vision (presbyopia) and who need a simple pair of magnifying glasses to see objects up-close. Scojo Foundation was founded to increase the number of people with access to affordable reading glasses, create jobs for local entrepreneurs, and facilitate access to comprehensive eye care. To increase access to reading glasses and comprehensive eye care, Scojo Foundation focuses on providing economic opportunities for low-income people by helping them create micro-franchises to sell reading glasses and refer people with complex eye problems. Scojo Foundation trains the micro-franchise owners to become Scojo Vision Entrepreneurs. The Vision Entrepreneurs? customers are low-income people in developing countries (farmers, weavers, mechanics, barbers, etc.) who need reading glasses to see up-close to sustain their livelihoods and maintain their quality of life (reading religious texts, separating stones from rice for daily meal, differentiating seeds types). Millions worldwide lose their livelihoods every year due to a lack of access to this affordable product. Scojo Vision Entrepreneurs also refer customers in need of more advanced eye care to local partner eye hospitals where they are treated for cataract, glaucoma, etc. This referral mechanism ensures that those patients needing advanced eye care have truly difficult cases while simple cases of presbyopia can be treated at the village level thereby reducing pressure on already over-burdened health systems.

About You
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Your idea
Focus of activity

Eye Care

Start Year

2001

Positioning in the mosaic of solutions
Main barrier addressed

Limited reach of healthcare infrastructure

Main principle addressed

Adopt market-based models as a scaling-up strategy

Innovation
Description of health product/service offering:

Scojo Foundation creates market-based solutions to the problem of distributing reading glasses to the nearly one billion people around the world who have blurry near vision (presbyopia) and who need a simple pair of magnifying glasses to see objects up-close. Scojo Foundation was founded to increase the number of people with access to affordable reading glasses, create jobs for local entrepreneurs, and facilitate access to comprehensive eye care. To increase access to reading glasses and comprehensive eye care, Scojo Foundation focuses on providing economic opportunities for low-income people by helping them create micro-franchises to sell reading glasses and refer people with complex eye problems. Scojo Foundation trains the micro-franchise owners to become Scojo Vision Entrepreneurs. The Vision Entrepreneurs? customers are low-income people in developing countries (farmers, weavers, mechanics, barbers, etc.) who need reading glasses to see up-close to sustain their livelihoods and maintain their quality of life (reading religious texts, separating stones from rice for daily meal, differentiating seeds types). Millions worldwide lose their livelihoods every year due to a lack of access to this affordable product. Scojo Vision Entrepreneurs also refer customers in need of more advanced eye care to local partner eye hospitals where they are treated for cataract, glaucoma, etc. This referral mechanism ensures that those patients needing advanced eye care have truly difficult cases while simple cases of presbyopia can be treated at the village level thereby reducing pressure on already over-burdened health systems.

Description of innovation:

There are no eye care programs, currently, focused exclusively on the distribution of reading glasses for low- income populations. Current eye care programs tend to be hospital or clinic-based, rely on highly-trained, and therefore expensive, medical professionals and focus on more complicated eye problems such as cataract and glaucoma. They tend to overlook the widespread nature of an easily solvable eye care problem--presbyopia. Furthermore, programs often provide products and services freely or through subsidy, requiring little-to-no expense from the customer and, therefore, limited sense of ownership. Scojo?s products and services are offered at market-appropriate price points which enable its Vision Entrepreneurs to earn a living helping their local communities. Because reading glasses are not readily available in the developing world, particularly in rural settings, Scojo Foundation is ground-breaking in its development of markets for reading glasses by creating new distribution channels. Scojo has linked eye care, employment and sustainability by training low-income women and men to start their own micro-franchises selling reading glasses. It has a model that is market-based, scalable, and replicable. By sourcing low-cost reading glasses from major manufacturers through the assistance of its parent company, Scojo Vision LLC, Scojo is able to pass low costs onto its entrepreneurs who can sell the reading glasses at a fraction of the cost charged by local opticians and eye doctors. This makes reading glasses affordable and available.

Operational model:

Scojo Foundation focuses on creating new markets for reading glasses and increasing access to eye care in communities in the developing world by training low-income people to start their own micro-franchises by becoming Vision Entrepreneurs. Scojo Foundation?s micro-franchise kit consists of all the tools and training necessary to run a business selling reading glasses and referring people in need of advanced eye care to reputable partner eye clinics. Equipment in this kit includes 20-30 pairs of reading glasses and UV-protected sunglasses, eye drops, cases, cords, a mirror, vision screening charts, uniform, data collection materials, and banners. Through a consignment model, Vision Entrepreneurs make a 30% margin on each pair of reading glasses sold (an average of $1-3 depending on the country) while Scojo Foundation earns 20% to recover costs for sustainability. Scojo Foundation utilizes the franchise structure in two ways to reach its target communities. First, it identifies individual low-income people and trains them to start micro-franchises and become Scojo Vision Entrepreneurs. These Vision Entrepreneurs work directly with local Scojo staff members. Second, Scojo partners with a variety of organizations including ngo?s, corporations, and government agencies to integrate its macro-franchise model into their existing programs. The macro-franchise consists of all the tools necessary to run a full Scojo program without direct management of Scojo staff. Partner organizations sign an agreement to receive training and technical assistance from Scojo but take responsibility for day-to-day implementation. This model enables Scojo to reach even more people, more rapidly without having to build its own costly infrastructure.

Human resources:

Dr. Jordan Kassalow and Mr. Scott Berrie are the co- founders of Scojo Foundation. With over 30 years of combined experience in international development, business, optometry, and public health, they are committed to bringing reading glasses to markets and impacting social change, health and economic opportunity through trade. Graham Macmillan, Director, and Neil Blumenthal, Director of Programs, are responsible for the day-to- day management of a team of 20 staff members located in three countries who have expertise in international development, business, eye care, rural marketing, financial management, and product marketing. Furthermore, Scojo Foundation works with partners that implement the programs, located in Bangladesh and Guatemala, who are leaders in the fields of public health, community development, livelihoods promotion, and economic development. Scojo Vision Entrepreneurs are village-based, low-income people willing to earn a living and help their communities. Generally, they have limited education but at least enough to record information. Often, they are leaders in their communities and respected for their work.

Key operational partnerships:

Scojo Foundation has 16 partnerships across four countries with 14 more scheduled by the end of 2006. These partners vary from eye hospitals which receive Vision Entrepreneur referrals to operational partners which implement full Scojo programs without any Scojo staff present. In Bangladesh, Scojo partners with BRAC (social) to integrate its micro-franchises within a network of 30,000 community health workers. In Guatemala, Scojo works with Community Enterprise Solutions (social) to run its full model there, and the eye health clinic Visualiza to handle referrals. In India, Scojo is working with local partners to leverage existing networks of providers including: Hindustan Lever?s Project Shakti program (corporate), Drishtee (private), CARE India (social), Andhra Pradesh Weavers Society (government), Vedanta (corporate), Byrraju Foundation (corporate/social) ITC e-Choupals (corporate), Medicine Shoppe (corporate), E-Sewa (government), Lace Park Societies (government), among others. Scojo?s eye care partner in India is the well-regarded L.V. Prasad Eye Institute. In El Salvador, Scojo?s eye care partner is FUDEM. The partners are fundamental to the success and replication of Scojo?s model. The eye health component requires all complicated eye problems to be referred for more advanced care to partners. For much of its program delivery, Scojo relies on the adoption of its franchise model by partners to scale up without having to build its own large and expensive network.

Impact
Financial Sustainability:

<ul><li class="entry-label">Fees charged to clients?: <span class="entry-text">Yes</span></li><li class="entry-label">How do you assure affordability?: <span class="entry-text">Scojo conducts extensive market analyses in each country prior to entry. Through this process, affordable price points are determined through customer surveys and interviews. While the reading glasses are the same in every country where Scojo works, the price points are different in each location. This reflects the consumer?s ability to pay along with disposable income levels. Furthermore, Scojo offers four different styles of reading glasses at different price points to ensure that even those with the least amount of money can afford a high- quality pair of reading glasses.</span></li><li class="entry-label">Earned incomes as a percentage of operating costs: <span class="entry-text">50</span></li><li class="entry-label">Other funding sources: <span class="entry-text">Scojo is 95% self-sustained in Guatemala, 50% in El Salvador, and 20% in India. In Bangladesh, the program is just getting off the ground and a break-even analysis has not yet been conducted. The reasons for these variations are: size of market (requires reinvestment in expansion), size of operations (staff size and operational capacity), and profit margin (less in India and greater in Central America). Other sources of income include loans, grants, and ?licensing? fees from partners. Scojo?s headquarters in New York does not receive any revenue from operations and relies on contributions from foundations, corporations, and individuals.</span></li><li class="entry-label">Strategy for long-term sustainability: <span class="entry-text">Scojo?s long-term strategy for sustainability is reliance on sales revenue from Vision Entrepreneurs in existing program locations. Through improved productivity, lower cost of goods, efficient distribution, innovative partnerships, and enhanced marketing, Scojo will achieve self-sustainability in each of its programs. In order to cover costs of programs in new countries, Scojo will rely on loans and grants for initial working capital. Eventually, however, Scojo will break-even through sales revenue. Headquarters? costs, in the long-term, will be covered through donations from its corporate parent, Scojo Vision LLC, which donates 5% of annual pre-tax profits to Scojo Foundation. As Scojo Vision?s revenues grow, so will its ability to support Scojo Foundation?s headquarters? expenses.</span></li></ul>

Current and Future Impact:

<ul><li class="entry-label">Total number of clients: <span class="entry-text">62,500</span></li><li class="entry-label">Clients in the past year: <span class="entry-text">40,250</span></li><li class="entry-label">Percentage of low-income clients: <span class="entry-text">100</span></li><li class="entry-label">Impact: <span class="entry-text">Wearing glasses enables clients to improve their productivity which, in turn, enables them to earn more money. Earnings are invested in education, food, and clothing for their families. In aggregate, this increase in economic activity creates a ripple effect where people benefit with more goods and services being bought and sold. Also, Scojo generates eye care awareness. Vision Entrepreneurs and social marketing campaigns raise awareness about causes of vision loss and where to receive treatment. Finally, Scojo?s programs have empowered communities. Through the organizing of eye campaigns and the training of Vision Entrepreneurs, communities have learned how to better mobilize themselves, recognize their rights as consumers, and respect dignity of choice.</span></li><li class="entry-label">Overall "market": <span class="entry-text">There are nearly one billion people worldwide in need of reading glasses due to presbyopia. Presbyopia occurs naturally in 95% of people aged 40 years and older and happens regardless of race, location, or income. The ability to obtain reading glasses, however, is limited to the developed world where reading glasses are accessible and affordable. The inability to see clearly, up-close affects everyone, however, those whose livelihoods depend on clear, up-close vision will suffer economically which will have a negative impact on other aspects of their lives. Weavers, tailors, artisans, and farmers are all occupations prevalent in remote, rural areas. These people need good vision to complete their tasks to earn an income and support their families. The ultimate challenge is to make reading glasses and eye care services accessible and affordable to low-income communities.</span></li></ul>

Scaling up strategy:
Stage of the initiative:

<i>Scaling Up</i> stage.

Expansion plan:

Scojo Foundation currently operates in four countries (India, Bangladesh, El Salvador, and Guatemala). Over the next three years, Scojo intends to expand its model to Mexico, Honduras, and Ghana through licensing of its macro- franchise to local partners. We project that within the next three years we will train more than 2,000 Scojo Vision Entrepreneurs, sell 350,000 pairs of reading glasses, and refer nearly 300,000 visually-impaired people for more advanced eye care to partner eye clinics. At headquarters, Scojo plans to hire two to three additional staff members to support programmatic growth and enhance reporting mechanisms.

Origin of the initiative:

Dr. Jordan Kassalow founded Scojo Foundation because he noticed that most eye care programs are not equipped to provide reading glasses due to a focus on more complex eye problems, yet, presbyopia affects nearly 40% of a population needing eye care. This means that 40% of people are threatened economically by a loss of productivity. Dr. Kassalow is co-founder of Scojo Foundation and Scojo Vision LLC. He is also a practicing optometrist and senior partner at Drs. Farkas, Kassalow, Resnick. Previously, he created the Global Health Policy program at the Council on Foreign Relations. Dr. Kassalow is on the board of Lighthouse International and on the medical advisory board of Helen Keller International. He earned an OD from the New England College of Optometry and a MPH at John Hopkins University. Dr. Kassalow is a Crown Fellow at The Aspen Institute and Draper Richards Fellow.

Sustainability
Policy change:

While Scojo Foundation relies on a market-based model for programmatic success, certain policy changes would accelerate social change in the fields of eye care and economic development. Most importantly, Scojo Foundation faces stiff customs duties on the importation of its reading glasses and other eye care products. In many cases, these duties add 30% to the cost of goods which, in turn, reduces the profit margins for both the Vision Entrepreneurs and Scojo Foundation. Lower profit margins mean less income for the Vision Entrepreneurs and less revenue for Scojo Foundation to reinvest in expansion. A reduction in import tariffs would immediately improve Scojo Foundation?s ability to accelerate its impact and allow higher quality products to enter the marketplace.