The Jaipur Foot's Standing Dilemma

The Jaipur Foot has pulled millions of disabled people out of their plight. But do its makers need a course correction to carry on?

By Prince Mathews Thomas

Published: Feb 28, 2013 06:56:45 AM IST

Updated: Mar 4, 2013 02:27:16 PM IST

Devendra Raj Mehta was a career bureaucrat who rose to the top, advising prime ministers as the deputy governor of RBI and taking on big corporate names during his stint as the Sebi chairman. But as one sits in his ‘office’ of over a decade, at the Bhagwan Mahaveer Viklang Sahayata Samiti (BMVSS) in Jaipur, the absence of any trappings of power from that 40-year career is striking. Mehta himself arrives in a modest hatchback and carries his bottle of water as he enters the office, which is also not his alone.

The room has two long tables joined as one, and half-a-dozen chairs around it. Mehta dictates mails to his secretary Khaleel, who types away at a laptop. Soon, his pet dog enters and nonchalantly climbs on to a corner chair and gets comfortable. Khaleel hands over a bunch of envelopes and papers to Mehta. These are cheques from donors, proposals from prospective partners and official communication from the local administration.

Every few minutes, there is a stream of people. They don’t need to knock or ask for permission to enter the room. They are all in need. Mehta addresses each of them and assigns his staff to help the visitors out.

“I’m sorry, we can’t serve you tea. You see, we want to use each rupee for the poor. We don’t even have tea during our board meetings unless a director sponsors it,” says Mehta, the founder and chief patron of BMVSS, which is better known for its product—the Jaipur Foot. One of his associates later added that to cut costs each of them even gets water from home.

Over the past 38 years, parsimony has been one of the reasons why BMVSS has been able to provide limbs to 1.3 million people for free. It has also developed a model that impresses many, entrepreneurs included, with its simplicity. “I have always read in management books that the best way to have an efficient operation is to keep it simple. But, as an entrepreneur, I realised it is very tough. But Mehta has done it very successfully,” says Praveen Kankariya, an NRI businessman from the US and a donor at BMVSS for the past three years.

The accolades continue to pour in. “The Jaipur Foot represents Gandhian or frugal engineering. Along with the Nano car, it shows that the best of technology can be brought to the customers at the bottom of the pyramid,” says eminent scientist RA Mashelkar. “There may be other places in the world where compassion is that tangible; it is just that we had not seen any,” says Armand Neukermans, an American entrepreneur and scientist who has tracked BMVSS through the last decade.

But even for an optimist who habitually looks at the brighter side, Mehta realises that the organisation he nurtured over four decades is today facing key existential issues. Can BMVSS survive after Mehta?

Tasneem Raja of Tata Trusts, the country’s largest philanthropy organisation, says, “One reason why the Jaipur Foot can’t be replicated is because it is driven by the passion of one man.” Adds Neukermans, “They [BMVSS] are not going to find a person with the same charisma and stature.”

The 75-year-old Mehta also has a financial problem. Though BMVSS is able to meet its annual budget of Rs 15 crore thanks to government grants, interest from its corpus and donations, once in a while Mehta has to dip into the organisation’s corpus to cover expenditure. The grants, which help meet almost one-third of the budget, have been erratic in the past and are unpredictable. With the number of patients hovering around 60,000 for the last three years, Mehta now needs more money to take the Jaipur Foot to the interiors of India and also enter more international markets.

This has led well-wishers, like Mashelkar, who is also on BMVSS’ Global Advisory Council, to call for a change in the free-for-all model. The former director general of the Council of Scientific and Industrial Research (CSIR) doesn’t see any wrong in “making a business out of doing good”.

Neukermans adds, “The way to develop the company is not by keeping the services free but by setting up a sustainable business.” In other words, Mehta should start charging at least a nominal amount for his product, which costs about Rs 2,500 to produce.

Charging for the product might help Mehta to also fund R&D in improving the Jaipur Foot—despite its collaborations with Stanford University and MIT, which are on a voluntary basis. R&D becomes necessary as the product is still to pass muster internationally, despite there being significant improvement over the years. Past attempts to foster partnerships with international bodies, like USAID and Red Cross, have faltered because of issues with product quality.

Mehta is aware of the debate, but it has only reinforced his belief that the present model is the best one. “It [change in model] will happen only over my dead body,” he exclaims. But with increasing calls for change and Mehta’s family members—who had been firmly backing him—acknowledging that “there is a need to look at it”, can the septuagenarian resist change when the iconic organisation’s survival is at stake?

THRIFTINESS AND COMPASSION
A couple of years ago, a leading management guru from Cornell University did some research on the Jaipur Foot and told Mehta, “Though you have done a great job, your company can’t sustain unless you change the free-for-all model.” “With due respect,” Mehta had replied, “You advise many leading companies in the US. Tell me, how many of them have survived for more than 35 years?”

A big part of that credit for BMVSS’ success goes to Mehta himself. Since he set up the organisation in 1975, the former secretary to the government of Rajasthan has laid the foundation of BMVSS on two pillars—thriftiness and compassion.

The late management guru CK Prahalad hailed BMVSS for its lean structure and added that it is probably the most efficiently-run organisation of its kind. The simplicity in its structure has enabled BMVSS to build scale—fitting more than 60,000 limbs a year—which others just can’t hope to replicate. Mehta has also been able to cut the red tape, which often bogs down patients at leading hospitals in the country. Scores visit the clinic in Jaipur every day. Many return the same day or the next. “Most of the time, the guard himself admits them. You don’t need a doctor to see that someone is missing a limb and has a problem,” says Mehta.

Once admitted to the clinic, a patient is assisted by a staff member till he or she checks out. And the whole process—from measuring and fabrication to fitting and training—resembles an assembly line approach. “At the same time, we make sure that the quality is good. It is part of our patient-centric management,” says Veerendra Raj Mehta, elder brother of the BMVSS founder, who took the organisation international by setting up a branch in Manila, the Philippines, in 1985.

Mehta is also aware that 95 percent of his patients fall below the poverty line. “Many of them don’t even have money to go back home,” says Mehta. So BMVSS not only puts up the patients in its dormitories but also provides them with food and warm clothes in winter. Every evening, once the clinic closes, Mehta makes his second visit of the day.

In the morning, while he talks to each patient to find out about their medical problems, he notices the neediest of the lot. During his evening vigil, he turns Santa Claus and distributes everything—from sewing machines to tricycles and items to set up a tea stall.

“We need to make sure they have a livelihood,” says Mehta. When he is not with patients, Mehta takes his visitors, including donors, on a tour around the clinic, looking as excited as a small boy. And like a superstar, patients and employees gather around him wherever he goes. “He goes about selflessly, without any ego,” says Kankariya. Donors have gone back from BMVSS to become life-long supporters. But, says Mehta, “The moment I start charging, the donations will dry up.”

A LASTING LEGACY
Mehta is aware that money from donors alone won’t be enough either to make BMVSS sustainable or expand boundaries. He studied business models of other organisations, like Arvind Netralaya, which treats its poor patients for free but charges the moneyed ones.

“But that model can’t be applied here,” says Mehta. His brother adds, “Most of us, irrespective of being rich or poor, do have cataract problems with age. But when it comes to limbs, most of our patients are the poorest of the poor.” So even if 5 percent of the patients are charged, it won’t be enough to cover for the rest.

One way to improve finances is to increase the corpus. While Mehta shared the corpus amount with Forbes India, he requests that it should not be disclosed. “If I can increase this corpus amount by 50 percent, then I will be relieved, as income from interest will cover our costs.”

Last year, he received a shot in the arm when the UK-based Paul Hamlyn Foundation gave a one-time grant of Rs 8 crore. Now Mehta is hoping that the new Companies Act, which stipulates companies to spend 2 percent of their net profits on CSR (corporate social responsibility), will also bring in more funds.

He has also developed a ‘franchisee model’ that lets him expand the ‘footprints’ in India and abroad without incurring costs. “We needed regional centres to absorb the demand and also offer better post-fitting training,” says Mehta. He has roped in some well-known companies and entrepreneurs to take over a branch or an associate centre.

Entrepreneurs like BK Modi, former bureaucrats such as PC Parekh and companies including TCI have opened BMVSS centres in second-tier cities like Varanasi and Guwahati. Mehta has followed the model internationally too, with the latest one in Columbia being opened with the help of a local organisation. A similar centre in Sudan will soon open in partnership with leading oil company ONGC. While these partners put in the money, Mehta ensures supply of product and the know-how.

But further international expansion, especially in developed markets like the US, would depend upon the product itself. A low-quality product would make them vulnerable to litigation in the US. Ken Endo, a Japanese researcher in MIT who was part of the team that improved upon the Jaipur Foot, recently brought four patients from his homeland to Jaipur. While the Jaipur Foot was much cheaper than a similar product in Japan, “they all complained [about] their socket”. “They hurt more when they use daily… I also found that there is no rehabilitation after amputees getting their prostheses,” says Endo.

Adds Amit Mukherjee, director at the world’s largest prosthetics company Otto Bock: “It is not important that you need to fit the limb and send patients back the same day. Training is needed.” The German company fits about 1,000 limbs every year in India. But its product, which costs from Rs 20,000 to Rs 3 lakh, caters to the other end of the market.

Mehta admits there are issues with the product that need to be sorted out. This includes longevity. A Jaipur Foot lasts for a little over three years, almost half the lifetime of the products manufactured by Otto Bock. Endo says, “Otto Bock uses titanium usually to satisfy ISO standards. However, the Jaipur Foot mainly uses HDPE [high density polyethylene] and rubber, which are cheap but not so durable.”

Fortunately for Mehta, technical collaboration with MIT and Stanford has brought in more suitors. The two American institutes have renewed their partnerships. After creating a new knee for BMVSS, researchers in Stanford are now testing a ‘Jaipur Hand’. Mehta has also signed research collaborations with IIT-Bombay and IIT-Delhi to improve specific aspects of the Jaipur Foot.

THE NEXT MEHTA
The most important step that Mehta has taken towards ensuring that his legacy is in safe hands is that he’s handpicked his successor. After ‘experimenting’ with young professionals, social activists and retired bureaucrats, Mehta has chosen ‘distant’ relative Bhupendra Raj Mehta to succeed him. An architect who had his own construction business, Bhupendra spends up to four hours at BMVSS every day. “I have been trying to observe Mr Mehta and learn from him. His discipline, patience and management style are exemplary,” says Bhupendra, who now takes care of finances, HR and purchase functions. “It is good that he is handling responsibilities. I tend to be emotional,” says Mehta with a twinkle in his eyes.

“Though initially there was hesitation [none could see anyone taking Mehta’s place], I have been able to create a rapport with the employees here,” says Bhupendra. He has also brought in an element of systems and processes within the registered society by making a five-year ‘verbal’ contract with employees on their salaries and making sure that 95 percent of its purchases happen through tendering.

Second, like his senior cousin, Bhupendra is a firm believer that the present model should continue. “We have our limitations [financially]. A significant amount of our expenditure is covered through donations, which can be unpredictable. But we are sure that to serve the needy, this model should continue,” he says.

Helping Bhupendra would be a network of accomplished gentlemen whom Mehta and his brother have roped in to form the Global Advisory Council of BMVSS. The panel met for the first time in December 2012. With eminent personalities like former Chief Justice AM Ahmadi, former cabinet secretary Naresh Chandra and top lawyer Harish Salve, Mehta is assured of sound advice. “These are accomplished people. They also come with fresh thinking, which can make a difference,” he says.

The first initiative propagated by the Council is to hold a limb-fitting camp in Afghanistan that will also see participation from Pakistani civil society. “It promises to be a great event,” says Mehta. He will be hoping that the camp would be the beginning of a journey that will make the Jaipur Foot a lasting legacy.

(This story appears in the 08 March, 2013 issue of Forbes India. To visit our Archives, click here.)

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