Sankara Eye Foundation India: Keeping the Vision in Sight

Between 2002 and 2014, Sankara Eye Foundation India expanded rapidly, establishing nine community hospitals to provide free eye care across eight states in southern, western, and northern India. Its operating model ensured that 80% of its patients received free care, subsidized by the remaining 20% who paid for services. The foundation set an ambitious goal of operating 20 community hospitals by 2020 under the banner "Vision 20/20 by 2020." A decade later, the organization was present in ten states, having opened its 14th hospital in Varanasi. However, it decided to pause further expansion until 2030 to reassess its strategy. Its operating model had shifted to a 75/25 split between free and paid surgeries. Additionally, the foundation ventured into non-core areas, such as optical retail, and introduced new initiatives like vision centers, which triaged patients for surgeries, glasses, and other services. Recently, after a strategic review, Sankara decided to open another hospital following Varanasi, while adjusting its 2030 target for free surgeries from 425,000 to 400,000. It now faces the challenge of realigning its free and paid surgical services to maintain patient satisfaction and uphold quality standards. At the same time, the foundation must refine its system of activities to maximize synergies across both its free and paid care models.

This case enables students to explore the strategic challenges faced by a social enterprise as its scales up its operations. Set in the Indian healthcare context as of 2024, the case highlights how a model of cross-subsidization, in which paying patients fund free surgeries, can be employed to achieve broad-scale social impact while ensuring financial sustainability. In discussing the case, students must contend with the issues and tradeoffs that underpin Sankara Eye Foundation India’s vision for growth through 2030: balancing growth with resource constraints; integrating technology and innovation (e.g., telemedicine, AI) to improve outreach; and resolving ongoing tensions between social and commercial objectives. The case can be used in courses on strategy and entrepreneurship where social impact considerations are salient