The chubby-cheeked baby Ghulam Nabi kicks away merrily on the steel chairs. He smiles beatifically as his mother takes him in her lap, his completely sightless eyes trying to focus on her face.

Standing in the cool sterile environment of the pediatric ward of Karachi’s Layton Rehmatullah Benevolent Trust (LRBT) hospital in Korangi, one can see the multitude of anxious parents cooing and calming their babies as they wait for their turn in the largest non-profit eye care network of Pakistan.

Ghulam Nabi is one of the three million children in Pakistan that are blind or visually impaired. The son of a cook, the baby travelled with his parents all the way from Usta Muhammad, Balochistan, to Karachi to receive treatment at Layton Rahmatullah Benevolent Trust (LRBT) facility.

According to Unicef, Pakistan has one of the highest prevalence of malnourishment in the world with 38 per cent of children under five stunted. Najmus Saquib Hameed, honorary chairman of LRBT, links the lack of nutrition in diet, particularly vitamin A, to the high rates of vision impairment in the country that has led to a population of 26m requiring treatments for sight.

The incidence of accidents increase around Eid as children use Eidi money to buy guns that can hurt eyes during play-shooting

Surprising, there is a seasonal trend to eye treatments needed by children. Around Eid, when they get Eidi money, toy guns are bought which leads to play-shooting that can hurt the eyes. The incidence of accidents in children increases around Eid.

A whopping sum of Rs1.8 billion is needed by the organisation this year to treat the over 3m patients expected to visit its facilities — 300,000 of which will require surgery. Completely run on Zakat and donations, LRBT currently treats about 10,600 people a day — over a thousand of which visit the Korangi hospital in Karachi alone.

Transparency & business class generosity

Talking about the generosity of the people of Pakistan, Mr Hameed, emphasises the compassion of the business communities and the middle-income class that are the main donors.

“Karachi is the major business centre so we get a huge chunk from it but Lahore is significant as well. Business people are very good at Zakat and donations. For example, the Chiniotis built a hospital building for us and we run it entirely funded by them.”

The bulk of the money — 40pc — is received during Ramazan, including the two weeks that precede and follow the holy month. It was about Rs600m last year when the LRBT raised Rs1.5bn, roughly 17pc of which was from abroad.

However, for donations to flow there must be complete transparency.

“All our books are open for examinations and we declare that on our website,” he says, handing the Dawn team the annual report with details of local and international donor funds. “Everything comes in through the banking channels; except petty cash, all our expenses are paid through cheques. Consequentially, we end up paying more because of services tax, withholding tax etc but we want everything on the books and everything kosher. No double-book keeping”

While the crackdown on terror financing has increased paperwork, LRBT’s transparency has allowed the funds to continue flowing from abroad.

Efficiency with passion

While the government of Pakistan caps administrative expenses for non-profit organisations (NPOs) at 15pc, it is not a problem for LRBT where a tight ship is being run. “Our administrative expenses are just over 4pc… must be among the best in the world given that some NPOs have rates as high as 20pc,” says Mr Hameed.

The entire network of 19 hospitals and 55 clinics dispersed all over the country is run with only about 40 people in finance, marketing and communications, IT and operations. All administrative activities are centralised in the LRBT house, he explains. “We do this because no charity can really succeed without passion and commitment. Even those working for a living do the work of a person and a half”.

Given the volume of patients, the hospitals need to be run by clockwork, Mr Hameed explains. “The average time for an outpatient from entry to exit is no more than two hours — most patients get out within an hour.”

Docs’ 10pc attrition rate

Except for Karachi, Lahore and Quetta, all LRBT hospitals are in small towns or rural areas. To incentivise doctors, LRBT provides furnished residential accommodation, transport allowance for their children to go to schools, payment of utility bills and a location allowance. “The more difficult the location, the higher the location allowance. It is the only way to attract doctors to work in remote locations”.

“We still lose them, at times to Gulf countries in the Middle East or the private sector. Our attrition rate is 10pc.” Hardly surprising, given that LRBT runs the largest programme for postgraduate ophthalmological training in the country which enables its doctors to be competent clinically as well as surgically.

A goal of 90pc

Rahim Yar Khan, Dadu or Sehwan, and if security conditions permit then Bannu, are the three places earmarked for future hospitals to cover the gaps in the network.

“At the moment we are covering about 70pc of the population of Pakistan, with the additional hospitals we will be very close to 90pc. That was the dream of the founders and our mission: no man, woman or child should go blind just because they cannot afford the treatment,” said the chairman. '

Published in Dawn, The Business and Finance Weekly, April 26th, 2021