Sam Conniff: What the NHS could learn from the Grameen Eye Hospital
The Guardian
Sam Conniff visited Grameen Eye Hospital - which is part of the social business established by Professor Mohammed Yunus. Photograph: David Levene for the Guardian
I have learnt that arguing about introducing pay at the point of service charging to the NHS, with your wine glass fully loaded, with people who sell life saving pharmaceuticals at a tidy profit, is not an ideal technique for getting invited back to dinner parties.
Health is one of those topics that people feel very strongly about, it causes debate, it causes upset, and it's been known to cause people to throw wine over their fellow guests.
While I reluctantly concede that the NHS is not the world leader it was, and there are arguments for competitive advantage and free market efficiencies, at the same time I can't help feeling that there are some things we shouldn't profit from.
I accept that the NHS does need a shot in the arm. And, there seems to be a prescription on offer that says social enterprise is the panacea to our sick system, but I haven't met the doctor or social entrepreneur yet who'll second that diagnoses. We need some radical models to inspire and excite our thinking and not blind belief and hope, even if it is social enterprise or right to request shaped.
Last month a visit to rural Bangladesh totally revolutionised my understanding of how a hospital can be run. The Grameen Eye Hospital in Bogra is a place of such streamlined efficiency the German Rolls Royce engineer I was visiting with nearly cried.
Initially patients are given an eye test, after which they are efficiently channelled into further testing and treatment. The ultra effective squeaky clean hospital flows the patients seamlessly on their journey to the operating theatre, where three surgeons work simultaneously.
The chief medical officer, Dr Nabi, who did the party I was travelling with the massive honour of doubling as our guide, is the fastest in the hospital, averaging six minutes, per eye, per operation.
This eye bogglingly fast turnaround means he personally completes more than 200 operations each month, motivating his team to match him, achieving an overall 30 to 40 eye operations a day across the hospital. And before you worry about efficiency compromising effectiveness, 88% of post-op patients have good vision, 7% higher than World Health Organization average.
Added to which, the hospital is stocked with the best equipment from Germany, UK and around the world.
And as if that wasn't good enough, the team there are pioneering new approaches to tackling health care issues that hold back millions of people worldwide.
The hospital is part of Grameen, the visionary social business established by professor Mohammed Yunus. Inspired by the Arvindh Eye Hospitals in India, Grameen Eye Hospital is run on a cost subsidy basis, 50% of the patients pay a subsidised amount, 40% pay a premium amount and 10% are treated free. The patients who can afford, and want to pay for such a great service, subsidise the patients who can't.
There is a simple questionnaire that patients fill out to assess how much they must pay. This seems as if it should be open to abuse but in fact it works so well that in it's third year, the hospital is using it's considerable profits to build a whole new floor for training.
The chief medical officer, Dr Nabi, smiled brilliantly and broadly when he said: "We show the rich no mercy".
And just when you thought the efficiency drive couldn't get any more efficient, we meet the Grameen Eye Hospital gardener, who's salary is paid for by the sales of the vegetable's grown in the hospital grounds.
The key to the success of the model is that Grameen delivers high quality care at an affordable cost in high volume, and it has highly trained technicians doing most of the examination and preparation work so that the ophthalmologists can focus on the operations.
Grameen's focus on social business to create lasting sustainable solutions is inspiring in every area it is applied, but the hospital stopped everyone I was visiting with in their tracks, and I was with some critical, high level big brains.
The question in my mind was what will this awesomeness now inspire elsewhere around the world, and is there medicine in this model for our own poorly NHS?
We need a dose of something fairly radical, and this model strikes me as more interesting than ending up with credit card machines on the sides of hospital beds. Looking for lessons as to how this seeming genius could be applied back home, I looked to the mission statement.
"Grameen Healthcare will design and develop a bottom up healthcare infrastructure that can take lessons from successful efforts around the world and improve upon them to deliver the highest quality Healthcare, in an efficient and sustainable manner, primarily to the poorest of the poor but also to the non poor, who may pay a little more than the target population."
And in that simple line, I found all the lessons I needed, we need to share knowledge, we need to help the most needy and we need to pay for it from existing resource.
I suspect it's best not to listen to those who sell social enterprise snake oil as a cure for everything, but there are some lessons out there to be learnt.
If the Grameen Eye Hospital teaches us anything, it shows that time and again, all around the world, and on your doorstep, we consistently know what the most pressing problems are, we often do know what the solutions are, or someone does, and when we think about it differently and don't rely on government or charity, we do have, or can make, the resources to make the solutions work.
This is the challenge to all social entrepreneurs everywhere, we know the problems, someone knows the solutions, the resource is out there … make it happen.
Sam Conniff is the co-founder of Livity - a socially responsible youth communications agency
http://www.guardian.co.uk/social-enterprise-network/2010/dec/16/nhs-could-learn-from-the-grameen-eye-hospital-sam-conniff
