Achieving Self-sustainability of Service Delivery in an Eye Care Program in Madagascar Using Time-driven Activity-based Costing

Eye care programs in developing countries need a high level of financial self-sustainability to maintain and grow their services as external funding is often inadequate and can be unreliable. In 2013, Seva Canada helped the Sava eye unit in Madagascar to develop and implement a cost-recovery program to better manage the cost of, and to improve revenue associated with, their three principle activities: consultation visits, cataract operations, and sale of glasses. The study illustrates how the Sava eye unit improved its cost-recovery over a 5 year period, from 68 to 102%, while maintaining their commitment to provide high-quality services and equitable care to their population.