At age fourteen, Sudha Chandran, an aspiring dancer, lost her right foot and part of her leg in a car accident. Devastated and convinced she would never walk again, let alone dance, she spent several months on crutches. Then one day in 1984, she read about Jaipur Foot.

A prosthetic foot in the United States costs on average $8,000. This cost is far beyond the means of the poor in developing countries,^[1] and even many of the poor in the United States.^[2] As many as four billion people, in India and the rest of the world, live in poverty on less than two dollars per day. When one loses a limb, the inability to work is catastrophic, often for a whole family. The Jaipur Foot is tailored specifically to the lifestyles of the poor and costs only about $30—affordable to all, and it is often given away free to many of the handicapped poor who have lost a limb. Here is a working model of a nongovernmental, nonreligious, and nonprofit organization able to financially sustain itself while helping the world’s disabled poor.^[3]

There are 10 to 25 million amputees in the world, a figure that grows by approximately 250,000 each year. People in developing countries are particularly susceptible to the loss of lower limbs^[4] from disease (70 percent), trauma (22 percent), congenital or birth defects (four percent), and tumors (four percent). In developing countries with recent war-torn histories, such as Afghanistan, land mines account for a significant number—approximately 300,000 children are severely disabled because of land mines, with an additional 15,000 to 20,000 new victims each year.^[5] In Afghanistan alone, there are nearly 10 million land mines.^[6] Diseases such as diabetes and even polio are the cause of even more of the amputees.

The Jaipur Foot was first developed in 1968 by Ram Chandra, one of Jaipur city’s finest sculptors. Concerned by the inadequacy of performance as well as the cost of imported artificial limbs, he began work on a rubber foot,^[7] which he refined with the help of Dr. P. K. Sethi, an orthopedic surgeon, Dr. S.C. Kasliwal, and Dr. Mahesh Udawat into what became known as the Jaipur Foot. To facilitate the spread of the foot, its creators decided not to patent it. Their society, Bhagwan Mahaveer Viklang Sahayata Samiti (BMVSS), was organized in 1975 to treat amputees and to distribute the product at as low a cost as possible, or for free when necessary.

The Jaipur Foot was designed to simulate normal foot movements and provide a quality solution for the masses that also allowed the poor to continue to earn a livelihood. Aspects specific to the cultural as well as working needs of the poor included being suitable to activities such as squatting, sitting cross-legged, walking on uneven ground, and barefoot walking. Other constraints the designers had to consider included the following:

The distribution of the Jaipur Foot occurs at BMVSS sites (of which there are seven in India, two in Jaipur alone) and at camps, including camps in 19 countries, including Afghanistan, Bangladesh, Dominican Republic, Honduras, Indonesia, Malawi, Nigeria, Nairobi, Nepal, Panama, Philippines, Papua New Guinea, Rwanda, Somalia, Trinidad, Vietnam, Zimbabwe, and Sudan. At a main site, such as one in Jaipur, a full-time doctor is on staff; other doctors contribute time to ensure the proper prosthetic fit and follow-up. Each foot is fitted by a technician, an artisan who makes the equivalent of $1,200 annually, about twice the per-capita income in India. The actual cost of materials used for an above-the-knee prosthetic foot is about $7.68, which includes the Jaipur Foot itself as well as the simulated joints for a below-knee limb. The most expensive piece of equipment used in a prosthetic fitting is the vacuum-forming machine used to get an exact replica of the mould of the patients remaining limb (stump). These run about $4,000 and last from five to seven years.

About 60 patients each day obtain prostheses from Jaipur Foot’s main facility in Jaipur, India. Remarkably, unless other medical conditions intervene, each patient is custom fitted with a prosthesis in one day—usually within three hours. The goal is to return the patient to his or her profession and an independent life after the patient’s first visit to the clinic. The society’s services do not just include a speedy fitting of a prosthesis. The operating process also attends to psychological needs, and there are on-site meals and overnight accommodations for patients at no cost. Free meals and accommodations are also provided for the patient’s family members who are thus able to provide on-site support and comfort.

BMVSS has laid down extremely simple procedures for reception, admission, measurement taking, manufacturing, fitment, and discharge of patients. Unlike in all other medical centers all over the word, patients are admitted as they arrive without regard to the time of day. In addition, patients are provided boarding and lodging facilities at the centers of BMVSS until they are provided with limbs, calipers, or other aids. In most orthopedic centers around the world, patients must come back several times for a custom fit. This process can take several weeks. Such a system is unsuitable to poor patients who find it extremely difficult, both in physical and financial terms, to come back a second time from long distances. Jaipur Foot is custom fitted on the same day (in fact, in less than four hours). Most significant, the prosthetics, orthotics, and other aids and appliances are provided totally free of charge to the handicapped. But for this policy, more than 90 percent of the patients would have remained deprived of artificial limbs, calipers, and other aids and appliances. The setting up of patient-oriented value and management systems was an equally important innovation.

BMVSS has ten branches in India. In addition, approximately 60 workshops fabricate or fit the Jaipur Foot in India. The society also has aided the establishment of several centers abroad. Funded by the Indian government and philanthropic groups, BMVSS and similar organizations offer medical care, room, board, and a prosthetic at no cost to the patient. It also has helped launch free clinics in more than a dozen countries.

The determination was made at the outset that the Jaipur Foot prosthesis would be provided at a low cost, or free when necessary, which necessitated a nonprofit framework. The prospect of no (or little) incoming funds for prostheses fitted forced administrators to focus on containing costs. In particular, emphasis was placed on the cost of the materials used to construct the Jaipur Foot, the capital equipment required to fabricate the foot, and the method by which the foot was fitted to a patient in order to make the prosthesis widely available.

Cost-efficiency is reflected in Jaipur Foot’s annual expenses. Jaipur Foot’s expense breakout for the 2002 fiscal year underscores the efficiency of expense and underpins the society’s effort to serve as many patients as possible given its financial resources. About 90 percent of the company’s expenses in the 2002 fiscal year were directly related to the cost of producing and fitting prostheses for the poor. Another 7 percent of the company’s expenses went toward other forms of charitable assistance. Only 4 percent of its expenditures went toward administrative and overhead expenses.

The number of limbs fitted every year by Jaipur Foot is about 16,000. Between March 1975, when BMVSS was established, and March 2003, the society fitted 236,717 limbs in India (and 14,070 others around the world). BMVSS is still finding innovative ways to help the poor. With all of its innovations in technology and management, and understanding the needs of its patients, BMVSS has developed a unique business model. This model spreads the Jaipur Foot technology that allows rickshaw-wallah (pedicab operators) amputees to perform their job, farmer amputees to be farmers, and in the case of fourteen-year-old Sudha Chandran, classical Indian dancer amputees to be classical Indian dancers.