Jaipur Foot 2014 India Business Conference

2014 C.K.
PRAHALAD CASE COMPETITION
The Jaipur Foot: Challenges in

Leading a Free Service Organization
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2014 Rao and Kumar. This case was written by Menaka Rao and Professor U. Dinesh Kumar of the Indian Institute of
ManagementBangalore. It won Honorable Mention in the 2014 NextBillion Case Writing Competition
next billion
2014 case writing competition
Honorable Mention
case 1-429-388
April 1, 2014
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The Jaipur Foot: Challenges in Leading

a Free Service Organization
It was around 9:00 a.m. and patients were being admitted at the Sawai Mansingh Hospital (SMS)
in Jaipur, India, where the not-for-profit organization (NPO) Bhagwan Mahaveer Viklang Sahayata Samiti
(BMVSS), better known for its productthe Jaipur Foot (JF)was located. Streams of people with different
kinds of locomotive disabilities were admitted daily. A few had traveled more than a thousand kilometers to
reach the center.
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Anybody could walk in at any time and register even with the security guard. The registration process
was simple: a staff member walked around with a registration book in which the patients name was noted,
along with his/her disability. Patients were first admitted as they arrived and then registered without
regard to time or filling in tedious details on a form, unlike in other health-care systems where registration
preceded admission. The patients were asked a few questions, such as Where have you come from? What
do you do? Who is accompanying you? and so on. This simple process was all that was needed to register
for a free prosthetic limb, a caliper, or other aids and appliances.
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Some patients, particularly those in need of tricycles and economic assistance for self-employment,
were retained at the SMS Jaipur Foot center. Other amputees and polio patients in need of calipers were
moved in ambulances to BMVSSs second facilitythe Jaipur Foot center at Malviya Nagar, Jaipur, located
about six kilometers away from the SMS center. At the SMS Jaipur foot center, once the registration process
was completed, measurements would be taken. The customized shank/socket would then be fabricated and
fitted with the Jaipur Foot piece. The patients were usually discharged on the same day or at the most within
three days. If there was a delay in the fitting, the patients and their caretakers were provided free boarding
and lodging.
Many of the technicians and employees (around 150 in all) working at the BMVSS
were victims of locomotive accidents, and they all wore a Jaipur Foot. In its 37 years,
BMVSS had fitted approximately 425,000 artificial limbs and over 350,000 calipers at its
Proud Sponsor Jaipur center and 20 other branches spread over the country.1 Other aids and appliances,
such as hand-paddled tricycles, wheelchairs, crutches etc, provided by BMVSS had helped
2014 NextBillion Case
Writing Competition
about 525,000 disabled people in India.2 In all, over 1.3 million disabled people in India
Published by GlobaLens, a division of the William Davidson Institute at the University of Michigan.
2014 Rao, Menaka and U. Dinesh Kumar. This case was written by Menaka Rao and Professor U. Dinesh Kumar of the
Indian Institute of ManagementBangalore. This case is intended to be used as a basis for class discussion and is not
meant to illustrate either the effective or the ineffective handling of an administrative situation.
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The Jaipur Foot: Challenges in Leading a Free Service Organization
1-429-388
had been rehabilitated between 1975 and 2012 (Table 1).3 Approximately 20,000 disabled people were
rehabilitated in various on-the-spot limb fitment camps that had been organized in 26 countries (Appendix
1).4 Approximately 60,000 beneficiaries received various aids and appliances from the organization annually.5
Over the years, BMVSS had grown to be recognized as the worlds largest organization for the disabled. The
organization was popular, as it catered to people at the bottom of the pyramid (BOP) without a single rupee
(USD 1 = INR 62 in October 2013) collected from patients. According to D. R. Mehta, the founder and chief
patron of BMVSS: We have come a long way since we began in 1975, but now the call of the day is to widen
our presence, as we are able to serve only a minor fraction of the disabled people in India.
Table 1
Fitments and Other Aids and Appliances Provided by BMVSS (19752012)
Artificial Limbs
Calipers
Tricycles/Wheel Chairs
Crutches & Other Aids
Hearing Aids
Polio Corrective Surgery
Total
No. of Fitments
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Category
416,272
348,666
84,662
403,643
21,502
7,376
1,282,121
Source: http://jaipurfoot.org/media/statistics/index.html#.Uw7Mu85Zc3g.
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Mehta knew that the organization had grown serendipitously and that the reach of the Jaipur Foot
centers was still limited. Though the Jaipur Foot had made significant inroads geographically, there were
still several thousands of people who needed the foot. He wanted to expand BMVSSs operation to reach as
many disabled people as possible and wondered how he could scale operations. In addition, he was handing
over the running of the organization to a successor, and many onlookers and well-wishers had expressed that
the organization might face existential issues without him. He felt among several questions that surrounded
the longevity of BMVSS, three important ones had to be answered before he handed over BMVSS completely
to his successor:
1. How would BMVSS identify representation gaps geographically and locate suitable partners or associates
to run more branch offices?
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2. The organization was largely dependent on government grants and donors for funds. How could the
organization overcome its donor dependency? How would it address the issue of donor fatigue?
3. Though the organization was able to meet its annual budget, sometimes it dipped into its corpus to
cover expenditures. Grants had been erratic and unpredictable in the past. How could the organization
find more money to reach interior India and enter international markets?
In addition to these problems, there was a strong feeling among many that the free for all model had
to change . Mehta refused to listen to this line of thinking. But at the back of his mind there was nagging
doubts: Would the organization finally have to resort to charging patients? And at a more philosophical
level, what would become of the organization if the business model changed from the core principles it had
been built upon?
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1-429-388
Loco-motor Disabilities in India

According to the government of India, there were about 10 million people suffering from loco-motor
disabilities, of which about 1 million had lost their limbs and 4 million were polio-affected.6
The loss of limbs was rampant as the result of accidents, land mine explosions, and gunshot wounds
in war zones and strife-torn areas, as well as the effects of diseases such as diabetes and Burgers disease.i
Disabled people constituted about 56% of Indias population in 2012, of which about 70% had locomotive
disabilities.7 The urban and rural population had similar numbers of people with loco-motor disabilities
(Exhibit 1).8 A combination of poverty and the absence of facilities for rehabilitation exacerbated the
problem. The World Health Organization estimated that in developing countries, only 12% of the patients
who needed rehabilitation actually had access to it.9
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Exhibit 1
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Percentage Distribution of the Disabled in Urban and Rural India
Source: Disabled Persons in India NSS 58th round (JulyDecember 2002), Report No 485 (58/26/1). National Sample Survey Organisation, Ministry of Statistics and Programme
Implementation, Government of India.
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Prior to 1975, there were very few institutions in India that manufactured artificial limbs. The most
popular was the Swami Vivekananda National Institute of Rehabilitation Training and Research (S.V. NIRTAR),
an autonomous institute established in 1974 that functioned under the Ministry of Social Justice and
Empowerment of India. Another was the Nevedac Prosthetic Centre, founded in 1973. The Artificial Limb
Centre (Pune), a part of the Indian Armys medical services wing, was dedicated solely to amputees from
the armed forces, and only its surplus capacities of a few hundred limbs were made available to civilians. In
the 1960s, only traditional limbs were being made in India. The foot pieces used the solid ankle, cushioned
heel (SACH) foot design and were made of laminated wood and rubber. The sockets were made of wood. As a
result, the limbs were heavy and cumbersome to use, and hence, the percentage of rejection by patients was
high. Moreover, the time taken to manufacture a custom-made limb was several weeks, if not months. They
were also too expensive to be within the reach of most people at the BOP.
Burgers disease is a recurrent acute and chronic inflammation and thrombosis of the arteries and the veins of the hands and feet.
Ulcerations and gangrene in the extremities are common complications, often resulting in the need for amputation of the involved
extremity.
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Bhagwan Mahaveer Viklang Sahayata Samiti (BMVSS)

The Idea for BMVSS
On January 7, 1969, while he was traveling to Pokhran, a truck hit Mehtas car. His right femur shattered
into several pieces and he began bleeding profusely. Since the accident occurred in a sparsely populated
area, he waited for three hours for medical attention. Finally, a passing vehicle gave him a lift and Mehta
obtained medical aid at a local dispensary. Five hours later, he was moved to Jodhpur. When he reached the
hospital, his bleeding was so intense that the doctors contemplated amputating his leg. One of the doctors
attending on him had second thoughts, as he felt that Mehta was young and maybe they could take a chance
by not operating on him. Luck and age were on his side, and the leg healed over time, although it took five
months in a hospital bed and nearly two years of physiotherapy to fully recover.
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After he fully recovered, he made it a point to frequently visit the two doctors at Jodhpur who had
operated on him to thank them for saving his life. Invariably, over each visit they would tell him:
You are living on borrowed time. You could have been dead. When you came to us, yourright alignment condition was so bad that we thought of cutting off your leg. Of course, in
your case, as you are an IAS (Indian Administrative Services officer), it would have been
different, as with funds from the government, you would have been sent to the U.S. or
the U.K. for treatment. But think of a poor man in your positionwhat would he do and
where would he go?
It was a nagging and powerful question to which Mehta had no answer at the time. Further, during his
visits to the hospital for physiotherapy, he was struck by the large number of people with amputated feet
and legs, which started him thinking: What can I do for them? It was here that his life changed.
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The Origins of BMVSS

The idea of starting a nonprofit service organization had been lying dormant in Mehtas mind for a
long time. However, as fortune would have it, as a member of the IAS, he became a member secretary of
the Rajasthan state-level committee to commemorate the 2,500th anniversary of the death of Bhagwan
Mahaveer (a renowned Indian sage) in 1975. With the use of funds available to the committee and private
donations amounting to INR 400,000 (approximately USD 6,450), Mehta set up BMVSS to provide free
prosthetic limbs to the poor. The authorities at the SMS, a government hospital in Jaipur, allowed the
organization to operate in their garages and use the space as storage depots and to make the Jaipur Foot
and other artificial limbs on a small scale. As the efforts grew, Mehta realized he needed to set up a formal
organization, so Mehta registered BMVSS on March 29, 1975.
The organization was an amalgam of several ideas the technology (the Jaipur Foot), a social value
system, a patient-centric management system, and a donation funding option. The objectives of the initiative
were to answer a humanitarian need and to attract government and donor funds.
In the first year of its formation, BMVSS fitted 59 limbs using the interest generated by the corpus of
INR 400,000. Since then, people not only from the BOP but from all walks of life have been drawn to the free
Jaipur Foot as a viable alternative to other costly prosthetic limbs. What began as a dream gradually turned
into reality as the small initiative grew into one of the largest organizations catering to the disabled with
centers across the country. However, since it was a free for all model, many wondered if the organization
would be sustainable over the long-term.
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Growth of BMVSS
The organization slowly grew over time with the help of Mehtas network of influential people in the government
and the support of several donors. As word spread of the free Jaipur Foot, more and more people began to stream
into BMVSS. Mehta was a professional fund-raiser with profound knowledge in running the operations of the
organization. In raising funds, Mehta deployed a unique style. He revealed the following incident:
I received a telephone call from an individual who was abroad who wished to donate USD
$10,000. Refusing the donation, I explained that I did not accept such large gifts from
individuals who had not yet witnessed the operation in action, and thus invited the donor to
view our facility in India. After touring the operational headquarters and witnessing firsthand
individuals limping in and walking out with a free limb that cost the organization a meager
USD 45, the visitor wrote a check for USD $20,000, which was double his original intention.
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Mehta was also a visionary with unique skill of simply looking at a disabled person and discerning what
could be done for his/her livelihood and rehabilitation. The organization went beyond just fitting highquality limbs at zero cost to those living in poverty. It prided itself on its ability to restore and advance
human dignity and self-respect. The organization ensured that no patient would be turned away.. The
organization had emerged as a large entity that had won several accolades (see Exhibit 2); Mehta personally
was the recipient of a number of awards for his work.
Exhibit 2
Awards Won by BMVSS
National Award for the Best Institute Working in the Field of Rehabilitation of the Disabled
from the Ministry of Social Justice and Empowerment, Government of India
1999
Mahavir Award for philanthropic services and welfare of the handicapped
1999
Diwali-Ben Award to Master Ram Chandra Sharma (the inventor of the Jaipur Foot)
2007
Tech Award for Innovation awarded to D. R. Mehta by the world-renowned Tech Museum
Innovation Organization, San Jose, California, for spreading the innovation of the Jaipur Foot
on an unprecedented scale. (Mehta was chosen from a pool of outstanding innovators from 68
countries.)
2008
The Padma Bhushan (Social Work), the Government of Indias third-highest civilian award,
was conferred on D. R. Mehta
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1988
Source: http://www.jaipurfoot.org/01_progress_awards.asp
The Jaipur Foot
The Jaipur Foot (JF) had a life span of three to four years. It had two parts: the factory-made foot and
the custom-made plastic shank/socket. The foot piece was invented in the SMS Medical College, Jaipur, by a
group of doctors (P. K. Sethi, S. C. Kasliwal, and Mahesh Udhawat) and a craftsman, Ram Chandra Sharma.10
The foot was fashioned out of two pieces of microcellular rubber and a wooden ankle piece to which toes
were attached. Rubber provided the foot with flexibility and the ability to absorb shocks. The assembled foot
was covered with skin-colored rubber, and was then placed in a die and steamed at high pressure to vulcanize
the foot. This foot was attached to a custom-made socket/shank made of high-density polyethylene (HDPE)
pipe. Making the foot was simple and replicable. Mehta explained:
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The technology for making this prosthetic device requires only a little start-up capital and
some machinery, locally available materials such as rubber, wood, etc. It is a combination
of science and art. We did not patent it, so that its benefit could spread without any let
or hindrance.
All the raw materials for the Jaipur Foot/limb were available locally in each of the geographical areas
in which the organization operated. The other requirements for the foot, such as the socks and the pipes
were sourced at Jaipur from agents or suppliers that often charged concession rates. For instance, the pipe
was sourced from Reliance Industries at a reasonable price. According to Mehta, a company making socks
exclusively for global brands such as Reebok and Nike charged BMVSS only INR 60 per pair as compared with
its market rate of INR 200300 (approximately USD $3.55).11
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Exhibit 3
Source: BMVSS
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The Jaipur Foot
Building the Organization
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According to Mehta:
We provide over 20,000 amputees round the year with limbs. I dont think any other
organization in the world fits even a thousand limbs a year. In addition, we hold on-thespot limb fitment camps outside India; in all, we have held more than 50 camps in 26
countries of Asia, Africa, and Latin America. And whatever we provide, we do so totally
free of charge with support from sponsors. One major feature about us, apart from the
efficiency of the limb, is the time taken for making it. People come in the morning and
leave in the evening or within three days at an outer limit.
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BMVSS operated with an annual budget of INR 150 million (approximately USD 2.5 million): government
grants accounted for about INR 50 million (approximately USD 0.8 million) of the budget.12 A section of the
Malviya Nagar Jaipur Foot Center was sublet to a software company, which agreed to provide training to
some of the patients of BMVSS. The interest generated by the INR 23 million corpusii that had been built over
the past 37 years accounted for 15% of the organizations income.13 The remaining 50% of the expenditure
came from large and small donations from India and abroad (Table 2).14 Complete operational integrity was
maintained right from inception with the result people trusted the organization and donated wholeheartedly.
Exhibit 4
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Parts of the Jaipur Foot
The Jaipur Foot is made of rubber generally used in the manufacture of automobile tires and looks
like a natural human foot. Barefoot walking is possible and the foot enables the user to sit crosslegged and walk on uneven surfaces.
The total contact socket is made of 10mm high-density polyethylene (HDPE) sheet thermo formed
on a plaster positive mold.
The outer socket or shank connects the socket and is made of HDPE pipes and gives the shape of
the leg to the prosthesis.
The suspension belts are made of leather.
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Source: BMVSS
The administrative and overhead costs of BMVSS hovered at 4%, compared with the nonprofit industrys
norm of 10%.15 In the case of many other international NGOs such costs could go up to 70% or 80%.16 BMVSS
was mindful of every rupee that was spent. Austerity and a parsimonious attitude were reasons why the
organization was able to provide limbs free for millions of people. Mehta said:
From the beginning, we instituted a culture that did not allow the use of funds for any
purpose other than our core objective. We did not even serve tea costing just 5 rupees a
cup during our meetings; and to cut costs each of us even gets water from home to drink.
We believe that if we divert even one rupee to an activity other than serving the poorest
of the poor, we are committing a moral sin and are legally wrong.
ii
Total amount of money invested by all investors in a scheme.
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BMVSS was largely dependent on the government for funds. However, the funds were received only if
representation from the organization was made annually. Mehta recounted:
For government grants to us, we detail an Excel spreadsheet that spans 21 columns of
information about our patients, including their signature and thumbprint. This is not our
money, and therefore it is our duty to be absolutely accountable for these funds, or we
might not receive them again.
Table 2
Concise Expenditure and Income of BMVSS

Fiscal Year
200809
200910
201011
201112
Expenditure(in USD)
675,737
651,826
656,933
1,004,311
Assisting devices
331,279
266,348
364,424
577,911
Expenses on amputees
113,072
150,236
245,049
205,302
Administrative and other expenses
186,280
156,110
198,909
221,531
Material transferred to branches
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Cost of limbs and calipers distributed
545,510
185,649
198,156
506,700
1,851,878
1,410,169
1,663,471
2,515,755
Grant in aid
898,985
424,650
874,358
1,166,000
Rent receipts
64,174
50,956
61,567
60,855
General collections
976,345
1,121,730
931,801
1,308,451
Interest
142,993
184,039
189,272
125,281
47,644
53,194
45,563
69,407
2,130,141
1,834,569
2,102,561
2,729,994
Total Expenditure
Dividend
Total Income
Source: BMVSS
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Income(in USD)
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The marketing of the Jaipur Foot was intimately tied to BMVSSs culture of accountability and the quality
of its products, rooting the organizations growth in rigid expenditure policies and scrupulous accounting.
A preaudit, an internal audit, and a statutory audit were performed on a regular basis. Mehta repeatedly
reaffirmed that the organization was squeaky clean and the office bearers did not debit even a rupee to
BMVSS for personal expenditures. The office bearers would not be reimbursed for travel, with the result that
any travel undertaken was only if required and at the individuals expense or with support from sponsors.
Inventory was taken on a quarterly basis. Requirements were calculated based on the number of
forthcoming camps and the average number of patients expected in all the branches, and a rough estimate
was drawn up, thus simplifying production and stock management.
The waste generated during manufacturing was auctioned through a bidding process and sold to the
highest bidder. Almost 810 kilograms of waste that was sold per day was recycled by the buyer. Environmentfriendly waste management was handled by the organization on a regular basis.
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All the technicians at each center were trained at Jaipur. Additionally, BMVSS partnered with a
government-run training center to set up a vocational training center at Jaipur for the rehabilitation of
patients. Patients were trained in carpentry and stitching. Mehta also provided financial aid to some of
the patients. Patients would be given seed money or kits to, for example, start a tea stall or buy a sewing
machine to help kick-start their self-employment efforts.
Mehtas Formula
In 2007, a professor from Cornell University said he would like to study BMVSS. Mehta, open to new
ideas, welcomed him. After studying the organization, the professor said: Sorry, you are not sustainable as an
organization. To the professors surprise, Mehta acknowledged that he was aware of this. The professor asked:
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What if your funds dry up? What would happen if the government or donors stopped
supporting the organization? What would you do? Today, you boast of not sending back a
single patient without treating him, but is it going to be the same always?
Mehta said:
We will beg and borrow, not steal. I feel compassion exists in the world and people will
support us, provided we work well and do not merely showcase ourselves. I also realize
that people must believe in us, believe that genuine work is going on, that there is no
fudging of accounts, and that the office bearers are not misusing their positions. Money
will come.
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In a lighter vein, he asked the professorwho had been teaching for several years and had come to be
known as a management guruhow many companies had sought advice from him. He estimated that the
number must run into several hundred. Mehta then asked how many of those companies still existed. The
point he was trying to make as he recounted the conversation was that despite not making plans, BMVSS had
survived for 37 years; certainly with doubts about its survival every year, but nonetheless, it had survived.
To Mehta the principle of solvency was simple:
DO
Professor, let me have the audacity of telling you a paradigm of mine: E = mc2. To most
people, this would mean energy = matter x (the speed of light)2. I have changed it to
E = effort, m is for money, and c is for compassion. Hence, my formula is E = mc2. We are
all human beings and we all have empathy and sympathy. This empathy and sympathy has
carried us through, and it has become a part of the enjoyment of growing; every time you
come out of it successfully, you realize that its all a part of social work.
Growing Domestically
BMVSS over the years had grown to become a pan-India organization with 22 centers spread across
India, most of which were located in government hospitals in the area of operations. Though each center was
independent, the Jaipur Foot technology and the principles on which BMVSS operated were common. To set
up a branch was simple. It needed little resources but plenty of dedication and passion to serve the limbless.
The cost of the equipment required for starting a center was approximately INR 1 million (approximately USD
20,000). The operational cost of running a center depended on the number of fitments. The flow of donations
for centers to operate smoothly was crucial. The Bangalore center of BMVSS, for instance, secured donations
amounting to about INR 200,000 (approximately USD 4,000) annually (although not consistently), which
was adequate to operate from the local government hospital.17
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All materials required for making the prosthetic foot were sourced from Jaipur. While some branches
paid for the foot, others were given the materials required to manufacture the foot free of charge from
headquarters. The technicians were trained in Jaipur, and the branches acted as fitment centers.
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Most branches were managed by a combination of social workers and industrialists/businessmen. While
the former provided the social input, the latter brought in funds and their business acumen. Each branch
aimed at transforming itself into a replica of the Jaipur center, right up to the point of manufacturing the
foot, working on partnerships, and their ability to be independent and self-sufficient. In addition to fitting
limbs at the hospital outlets, the branches held on-the-spot camps in areas close to the branch offices to
avoid the need for patients with financial and physical difficulties to travel far. These camps were sponsored
by institutions, individuals, or the government. The doctors and technicians from BMVSS or from the closest
branch traveled with equipment and material to the camps. They provided on-the-spot fabrication, fitment,
and delivery of the limbs in addition to other aids and appliances. This system particularly helped the rural
areas get access to the limbs.
Some branches also had mobile workshops set up in vans. The vans, fitted with the required equipment
to manufacture the limbs, cost approximately INR 1.5 million ($30,000 USD). These vans would travel
to nearby villages to benefit the local villagers. In addition, to address BMVSSs lack of presence in rural
areas, the branches networked with local or national NGOs and partnered with them to service rural areas.
For instance, the Bangalore branch had a tie-in with the Red Cross. Funds from the state government were
allocated to the Red Cross, and a part of this was given to the Bangalore branch of BMVSS to be used for foot
fitments in rural areas. The Bangalore branch would bear the cost of obtaining the foot from Jaipur and the
Red Cross provided travel, fitment, and other expenses free of cost.
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Additionally, the branches networked with local NGOs dealing with prosthetics. The foot was given to
these NGOs with a no profit, no loss payment, while the fitment was done by BMVSSs staff.
Going International: Putting a Foot across the Ocean

Wanting to spread its wings, the organization in 1995 began its first overseas venture. Four camps
were held in Afghanistan, with the government of India sponsoring three of them.18 The fourth camp was
sponsored by J. P. Morgan Bank, U.S.A., on the recommendation of Frank Wisner, a former U.S. ambassador.19
Following the success of this camp, other international camps were organized. Camps were held at Karachi
and Islamabad in Pakistan with the help of a leading industrialist.
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BMVSS was also involved in a joint venture (JV) called the Mahaveer K-Mina Foundation in Madeline,
Colombia, with the support of a local industrialist whose trust met the expenses while BMVSS provided some
of the foot pieces free of cost from Jaipur.20 As of 2012, about 2,373 limbs had been fitted in Sri Lanka.21
Further, an associate of the BMVSS, Mahaveer Philippines Foundation Inc., Manila, operated three centers
two in Manila and one in Zamboanga.
In all, more than 50 on-the-spot camps had been held in 26 countries, all of which were sponsored by
the country where the camp was held, by the local government, or by individuals.22
All the other overseas ventures were managed as camps and were handled locally. Further, BMVSS helped
set up a large number of independent artificial limb fitment centers in Asia, Africa, and Latin America. The
organization had also been given a special consultative status with the Economic and Social Council of the
United Nations Organization (UNO). However, BMVSSs presence in the developed world was absent mainly
because of regulatory issues.
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The Expansion Phase

On August 10, 2008, Mehta visited Stanford University to request assistance to develop a knee joint
for above-knee amputees.He was accompanied by Armand Neukermans, founder of Xros (part of Nortel), an
entrepreneur for over 35 years and a patron and major contributor to BMVSS for over a decade.
Mehta said:
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I signed an MOUiii with Stanford University in late 2008. The first research project was to
develop a new knee joint for above-knee amputees. Their team came to Jaipur four times
and interacted with our doctors and also our technical committee, which had professors
from IITs,iv MNIT,v and other experts from the field of prosthetic and orthotics and material
sciences. Finally, a four-bar-linkage polycentric knee joint was developed. It was hailed by
Time magazine as one of the 50 Best Inventions of the World for the year 2009.
Time wrote:
Poor patients who lose a knee joint have few options: a titanium replacement can cost
$10,000, and crude models dont work very well. Now a team of Stanford engineering
students have designed a knee that is not only dirt cheapjust $20but also mimics the
natural joints movements. Developed with the Jaipur Foot group, the Jaipur Knee is made
of self-lubricating, oil-filled nylon and is both flexible and stable, even on irregular terrain.23
The Jaipur and Delhi centers of BMVSS were involved in the manufacture of the new knee, and from late
2008 to 2012 BMVSS had fitted more than 5,000 such joints.24
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After the initial signing of the MOU with Stanford, BMVSS established a technical committee to guide
its research and development. The organization then signed an MOU with the Indian Space Research
Organization (ISRO) for a new design of the polyurethane foot (PU foot) called the Mahaveer-ISRO foot,
which was through a computer-controlled injection molding process.25 The Department of Science and
Technology of the government of India sanctioned a research project for additional gradations of the Jaipur
Foot. There were other projects as well, such as the development of a terminal device (hand) for upperlimb amputees in collaboration with Stanford University, the development of upper-limb prosthetics with
the Rehabilitation Institute of Chicago, the designing of a wheelchair-cum-tricycle with the Massachusetts
Institute of Technology (MIT), and so on.26
DO
The Paul Hamlyn Foundation, a British charity, donated $1.5 million in 2012 to BMVSS.27 The amount
was invested to establish a corpus to aid long-term financial sustainability and set up an International
Research Center for Prosthetics & Orthotics. The center was intended to attract ideas and experts from all
over the world and help in-house and collaborative research with universities such as Stanford, MIT, and the
Indian Institutes of Technologies of Delhi, Mumbai, Chennai, and Jodhpur.
As part of Dow Indias corporate social responsibility (CSR) program, the company collaborated with
BMVSS on an initiative called the Jaipur Foot on Wheels. From 2005 over the next several years, Dow
Chemical donated INR 40 million (approximately USD 800,000) to fund the manufacture and distribution of
limbs andcalipers through a fully equipped mobile workshop, where company employees would volunteer as
camp facilitators.28 Dr. Ramesh Ramachandran, the president and CEO of Dow India, then said:
Memorandum of understanding.
Indian Institute of Technology.
v
Malviya National Institute of Technology, Jaipur.
iii
iv
11
1-429-388
The Jaipur Foot initiative shows how successful a close collaboration between a technology
company and an NGO can truly transform science and innovation into tangible benefits
for the societys less fortunate. Our partnership with BMVSS has reached out to more than
40,000 people since 2005.
Challenges
Mehta said, At the current setup in Jaipur, we have the capacity to fit 10,000 more limbs each year, but
we lack the funding to fulfill that capacity. And because of this challenge, Im the biggest beggar in India.
NO
T
CO
PY
A lack of funds had haunted BMVSS from the time of its inception, and though the organization had
managed to ward it off to some extent, mainly with money from the corpus and several large donations,
it was perennially cash-strapped. Being largely donor dependent, BMVSS would look for funds in every
nook and corner possible. In 2012, the Indian government had introduced a new Companies Bill, which
prescribed that every company with a net worth of over INR 5,000 million ($100 mil USD), or turnover of
over INR 10,000 million ($200 mil USD), or a net profit of over INR 50 million ($1 million USD) would have
to spend 2% of its three years average profit on CSR activities.29 This gave hope to BMVSS. In addition to
managing the organization with meager sporadic funds, there was an immense need to invest in research
and development in order to seek lighter and cheaper material for the manufacturing of limbs. For example,
the foot was hand-designed and at times suffered from a lack of adherence to consistency parameters, with
the total weight of a below-knee limb varying between 1.3 and 1.5 kg. While the possibility of reducing the
weight existed, it would require research, technical expertise, and adequate funds. In addition, with the lack
of any quality certifications, the Jaipur Foot was not accepted in many countries. When the Jaipur Foot was
used by people at the BOP, certification did not matter due to the sheer necessity of using the product, but
it did pose a limitation when the class or quality of the user changed. Though BMVSS had undertaken several
initiatives to improve the quality of the Jaipur Foot through research collaborations with national and
international organizations, it still had a long way to go, especially in light of past failed attempts to foster
partnerships in the joint manufacture of advanced prosthetics with international bodies, such as USAID and
the Red Cross, on issues of product quality.30
Unique Method of Management
DO
The BMVSS management consisted of an Executive Committee composed of honorary office bearers and
members (Exhibit 2a). Mehta was the founder and chief patron. The secretary general managed the executive
office, supported by the chief executive officer and the chief technical consultant. Following a resolution by
the executive committee, Mehta was given the same powers as the secretary general. However, Mehta was
mostly involved in strategic matters, patient care, and welfare. In addition, there were several sections at
the head office in Jaipur, with independent functions reporting to the Executive Committee (Exhibit 2b).
The value system and the management practices followed at BMVSS were driven by a humane social
philosophy that was patient-centric followed by an open-door policy.
The management of the organization was founded on four pillars. The first was free assistancelimbs,
calipers, and other aids and appliances were given free of cost. Though several people criticized the organization
for providing assistance free of cost, BMVSS believed that money was not the measure for everything. The
second pillar was the philosophy that the limbless were provided help and not charity. The third pillar was
equality in assistance, which was to provide help without any distinction based on caste, creed, religion, or
12
1-429-388
region. The last pillar of the organization was proper treatment. In the language of BMVSS, this meant that
patients were treated individually with respect and as human beings. BMVSS attempted to be different from
other nonprofit organizations in its belief that as an institution, it was simply an instrument to provide needgenerated assistance.
The Future
Neukermans (a patron and major contributor to BMVSS) would constantly tell Mehta: The way to
develop the company is not by keeping the services free but by setting up a sustainable business. This was
also the thinking of many well-wishers of the organization.
CO
PY
Growing the organization to its present state had not been a bed of roses. The growth was ad hoc and
haphazard, with no clearly defined strategy. Critics questioned the sustainability of the organization with
the suggestion that there should be a change in the free for all model. Though fortuitous expansions had
taken place, many felt that there was nothing wrong in making a business out of doing good. However,
Mehta continued to be against charging because it went against the basic objective of the company and his
principles.
Mehta, realizing that he would soon be handing over his position became reflective. Thinking about
how to make the organization better had almost become a habit for him. His thoughts wandered on many
aspects, and he hoped his successor would do well in developing them:
DO
NO
T
How should BMVSS become self-sufficient and scale up simultaneously?

Would the organization benefit from partnering with other NGOs for rehabilitation as it had with
technical partners?
How could short-term assistance be coordinated with long-term livelihood and sustenance on a
more standardized basis?
Was it the right time to expand? Would expansion mean an increase in the administrative costs
from the current 4%?
How should BMVSS address the reality of cost escalations in raw material and manpower?
Many people had told Mehta that he needed to charge some of his wealthier patients a nominal
fee. Was the option worth considering, especially now that a new leader would replace him soon in
the organization?
13
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Appendices
Appendix 1
Jaipur Limb Fitments in Camps Held at Foreign Countries

Country
No. of Fitments
Afghanistan
3,051
Bangladesh
1,000
500
Honduras
400
Indonesia
869
Malawi
250
Nigeria
Nepal
Nairobi
Panama
Philippines
Papua New Guinea
Rwanda
Somalia
Trinidad & Tobago
Vietnam
CO
PY
Dominican Republic
500
200
500
400
3,000
170
500
1,000
200
600
NO
T
Zimbabwe
Sudan
250
1,800
Lebanon
381
Zambia
121
Pakistan
987
Iraq
882
1,210
Senegal
607
Fiji
300
DO
Sri Lanka
19,678
Total
Source: http://www.jaipurfoot.org/02_progress_performance.asp.
14
1-429-388
Appendix 2
BMVSS Organizational Charts
CO
PY
Appendix 2(a): Organizational Chart of the Central Office of BMVSS
NO
T
Appendix 2(b): Sections of the Executive Office of BMVSS
DO
Source: http://www.jaipurfoot.org/02_management_whatisourorg.asp
15
1-429-388
Appendix 3
DO
Source: BMVSS
NO
T
CO
PY
The Jaipur Foot and Prosthetics to Be Fitted on an Amputee
16
1-429-388
Endnotes
Company website, http://jaipurfoot.org/media/statistics/index.html#.Uw7Mu85Zc3g.
IBID
IBID
IBID
IBID
jaipurfoot.org/images/BROCHURE.pdf
Disabled Persons in India Report No. 485 (58/26/1). National Sample Survey Organisation, Ministry of Statistics and Programme
Implementation, Government of India, December, 2003.http://mospi.nic.in/rept%20_%20pubn/485_final.pdf (last accessed on 2
December 2012).
Disabled Persons in India NSS 58th round (JulyDecember 2002) Report No. 485 (58/26/1). National Sample Survey
Organisation, Ministry of Statistics and Programme Implementation, Government of India.
Disability Statistics and Facilities in India: Statistics on Locomotor Disabilities in India. http://pmr-sjmch.tripod.com/
disabilityindia.htm (last accessed on 2 December, 2012).
10
http://www.nytimes.com/2008/01/08/world/asia/08seti.html?_r=0, also provided by the company.
11
Company provided
12
IBID
13
IBID
14
IBID
15
http://www.fundsforngos.org/budget-for-ngos/defining-terms-budget/
16
Company information
17
IBID
18
IBID
19
IBID
20
IBID
21
IBID
22
IBID
23
The 50 Best Inventions of 2009: The $20 knee. Time (Print issue: 23 November, 2009) http://www.time.com/time/specials/
packages/article/0,28804,1934027_1934003_1933963,00.html (last accessed on 2 December, 2012).
24
Company Information
25
IBID
26
IBID
27
IBID
28
IBID
29
The Financial Express, 2012
30
Company Information
DO
NO
T
CO
PY
17
1-429-388
DO
NO
T
CO
PY
Notes
18
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DO
NO
T
CO
PY
Notes
19
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2014 C.K.

PRAHALAD CASE COMPETITION

The Jaipur Foot: Challenges in

GlobaLens, publishing division of the William Davidson

Case study publisher at the University of Michigan

2014 case writing competition

The Jaipur Foot: Challenges in Leading

The Jaipur Foot: Challenges in Leading a Free Service Organization

Fitments and Other Aids and Appliances Provided by BMVSS (19752012)

The Jaipur Foot: Challenges in Leading a Free Service Organization

Loco-motor Disabilities in India

Percentage Distribution of the Disabled in Urban and Rural India

The Jaipur Foot: Challenges in Leading a Free Service Organization

Bhagwan Mahaveer Viklang Sahayata Samiti (BMVSS)

The Origins of BMVSS

The Jaipur Foot: Challenges in Leading a Free Service Organization

Awards Won by BMVSS

Mahavir Award for philanthropic services and welfare of the handicapped

The Jaipur Foot

The Jaipur Foot: Challenges in Leading a Free Service Organization

The Jaipur Foot

Building the Organization

The Jaipur Foot: Challenges in Leading a Free Service Organization

Parts of the Jaipur Foot

Total amount of money invested by all investors in a scheme.

The Jaipur Foot: Challenges in Leading a Free Service Organization

Concise Expenditure and Income of BMVSS

Administrative and other expenses

Material transferred to branches

Cost of limbs and calipers distributed

The Jaipur Foot: Challenges in Leading a Free Service Organization

The Jaipur Foot: Challenges in Leading a Free Service Organization

Going International: Putting a Foot across the Ocean

The Jaipur Foot: Challenges in Leading a Free Service Organization

The Expansion Phase

The Jaipur Foot: Challenges in Leading a Free Service Organization

Unique Method of Management

The Jaipur Foot: Challenges in Leading a Free Service Organization

How should BMVSS become self-sufficient and scale up simultaneously?

The Jaipur Foot: Challenges in Leading a Free Service Organization

Jaipur Limb Fitments in Camps Held at Foreign Countries

The Jaipur Foot: Challenges in Leading a Free Service Organization

BMVSS Organizational Charts

Appendix 2(a): Organizational Chart of the Central Office of BMVSS

Appendix 2(b): Sections of the Executive Office of BMVSS

The Jaipur Foot: Challenges in Leading a Free Service Organization

The Jaipur Foot and Prosthetics to Be Fitted on an Amputee

The Jaipur Foot: Challenges in Leading a Free Service Organization

http://www.nytimes.com/2008/01/08/world/asia/08seti.html?_r=0, also provided by the company.

The Financial Express, 2012

The Jaipur Foot: Challenges in Leading a Free Service Organization

The Jaipur Foot: Challenges in Leading a Free Service Organization

Case study publisher at the University of Michigan

The WILLIAM DAVIDSON INSTITUTE is an independent, non-profit education, research,

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