When Purpose Guides Action

We’re in the final stretch of the global health master’s program – just a few weeks left. I’ve spent the last week glued to my computer attempting to analyze my capstone data and write the results.

My research involves a health system in Tamil Nadu, India, called Aravind Eye Care System. Aravind is known globally as an innovative nonprofit eye care system that provides high-quality care across urban and rural areas for anyone who needs it. Their financially sustainable approach subsidizes services for those who cannot afford them with the “profit” made from patients who can. Aravind charges the paying patients a rate commensurate with the high quality of the services but achieves impressive margins due to its economies of scale: Aravind completes more than 4 million outpatient visits and nearly half a million surgeries and procedures each year.

When my mentor first encouraged me to work with Aravind, I was impressed, but skeptical. Doesn’t every healthcare organization have a “strong commitment to patients and quality”? Aren’t they all trying to reach as many patients as they can?

Classmates like to remind me I entered the program with the intent to focus my research domestically given my previous experience and interest in improving the U.S. healthcare system. Aravind for me is a beacon of what might be possible for our systems. Perhaps the most meaningful experience for me in the program has been learning from and working with Aravind and their exceptional staff. After reading many case studies and interviewing employees, I think what makes Aravind most exceptional is how honestly and consistently their actions and impact align with what they say they value. They say patients come first, and they actually do.

In the U.S., we are okay at aligning our actions with our purpose and values. But there’s a lot of inconsistency. One recent example is the wave of companies and organizations suddenly open and vocal about their support of black lives and inclusion. If that is genuine and in line with their purpose, it’s a great thing because it means there will be change. If it’s not, there will be pats on the back and it will end there. Black lives, and society more broadly, will continue to be held back.

So how do we start to do better? For Aravind, it was with clearly defining its purpose: “eliminating needless blindness.” An early focus for the organization was to find a way to reach the millions of people in rural areas with limited or no access to eyecare – a group largely underserved and therefore a large contributor to avoidable blindness. Next, is the hard part: Aravind built its systems to support and perpetuate its values. The value that came up most in my interviews with employees was a commitment to patients. Aravind prioritizes patients above all else. Every system is built around how it will serve and support the patient: The problems to solve are identified based on how they negatively impact patients. One example is the payment structure. If Aravind’s goal is to eliminate needless blindness, then it must find a way to provide care even to those who cannot afford it. Even for those who can afford care, Aravind is incentivized to provide the best quality care to improve outcomes, but also to maintain patient satisfaction which drives demand for services and contributes to their successful high-volume model that makes free and subsidized care possible. It’s a virtuous cycle.

Yes, Aravind is in India, and many people in healthcare will argue that their external environment, specifically their regulatory environment, allowed them to create such a system. I don’t disagree. But is this not an indication that we need to reevaluate our systems? If we ask, and honestly and critically answer the “Why?” of our systems, we may realize they’re not serving their purpose. We may realize they are old and outdated answers to problems we no longer wish to solve.

As master’s students in global health, when discussing complex issues, we’re often unsettlingly left with, “Well, you’re the future leaders of health!” I feel hopeful because my whole cohort is thinking about systems. We’re trying to be pragmatic about our potential impact, knowing that systems are broken and often working against our cause. My hope is that we collectively and actively stay humble, imaginative, optimistic, and uncompromising as we work toward undoing and rebuilding the systems that shape our lives and health.