Looking for a solution to bring sustainable eye care to many more people, The Fred Hollows Foundation explored a bold new model when it launched social enterprise Alina Vision in 2018.
Alina Vision was to be an eye hospital making profits from wealthy patients and high volumes of surgery, so it could afford to provide free and no-fee gap surgeries for those less well off. This could then expand to a network of hospitals by using investor’s money, rather than philanthropic donations.
Not only had an eye care model like Alina Vision never been attempted in Vietnam, but for the first time The Foundation diversified its traditional role from grant funder to providing catalytic grant funding and capital to set up the social enterprise.
“It was a bold move for The Foundation,” The Foundation’s Legal Governance Risk and Compliance Director Penny Palmer explained. “Investing in a social enterprise was something quite new for us.”
Over the past five years, Alina Vision, which was co-founded by The Foundation and Japanese company Rohto Pharmaceutical, has provided over 6,600 cataract surgeries, 135,000 eye screenings, and trained hundreds of medical staff, with more than 80 staff based over two hospitals.
In December 2023, the social enterprise was given a boost when renowned growth capital investor TVM Capital Healthcare came on board as major shareholders.
"This deal marks the most substantial investment by TVM Capital Healthcare in the region to date,” the company’s Managing Director Hoda Abou-Jamra said.
The Foundation’s CEO Ian Wishart said the significant investment Alina Vision had secured from TVM Capital Healthcare would ensure its next stage of the growth journey, which The Foundation had envisaged at its creation.
“We’re pleased The Foundation created a scalable business model which has attracted external investment five years on. We have now reduced our stake in Alina Vision, but we remain on this journey with Alina, Rohto and TVM and hope the business continues to make a positive impact,” Mr Wishart said.
Like all pilot ventures, the path to scalability was not always straightforward.
The aim for the fledgling start-up was to build and operate a network of financially sustainable eye care hospitals in underserved communities around the world.
But when Victoria Morris became CEO of Alina Vision in 2020 – smack bang in the middle of Covid – the eye care business had been operating for two years and had opened one hospital.
“Because of Covid I couldn’t actually go over and see the hospitals and meet the team until mid-2022,” Ms Morris said.
“Everything was remote and there were very hard lockdowns in Vietnam. Things were hard going because of Covid, but we managed to make it profitable by the end of 2022 and opened a second hospital in October 2022.”
Ms Morris, who ended her tenure with Alina Vision in 2023, said the model was also a far cry from The Foundation’s “business as usual”.
“Alina Vision was a start-up, so having a start-up inside a large not-for-profit is not easy,” Ms Morris said.
“It was also not easy because Alina isn’t a not-for-profit, it’s a social enterprise. So it was hard for some people to understand the balance of the profit and impact.”
Despite the challenges, Ms Morris said the team was able to create real impact in Vietnam.
She put this down to the sheer determination of Alina Vision staff, ophthalmologist Dr Tran Minh Ha, who led the development of Alina Vision’s inaugural hospital, and some “key supporters” at The Foundation.
“There are a number of people at The Foundation that really just kept going and stuck to it when things were really tough, and that’s a testament to The Foundation’s leadership as well,” Ms Morris said.
“There were also 80-100 staff in Vietnam who have been slogging it out day-by-day to treat patients and forge the partnerships Alina Vision has today.”
Ms Morris was thrilled when she learned Alina Vision had formally welcomed TVM Capital Healthcare as major shareholders.
“Capital raising process is not for the faint hearted,” Ms Morris said.
“But we were lucky that the investors saw the potential we did. Another thing that made Alina Vision really appealing to the investor was its strong governance underlay. Not a lot of start-ups have that, so they knew from a risk-management perspective it was solid.”
The Foundation’s Strategy and Planning Director Lee-Jan Chung pointed to the use of blended finance, where organisations with traditionally different objectives (profit and purpose) pool together to achieve a common goal.
“Alina Vision was part of The Foundation’s exploration of the role of blended finance in social impact investing. It was an experimental solution for us,” she said.
“We provided catalytic grant capital and equity investment to set up a social enterprise eye hospital, which was then able to attract external investment to fund its expansion.”
Mr Wishart said Alina Vision today is the result of a novel approach by The Foundation to making eye care accessible.
“The Fred Hollows Foundation will always prioritise building public health systems and our core business as a charity remains helping people who are most in need in that way,” he said.
“But Alina Vision was a project where we moved out of our traditional bounds to invest because we saw potential. The journey isn’t finished because we don’t know exactly what the future holds for Alina. We would like to look back in 5-10 years and see it has expanded significantly and is reaching even more people.
“We do know already though that it has transformed thousands of lives through the power of social enterprise, blended with philanthropy and social capital.
“It’s Fred’s pioneering attitude infused in our work.”