Case

Caring Vision: Fighting Against FIIB Business Review

8(1) 17–24, 2019
2019 Fortune Institute of
Blindness in Bangladesh International Business
Reprints and permissions:
in.sagepub.com/journals-permissions-india
DOI: 10.1177/2319714519831545
journals.sagepub.com/home/fib

Jashim Uddin Ahmed1

Sadeq Ahmed2
Asma Ahmed3
Mohammad Abdul Majid3

Abstract
Caring Vision Hospital (pseudo-name) started as a small charitable organization in Bangladesh which later turned to be a renowned
eye care institute. This eye care service model is dedicated towards providing proper eye care to both the affluent and underprivileged
patients through cross-subsidization measures. A key to the success of this concept is due to the good relationship between foreign
non-governmental organizations, philanthropists and renowned ophthalmologists who act as key stakeholders. The present case study
highlights the growth of Caring Vision. Moreover, the problems and future scopes shed light into the practical business world which
can be implemented across any organization.

Keywords
Bangladesh, eye care, cross-subsidization, cataract, blindness

A world in which nobody is needlessly visually impaired,
where those with unavoidable vision loss can achieve their full
potential and where there is universal access to comprehensive
eye care services.
—Universal Eye Health: A Global Action Plan 2014–2019
Blindness: Magnitude and
Prevalence
The World Health Organization (WHO) member states
endorsed the new ‘Universal Eye Health: A Global Action
Plan 2014–2019’ in the 66th World Health Assembly to
strengthen eye health care and blindness prevention
programmes. The Global Action Plan (GAP) highlighted
the ‘need for generating evidence on the magnitude and
causes of visual impairment and eye care services and using
it to advocate greater political and financial commitment by
Member States to eye health’ (WHO, 2013).
Multiple organizations collaborated to eliminate
blindness due to injury, disease or congenital conditions and
overcome impaired vision—the Global Initiative, VISION
2020: The Right to Sight. Vision 2020’s prime concerns are
the cataract; trachoma; onchocerciasis; corneal blindness,
refractive error and low vision (Pizzarello et al., 2004).
These have been selected not only because of the major
issues but also due to its affordability and feasibility of
performing actions required to prevent and treat these
medical conditions (Holden & Resnikoff, 2002).
There are about 285.405 million people in the worldwide
who are suffering from vision impairment. Out of them,
39.365 million are blind and 246.024 million of them have
impaired vision. According to an estimate by WHO (2012),
4.24 per cent of the world population is visually impaired
and 0.58 per cent are blind—BCVA (best corrected visual
acuity) <3/60 in the better eye—and 3.65 per cent have low
vision—BCVA <6/18–3/60 in the better eye. Of the over
39 million, 6 million (15%) were from Africa, 2.7 million
(7%) from Europe, 23 million (67%) from Asia, 3.2 million
(8%) from America and 5 million (12.5%) from the Eastern
Mediterranean (Aggarwal, 2015). Among them, 82 per
cent blind were over 50 years of age. In developed

1 Department of Management, School of Business & Economics, North South University, Bashundhara, Dhaka, Bangladesh.
2 School of Public Health, University of South Asia, Dhaka, Bangladesh.
3 InterResearch, Bashundhara, Dhaka, Bangladesh.

Corresponding author:
Jashim Uddin Ahmed, Department of Management, School of Business & Economics, North South University, Bashundhara, Dhaka 1229, Bangladesh.
E-mails: jashim.ahmed@northsouth.edu; jashimahmed@hotmail.com
18
countries, the principal causes of blindness are age-related
macular degeneration (AMD), glaucoma and diabetic
retinopathy. In the rest of the world, cataract1 (47%) is the
major cause.
Additionally, the report also expressed that 12.049
million blind people and 78.482 million people with vision
impairment reside in the Southeast Asian region. This
represents 30.60 per cent of world’s blind people and 35.89
per cent of world’s people with impaired vision. The
WHO’s 2010 data contained many key parameters that
form the base line data for the application of GAP to
universal eye health as laid down by the WHO Resolution
of 66.4 (WHO, 2013).
Bangladesh Context
Bangladesh has been economically and socially recognized
as a developing country with a population of 159.453
million (July 2018 estimate). Moreover, the population
density (1,045 people per square kilometre—five times
than that of any other ‘mega’ country [>100 million])—
also poses a challenge (CIA, 2018). The nation faces
considerable barriers that prevent it from satisfactorily
meeting its rising health care needs, including eye care
(Ahmed et al., 2015). In middle- and low-income countries,
cataracts are known to be the leading cause of blindness.
There is a twofold variation in the widespread presence of
blindness between the richest and poorest divisions (Muhit
et al., 2016). Blindness in developing countries, as well as
in Bangladesh, is most commonly found in backward and
rural, often remote underdeveloped areas. Over 90 per cent
of the population health care expenditure is out-of-pocket,
and 10 per cent are supported from the non-governmental
organizations2 (NGOs) and government sector (Das et al.,
2017).
In Bangladesh, the number of blind people aged 30 and
above is 750,000; 85 per cent of them have become blind
due to cataract (Ahmed, 2018). A staggering 120,000 people
are added each year to that figure. More than 6 million
people in Bangladesh need vision correction by spectacles
or by any other means.
The Government of Bangladesh is one of the signatories to
the Global Initiative launched in 1999 known as Vision 2020.
In 2005, National Eye Care (NEC) plan was set in motion
along with a different operational plan of Health Nutrition and
Population Sector Program (HNPSP) which was subsequently
consolidated in the new Health, Population, and Nutrition
Sector Development Program (HPNSDP) (Figure 1).
The motive of the national plan was to build secondary care
and strengthen primary health care infrastructure to facilitate
operation of prevention and referral cases. The detailed
proposal included a combination of public–private and NGOs
in partnership with achieving Vision 2020 goal (The
International Agency for the Prevention of Blindness, 2014).
FIIB Business Review 8(1)
National Eye Care Plan 2005–2009 approved by the government
2005 followed by a groundbreaking event-creation of a post of line director
for National Eye Care
2006 First operation plan (2007–2011) for National Eye Care
formulated under HNPSP
2011 Second operation plan (2011–2016) for National Eye Care formulated
under HPNSDP
2013 National blinding eye disease survey in Bangladeshi adults
2014
Review of National Eye Care Plan 2005
Figure 1. Milestones of National Eye Care in Bangladesh
Source: Authors, 2018.
Eye Care Service
The eye care service is principally worried about the
safeguarding of ocular health and rectification of eye
problems that can reduce vision capacity. The primary
objective is to provide eye examinations to visually
impaired persons by providing prescriptions for spectacles,
as well as retailing these products, that is, lenses and
frames.
Qualitatively speaking, the cataract surgical rate is
1,475 per million (2014 data) with a cataract surgical
coverage of 32 per cent. In Bangladesh, on average 1,000
eye doctors are present with a ratio of (1:162,494) for
156.18 million people with an eye health epidemiology
(blind) of about 1.6 per cent. The ratio of optometrists to
technicians: (n = 1,200) 1:125,000 (Das et al., 2017).
Optometrists, opticians and ophthalmologists are the
primary caregivers when it comes to eye care service.
Optometrists measure eyesight, prescribe corrective lenses
and detect eye diseases. Opticians typically manufacture
and dispense glasses and corrective lenses in a variety of
locations as prescribed by an optometrist or ophthalmologist.
Overall treatment of disorders and diseases of the eye is the
specialty of an ophthalmologist. Laser surgery can
eliminate the need for glasses or contact lens and has
consequently experienced a rise in demand driven by those
who can afford it.
In Bangladesh, the eye care scenario seems worse when
weighed down by the fact that 90 per cent of doctors and
paramedics are based in urban areas while 80 per cent of
people suffering from vision impairment live in rural areas
where the treatment facilities are extremely poor. Visual
impairment of children limits their participation in
opportunities for education and self-development. More
than 90 per cent of blind children receive no schooling
at all.
Ahmed et al. 19
Eye care programmes have primarily focused on the
increasing numbers of cataract surgeries rather than the
quality of outcomes or patient satisfaction. In some clinics,
fewer fees attract more patients, leading to more net
income. Rural, illiterate and underprivileged people are not
completely mindful of the various interventions that can be
accessed to return vision to the blind. People suffering
from eye diseases do not seek surgery because of different
cultural, social (lack of attendant) and psychological
reasons (fear). The concept of comprehensive eye care
(CEC) is to guarantee that recipients get a system of
assistance that successfully prevents blindness, promotes
eye health and ensures provision of clinical services for
treating the common and blinding eye diseases.
Background: Caring Vision Eye
Hospital
In the late 1950s, Caring Vision Eye Hospital (referred to
as Caring Vision3) and Shamsuddin Institute of
Ophthalmology were established by industrialist and
philanthropist late Mr Shamsuddin in Dhaka as a donation
for the welfare of the underprivileged community of
Bangladesh (Activity Report 2010–2012). Initiated as a
philanthropic dispensary, it was later transformed into a
specialized eye hospital with the express intent of reducing
the number of unnecessary blindness among the deprived
people of the country. Since then, the hospital has been
providing the best and cost-effective eye treatment by
allocating the most modern technology, best physicians,
well-trained ophthalmologists and other support staff. It is
the first and most equipped eye hospital of Bangladesh, and
it has always been like a non-profit organization. Towards
the end of 2011, the hospital was renamed as Caring Vision
Eye Institute and Hospital. The change emphasizes that it is
not just a hospital. It is also an institute where ophthalmic
trainings are provided to the ophthalmic nurses and
paramedics. The institution is offering postgraduate
fellowship programmes for the doctors who are interested
to pursue their career in ophthalmology. Due to the lack of
proper government regulation of fellowship programmes,
the proposed fellowship programme by Caring Vision is
yet to be established by legal authorization.
When Mr Shamsuddin established this hospital, his aim
was to ensure quality eye care services to that economic
section of the society which cannot afford quality treatment.
Currently, this 50-year-old biggest ‘multidisciplinary’ eye
hospital is providing quality treatment to all the socio-
economic sections of Bangladesh. This is because the new
management committee recently realized that it is difficult to
run such a large hospital and institute solely with donations
from individuals and organizations. Additional funding is
required for branding of the hospital and institute as well.
Therefore, cross-subsidization has been introduced to earn
money from the affluent patients and then use the money to
treat the poor. Even though facilities such as type of surgery
(SICS usually for poor and phacoemulsification usually for
affluent), type of surgical material (American IOL usually for
affluent and Indian IOL usually for poor), waiting area,
waiting hour, air-conditioned wards and other facilities vary
according to patients’ preference and affordability, the hospital
ensures the same quality treatment for all levels of patients.
Mr Shamsuddin’s dream of eradicating avoidable
blindness from Bangladesh has expanded outside the border
of Dhaka with branches being established in Barisal,
Jamalpur and Naogaon. The establishment of these ‘25-bed-
capacity’ hospital branches was supported by Orbis
International,4 and the goal of the branches is ‘Creating
Access to Eye Care Services for Rural People of Bangladesh’.
These branches provide treatments specially for ‘cataract
and refractive’ errors, which are the major reasons of
blindness in Bangladesh (Activity Report 2010–2012).
Strategies of Service and Cross-
subsidize Revenue Model
In order to achieve the goal of providing free-of-charge
quality eye care to those who cannot afford to pay, the
Caring Vision Eye Institute and Hospital inevitably resorted
to extracting a surplus of funds by treating those who can
afford to pay for their treatment—in other words, by
adopting the model of cross-subsidization. In order to do
this, and to ensure that the operational model currently
being employed is sustainable, the solution is twofold:
First, the model for general and poor patients must have
low fees, small profit margin, economies of scale and high
volume. Second, upscale facilities must be provided for
wealthier patients, so they can be charged a premium that
may be used to cross-subsidize the less fortunate patients,
and thus ensure sustainability. To establish this strategic
model, three groups of patients5 are self-selected to receive
treatment from the Caring Vision Eye Institute and Hospital
based on their financial ability to pay for the services:
1. The established and affluent group, who will spend
premium sums to obtain premium facilities. This
group will, as a result, finance a significant part of
the medical care required by poor patients.
2. The ‘general patients’ from the aspirant and emerging
middle groups who will get phenomenal treatment,
but who will pay only a modest amount that will be
within their means. The large number of patients
in this group enables the small margin charged to
be able to compensate for the expenses incurred in
running the hospital.
3. The poor patients (bottom of the pyramid), who live
beneath the poverty line, and who cannot pay for
their services, will be treated without charge, and
will be presented with housing in modest facilities.
However, they will be provided with the most up-to-
date treatment with the finest equipment.
20 FIIB Business Review 8(1)

Special attention should be given to the fact that the Caring
Vision Eye Institute and Hospital’s emphasis is to ensure
that all patients are given the same quality of treatment and
the only differentiating factors are the facilities offered.
One can see that this model depends on Caring Vision’s
ability to surpass the expectations of affluent individuals
while simultaneously providing the poor patient with
compassionate care and respectful consideration. A model
such as this requires not only the delivery of technically
superior treatment but also the possession of facilities,
equipment and ambiance needed to ensure the comfort of
middle-upper class patients. In addition, it requires expertly
trained doctors who are skilled specialists in their fields
and an exceptional management team present in the
hospital who will in the future be able to allow further
development and expansion of numbers.
Competitive Advantages
Caring Vision Eye Institute and Hospital is a centre of
excellence for providing modern, efficient and cost-
effective eye care by ensuring latest sight-saving medical
and surgical techniques. Moreover, it has got the best
ophthalmic paramedics and nurses along with the best eye
specialists. Since its establishment in 1960, Caring Vision
has persevered to meet the eye care needs of the country.
Caring Vision Eye Institute and Hospital is proud of its
competence regarding four standards of proficiency:
service, cleanliness, patient handling and support services
for both indoor and outdoor patients. Furthermore, it has a
built-in medical and surgical follow-up regimen. The
Caring Vision Eye Institute and Hospital offers a broad
range of services (as shown in Table 1).

Table 1. Service Portfolio

Services
Outdoor department
(OPD) services
Fast-track services
Counselling services
Accommodation services
Surgery facilities
Sub-specialty services
Medical support services
Laboratory services
Support services
Welfare services
Source: Various internal documents (2018).
Types
• All OPD rooms are equipped with slit-lamps and other instruments
• Availability of day-care services
• Availability of 24-hour emergency services
• Separate registration counters
• Separate air-conditioned waiting areas
• Availability of attendants for quick services
• Separate counselling facility/room
• Professional counselling for patients
• Availability of clean cabins and wards
• Separate facilities for children
• Availability of fully equipped modern operation theatres (OTs):
(a) Different OTs for different types of operations
• All types of advanced eye surgeries, such as:
(a) Cataract: Phacoemulsification
Small incision cataract surgery (SICS): Paediatric cataract surgery
(b) Keratoplasty (corneal grafting)
(c) Oculoplastic surgeries: Squint surgery, ptosis surgery and dacryocystorhinostomy
(d) Vitreoretina surgery: Retinal detachment surgery, vitrectomy surgery
(e) Laser: Retinal laser (panretinal photocoagulation), Yag laser and laser for glaucoma
• Cataract, cornea, glaucoma, retina, oculoplasty, paediatric ophthalmology, uvea, neuro
ophthalmology
• Low vision centre, contact lens clinic, refraction unit
• Internal Medicine, Cardiology and Anaesthesia
• Microbiology, Biochemistry, Pathology, Serology and Histopathology
• Pharmacy: Availability of full range of eye medicines
• Optic shop: Different types of frames (low cost/high cost), lenses and contact lenses
• Cafeteria: Fast food and soft drinks.
• Public awareness service
• Assistance in registration and guidance
• Provision of food, medicine and clothing for patients, assistance in transportation
• Treatment and rehabilitation of destitute visually impaired patients
Ahmed et al. 21
Caring Vision Eye Institute and Hospital is not only an eye
hospital, but it is also an institution to train the eye
specialists and ophthalmic paramedics, along with a
specialty eye care. For the doctors who want to pursue their
career as ophthalmologists, the institution offers courses
such as Diploma in Ophthalmology, postgraduate degree
course like Fellow of College of Physicians & Surgeons,
Part-2 course in ophthalmology and so on. Moreover, the
Caring Vision Eye Institute and Hospital has signed a
memorandum of understanding with India’s LV Prasad Eye
Institute and Aravind Eye Care System. Caring Vision
sponsored doctors’ education as per the institution’s policy.
Along with the doctors, ophthalmic paramedics such as
nurses, optometrists and ophthalmic paramedics can also
visit these two institutions for doing relevant courses.
The institute also offers courses for outside ophthal-
mologists who are working for different eye hospitals and
NGOs. These courses are as follows:
1. Basic eye care medical officers
2. Primary eye care training for physicians
3. Orientation programme for postgraduate doctors
in all sub-specialties.
The institute also offers courses for ophthalmic paramedics
in Bangladesh. Other eye hospitals are also sending their
nurses, ophthalmic paramedics and optometrists for
ophthalmic training. The courses offered are ophthalmic
training for nurses and assistant nurses, ophthalmic OT and
sterility maintenance.
Other training programmes are Ophthalmic Pathology
and Microbiology Training, Low Vision Training Programme,
Optical Dispensing Training Course, Diploma in Ophthalmic
Techniques, Refraction Training Programme. Other than
these training programmes, four more new programmes are
also going to be started which are as follows:
•• Fundus photography, fundus fluorescein angiog-
raphy, optical coherence tomography and observa-
tion for B-scan and laser
•• Ocular prosthesis, contact lens basic
•• Biometry and auto-refractometer refraction
•• Applanation tonometry procedure, visual field test
Affluent Patients
To achieve the objectives of Caring Vision, the facilities
need to be improved and contemporized, with special
attention paid to those areas where the more affluent
patients are served. The process is currently underway, for
example, by providing a new section for private patients.
The new examination area for private patients has 15
examination rooms and a separate private waiting area. In
December 2011, a 9-room, 11-bed private ward was
opened. Each room is carefully decorated and provides the
patients with superior accommodation. All rooms are
air-conditioned and nicely furnished.
The new OT suite encompasses more than 15,000
square feet and comprises 10 new operation theatres. Each
theatre is equipped with 17 operation tables. Moreover, the
complex accommodates a pre-operative waiting area, post-
operative recovery areas, an operation theatre store and a
central sterilization department consisting of the most
modern autoclaves and sterilizing equipment. A new
anaesthetic and monitoring machine with a central gas
supply is also incorporated in the new operation suite to
meet or exceed international standards.
Underprivileged Patients
For the rural people who are financially insolvent and
incapable of travelling, Caring Vision hospitals have
arranged an alternative to reach to them with support from
Orbis International, establishing three branch hospitals,
one each at Barisal, Jamalpur and Naogaon under the
banner: ‘Creating Access to Eye Care Services for Rural
People’. Each hospital has a 25-bed capacity. The branch
hospitals were established to make eye care increasingly
accessible to the poor and underserved rural population
and to provide services aimed specially at addressing the
issues of cataract and refractive errors, which are two of
the leading causes of blindness.
Specifically, objectives of the branch hospitals include
making quality, cost-effective and sustainable eye care
services available in these areas. In addition to these branch
hospitals, Caring Vision hospitals established vision
centres in those villages which have no access to ophthalmic
care. These vision centres are equipped with basic eye-
testing equipment and a trained technician. The first branch
hospital was launched at Jamalpur in 2008, followed by the
branch hospital at Barisal in 2009, and finally the third one
at Naogaon in 2011.
The hospitals are staffed by doctors trained in Dhaka,
and they are performing thousands of cataract surgeries
each year, along with other ocular surgeries. The patients-
screening programmes identify cataract patients in the
community and at camps, and these cataract patients are
then referred to the local branch hospital for surgery. Since
the project area are poverty-stricken, many surgeries (up to
30% of patients) are performed either free of charge or at a
subsidized rate (65%). However, a certain percentage of
patients pay for their surgeries.
Since the first branch hospital was opened in May 2008,
a total of 272,924 outpatients have been seen and 11,991
surgeries have been performed up to December 2011 in the
three branch hospitals. Six vision centres have been
established in six upazilas (sub-districts) in partnership
with local NGOs. These refractionists are trained at the
hospital in Dhaka. They see patients in the vision centres
and in the screening camps, do refraction, dispense glasses,
refer patients to the hospital for further treatment as needed
and promote eye health education.
22
Setbacks and Challenges
Caring Vision is located in one of the most crowded places
in Dhaka city. Patients travelling with private vehicles will
find it difficult to find a parking spot when they visit the
eye hospital.
As it relies completely on donations, it is possible that
the eye care equipment cannot be upgraded as often as
needed, especially when compared to private hospitals.
This also applies to outdated software, and ineffective
software might lead to system glitches, disrupting the
transparency of a non-profit organization. Software
glitches will likely cause a lot of time being lost which also
has a financial implication. It is also safe to assume that
their staff are underpaid and not compensated
proportionately to the service they provide. Dissatisfied
workers might not provide adequate or the qualitative
service that patients expect to get there.
There are some challenges for the eye hospital. These
being: more than 700 employees in the hospital, and yet,
there are less than 10 employees handling the functions
related to human resources, with no significant teamwork
among them. There is a lack of proper planning; therefore,
the salary structure remains a questionable topic, and, as a
result, employee dissatisfaction arises. Needless to say,
there is no scope of quantitative evaluation and feedback.
For example, security personnel earn almost the same as
pharmacists who possess higher qualifications and skills.
This is another key problem to note: the building being
almost 50 years old lacking modern facilitation such as a
proper alarm system, proper ventilation, limited
washrooms, etc. The building is built in such a way that
there are many empty spaces which are not being utilized.
The misconceptions in people’s mind about the eye hospital
stand as a major challenge for the hospital in terms of its
image. A section of the people views the hospital as a
government institution with inadequate services. On the
other hand, there are people who think that it is a corporate
hospital that no longer provides the noble and charitable
services to the underprivileged segment of the society.
From Saturdays to Wednesdays, it closes by 7:30 pm and
on Thursdays it stays open until 1:30 pm. The working
population may find obtaining an appointment difficult as
they can only opt for Saturdays. As that is the only day of the
weekend that the hospital is open, it is possible that patients
have to wait for weeks to even get an appointment. Some
patients will choose to visit a different eye hospital altogether.
This will lead to the loss of two revenue streams: (a) the
current patients who choose to go to a different eye clinic
due to the limited time and (b) the prospective patients who
are turned away from the negative word of mouth by the
current patients. However, no such problems arise in a crisis
situation as their emergency service is open for 24 hours.
The eye hospital may not reach the expectations of the
established and affluent population. These patients will also
have a difficulty visiting an eye clinic that caters to people of
FIIB Business Review 8(1)
all social classes. The former will always want to differentiate
them and may want to be among patients with their similar
stature. They would be willing to pay more to get the
preferential treatment. As a result, the institution may lose
out on a big portion of the population. Many patients have
complained about the duration of time that they need to wait
in the waiting room. Although the specialists keep the
patients busy by asking them to fill out forms, getting the
basic eye checked and tested before a consultation, it usually
takes hours before the patients are finally finished with their
appointment. Being a non-profit hospital, they are unable to
focus on the appearance of the facility. The servicescape or
the physical environment has a lasting impact on the minds
of whoever is in vicinity. As there is a long waiting time
before the patient can finally consult a doctor, the waiting
rooms need to be equipped with multiple fans, adequate
comfortable chairs and clean drinking water. If possible,
newspapers, magazines and a small television should be
allocated to keep the patients waiting time comfortable and
stress-free. Some patients have had to stand due to the over-
capacity of patients and due to the unavailability of seating
arrangements in the waiting room.
Moving Forward
Caring Vision is facing pressure when it comes to funding
due to the cross-subsidization effect which divides the total
cost over the total number of patients. However, with its
humble mission, Caring Vision is recruiting expert nurses
and other paramedics, and is providing them with
ophthalmic training to ensure the smooth functioning of
the hospital. These trained nurses and ophthalmic
paramedics are required to sign a bond that they are going
to serve Caring Vision for three years. These strategies are
not enough to ensure excellent ophthalmic services for the
increasing patients of Bangladesh. Hospital service is
highly discriminative because of emergency patients which
results to refusal and rescheduling of non-resident patients.
This quality versus quantity dilemma is reduced by some
strategies by Dr David Richardson, who worked as the
CEO of the Caring Vision Eye Institute and Hospital. In
future, renovation activities will be done with the help of
profits earned from the private OPD and some with the
help of donations from different individuals and
organizations. Moreover, currently the institution offers
more courses for doctors and ophthalmic nurses and
paramedics along with fellowship programmes.
In order to effectively prevent and control avoidable
blindness and improve the overall eye care industry in
Bangladesh, the following strategic directions are being
taken. Improved accessible and affordable services are to
be provided; quality of surgeries will be improved through
ongoing monitoring according to standard protocol. School
screening programmes will be set up to diagnose children
with eye issues. Public awareness will be raised to facilitate
early detection and establish preventive measures. Various
Ahmed et al. 23
programmes are being undertaken to address the restoration
of the vision of the underprivileged blind people. The
community centred rehabilitation and inclusive education
services will be integrated with the CEC programmes.
Finally, impact studies will be organized and carried out to
determine the sustainability of CEC programmes.
One major concern is that the people of Bangladesh
who are financially solvent are travelling to neighbouring
countries for better treatment. Caring Vision’s target is to
provide quality eye treatment to the affluent socio-
economic section of Bangladesh. As a result, the quality
team is working very hard to ensure the desired quality in
each department. To ensure quality, Caring Vision’s target
is to achieve the standard of Joint Commission International
Accreditation which is not even fulfilled by the other
renowned hospitals of Bangladesh.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect
to the research, authorship and/or publication of this article.
Funding
The authors disclosed receipt of the following financial support
for the research, authorship and/or publication of this article:
The authors would like to thank InterResearch, Bangladesh, for
funding and supporting this study.
Notes
1 Any congenital or acquired opacity of lens capsule or sub-
stance, irrespective of the effect on vision, is cataract (Kanski,
2007). In a normal eye, light passes through the transparent
lens to the retina. Once it reaches the retina, light is changed
into nerve signals that are sent to the brain. In cases of cata-
racts, the lens becomes cloudy and transmits a blurred image
to the retina. Surgery is performed to replace the opaque lens
with an artificial transparent intraocular lens (IOL) when
vision loss interferes with daily activities.
2 Major eye health international NGO operating in Bangladesh:
Andheri-Hilfe Bonn, Christian Blind Mission, Fred Hollows
Foundation, Heart to Heart, Helen Keller International,
Orbis International, AL-Basar International Foundation and
Sightsavers.
3 Caring Vision is a pseudo-name used due to confidentiality of
the organization; however, all facts and figures remain true to
their functions.
4 Orbis International is an international non-profit NGO dedi-
cated to saving sight worldwide. Its programmes focus on the
prevention of blindness and treatment of blinding eye diseases
in developing countries through hands-on training, public health
education, advocacy and local partnerships. Since 1982, Orbis
capacity-building programmes have enhanced the skills of
325,000 eye care personnel and provided medical and optical
treatment to more than 23.3 million people in 92 countries.
5 Bangladeshi people are divided into five basic income groups:
bottom of the pyramid, which refers to five-member house-
holds subsisting on incomes of less than USD150 a month;
aspirant, with income from USD 151 to USD 250; emerging
middle, with income from USD 251 to USD 400; established,
with income from USD 401 to USD 650; and affluent, with
income of more than USD 650 (BCG, 2015). In a developing
country like Bangladesh, 7 per cent of the population, approxi-
mately 11 million people, are ‘middle and affluent consumers’
(MAC)—who are viewed as confident, with an expectation of
seeing their incomes increase positively in coming years. Two
particular income segments established and affluent comprise
the MAC population of the country, because they have attained
the purchasing power to buy a broad variety of consumer goods
and service. Besides, they have acquired the MAC purchasing
traits, such as buying goods and services that offer convenience
and luxury in addition to basic necessities (BCG, 2015).
References
Aggarwal, R. (2015). Double vision: Making eye care through
cross-subsidization. France: INSEAD.
Ahmed, J. U., Shimul, A. S., Sen, P., & Khan, N. N. (2015).
JibonTari: A floating hospital to serve distressed humanity.
Business Perspectives and Research, 3(2), 146–160.
Ahmed, M. (2018). Universal Eye Health Critical to Achieving
SDG-3: Good Health and Well-Being of People. Retrieved
from https://www.daily-sun.com/post/345291/2018/10/24/
Universal-Eye-Health-Critical-to-Achieving-SDG3:-Good-
Health-and-WellBeing-of-People
BCG. (2015). Bangladesh: The surging consumer market nobody
saw coming. Retrieved from https://www.bcgperspectives.
com/content/articles/centercustomer-insight-go-to-market-
strategy-bangladesh-surgingconsumer-market/?chapter=2
Caring Vision Eye Institute and Hospital (2010–2012). Activity
report (2010–2012). Dhaka, Bangladesh.
CIA. (2018). CIA world factbook—South Asia: Bangladesh.
Retrieved from https://www.cia.gov/library/publications/
the-world-factbook/geos/print/country/countrypdf_bg.pdf
Das, T., Ackland, P., Correia, M., Hanutsaha, P., Mahipala,
P., Nukella, P. B., … & Sapkota, Y. D. (2017). Is the 2015
eye care service delivery profile in Southeast Asia closer to
universal eye health need! International Ophthalmology,
38(2), 469–480.
Holden, B. A., & Resnikoff, S. (2002). The role of optometry in
Vision 2020. Community Eye Health, 15(43), 33–36.
Kanski, J. J. (2007). Clinical ophthalmology: A systematic
approach. Oxford: Elsevier Butterworth-Heinemann.
Muhit, M., Wadud, Z., Islam, J., Khair, Z., Shamanna, B. R.,
Jung, J., & Khandaker, G. (2016). Generating evidence for
program planning: Rapid assessment of avoidable blindness
in Bangladesh. Ophthalmic Epidemiology, 23(3), 176–184.
Pizzarello, L., Abiose, A., Ffytche, T., Duerksen, R., Thulasiraj,
R., Taylor, H., … & Resnikoff, S. (2004). Vision 2020:
The right to sight. A global initiative to eliminate avoidable
blindness. Archives of Ophthalmology, 122(4), 615–620.
The International Agency for the Prevention of Blindness.
(2014). Vision 2020 Workshop Report, October 20 and 21,
2014, Dhaka, Bangladesh. London: INGO Forum, National
Eye Care and IAPB, SEA.
WHO. (2012). Situational analysis of VISION 2020 in the WHO
South East Asia Region 2012. Geneva: WHO.
———. (2013). Universal eye health: A global action plan
2014–2019. Geneva: WHO.
24 FIIB Business Review 8(1)

About the Authors

Jashim Uddin Ahmed, PhD is a Professor and Chairman of the Department of Management and Acting
Dean of School of Business & Economics, North South University, Bangladesh. He is the founder of
InterResearch, a leading research organization in Bangladesh. He has been awarded his PhD in
Management Sciences from the University of Manchester Institute of Science and Technology (UMIST,
currently known as The University of Manchester), UK. He has achieved Master degrees both in
Marketing and Management from the University of Northumbria, UK. He also studied in the University
of Reading and the University of Lincolnshire and Humberside (currently known as University of
Lincoln), UK. His research interests lie broadly within social innovation, strategic management and
contemporary issues in business. He has published over 100 research articles and case studies in reputed
journals. An expert on Asian and Emerging Markets business case writing, Prof. Ahmed's extensive
cases exceed 50 in number and cover diversified industries and sectors. His works published in
International Journal of Logistics Management, Vision - The Journal of Business Perspective, South
Asian Journal of Business and Management Cases, Global Business Review, Higher Education for the
Future, Research in Education, Decision, Business Perspectives and Research, SAGE Business Cases,
International Journal of Consumer Studies, Journal of Strategic Contracting and Negotiation, Journal
of Developing Societies, Journal of Global Entrepreneurship Research, Society and Business Review,
Australasian Journal of Information Systems, and Asian Case Research Journal. Currently, he is
Advisory Editorial Member of South Asian Journal of Business and Management Cases also Editorial
and Reviewer Board member of Business Perspectives and Research. He can be reached at jashim.
ahmed@northsouth.edu; jashimahmed@hotmail.com

Sadeq Ahmed is an Assistant Professor of Ophthalmology, School of Public Health, University of South
Asia, Dhaka. He is a Fellow and Member of Bangladesh College of Physicians and Surgeons. He
received Diploma in Ophthalmology from Dhaka University. He became medical graduate from Dhaka
Medical College. He completed Fellowship in Neuro-ophthalmology from National Institute of
Ophthalmology & Hospital, Bangladesh. He is serving as Neuro-ophthalmologist in Vision Eye Hospital,
Dhaka. His research interests are in the fields of ophthalmic patient management, ophthalmic
microsurgery and medical education. He is co-author in a published article in the journal “Ophthalmology”.
He can be reached at drsadeq.tapan@yahoo.com

Asma Ahmed is a freelance strategic planner in Bangladesh. Her Master’s degree and Bachelor’s degree
are from National University of Bangladesh. Her research interests are in the area of social innovation,
intellectual and human capita, higher education and strategic management. Currently, she is a senior
research associate with InterResearch, Dhaka, Bangladesh. She can be reached at ahmed.interresearch@
hotmail.com

Mohammad Abdul Majid is a professional digital marketer working as a strategic planner in

Bangladesh. He is currently pursuing his MBA in Marketing from University of Dhaka. He graduated
from North South University in 2015. His research interest includes product planning, brand management,
advertising and education. Currently, he is a research associate in InterResearch, Dhaka, Bangladesh.
He can be reached at mamajid2010@gmail.com