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Sunday, December 16, 2018

Sustainability of Non-Profits: Initiatives of Audiology India

By Vinaya Manchaiah, PhD; Spoorthi Thammaiah; and Rajalakshmi Krishna, PhD

Sustainability has become the talk of today's stakeholders in the modern era in all areas from climate change to health care. In general context, sustainability refers to finding a way to use resources in a manner that prevents their deprivation. However, for charitable non-profit groups, the term "sustainability" refers to the organization's long-term ability to sustain itself and continue to fulfill its mission. Hence, the sustainability in the non-profit context extends beyond financial capacity and includes succession planning, adaptability, and strategic planning. Notably, the main aspect that most non-profits organizations struggle with is financial sustainability.

For a non-profit to be sustainable, the organization's key players need to know how much it costs to deliver the programs and services, so that they can raise enough resources to cover these costs. Otherwise, the organization will end up in a "starvation cycle" in which the main focus will become finding resources instead of accomplishing its mission. Hence, non-profits need to embrace a sustainable mindset from the beginning and review every stage and level of the organizational process—as is the strategy learned by Audiology India.


Audiology India is a non-government and not-for-profit organization that aims to promote hearing health care in India by breaking down known barriers to hearing service delivery. Founded by Vinaya Manchaiah, PhD, and Srikanth Chundu, AuD, in 2009, Audiology India was first established as a website that offered information about ear and hearing health care specifically for audiologists and audiology students. Expanding from the goals of a successful website, it has grown into a multidisciplinary team serving individuals with hearing difficulties, especially in suburban and rural communities. The group's main objectives are to:

(1) provide hearing health care services for underserved population using a community-based rehabilitation model;

(2) raise public and professional awareness of the importance of hearing health; and

(3) conduct high-quality research to understand the social and environmental factors that influence hearing health care outcomes and implement best practices in care delivery.

Audiology India mainly conducts free hearing screening camps and community-based hearing rehabilitation (CBHR). Hearing rehabilitation with hearing aids is conducted systematically in three phases that focus on the underserved and financially communities in the Southern India. So far, Audiology India has conducted 43 hearing screening camps and tested more than 2,100 individuals. At the screening camps, about 950 behind-the-ear (BTE) hearing aids have given for free to individuals who need them.

Audiology India also conducts public awareness programs on hearing and related disorders. Audiology India has organized more than 20 such programs so far including rallies, orientation programs, and newspaper articles.

In addition, Audiology India team has been conducting need-based research in the hearing-health sector in India. A survey-based project examined the practice across the country, places of work, and professional issues related to audiologists practicing in India (Indian J Otolaryngol Head Neck Surg. 2013 Dec; 65(Suppl 3): 636–644; Audiology Today. 2009;21(6): 38-44;; ENT & Audiology News. 2016; 25(1):73-74). Such surveys repeatedly provide evidence for the need to develop nation-wide guidelines for service delivery, diversification, and definition of clear roles for audiology professionals from varied degrees/background in training. More recently, the team members are involved in studying the efficacy and effectiveness of CBHR in comparison with the institution-based hearing rehabilitation (IBHR). First stage of this project was focused on translation and adaptation of structured outcome measures to Kannada language (Audiol Res. 2016 Apr 20; 6(1): 153; Int J Audiol. 2017 Mar;56(3):194-201; Disabil Rehabil. 2018 Nov;40(22):2650; Int J Audiol. 2018 Mar;57(3):161-175). In the current stage, we are gathering outcome data using these outcome measures to compare the hearing rehabilitation outcomes as a result of CBHR and IBHR service delivery models.


Funding requirements have grown since our humble beginning, where much of Audiology India activities were managed through collaborations. For instance, (CBHR) camps are usually sponsored by other government or non-government organizations (e.g., Rotary Clubs). However, our expanded objectives demand more directed funding to support an office, a full-time employee and travel expenses for volunteers.

Currently, we rely heavily on donations and fundraising activities conducted locally in Mysore, Karnataka. In the last seven years, the Audiology India team has conducted only two fundraising events. The team has agreed that the any fundraising initiative should have various other outcomes in addition to merely raising money, i.e., (1) promoting Audiology India's mission and activities; and (2) building good public relations.

The first fundraising activity was conducted in Mysore, India during July 2015. This included a musical event in which the local upcoming singers were recruited through auditions for a singing competition. The funds were raised through ticket sales paid by public for attending the music event and the event expense was generated through sponsorships. The second event was conducted in 2017 and it was a standup comedy show. These events generated ongoing news in the local media and by the end of the event most people in Mysore were aware about the organization and its mission.


After seven years of running a non-profit organization, we have identified various factors related to sustainability. Consider the ideas below that help ensure an organization's sustainability.

  • Have clarity of thought: People who are interested in humanitarian activities are enthusiastic. Often, they like to solve the problems in the world and they have plenty of ideas and projects in mind. The first step in making anything workable and sustainable is to develop clear objectives and working plan. Non-profit initiatives and organizations should give the highest importance to clarity of thought in their mission.
  • Keep costs low: There is no better way to be sustainable than keeping costs low. This could be related to products (e.g., finding affordable hearing aids of good quality, making earmolds in local place at cheaper price), services (e.g., finding volunteers, finding consultants who will work for limited allowances) and finding space (e.g., using schools during weekend as a place to offer services). Consider the best possible ways to reduce cost without compromising quality.
  • Recruit and retain committed volunteers: Volunteers play a key role in the success of charity and non-profit organizations. Attracting those who are interested in serving the organization, providing them with appropriate training, and keeping them engaged is important for sustainability. In our view, developing a good working relationship—in which volunteers become friends and not just co-workers—has proven to be an effective strategy. This way volunteers always find a way to meet, exchange ideas and to work on a common goal.
  • Collaborate with other organizations: Often the hearing health care organizations are small with limited resources. However, there are many other non-profit organizations with broader mission and sufficient resources. Hence, collaborating with such organizations by providing them required services in exchange to resources required to the organization could be one of the important considerations for ensuring ongoing endeavor.
  • Pilot test your service program to test feasibility and then scale it up: Many organizations often develop new ideas in launching a service program. To avoid the risk of failure, pilot test the program to see its feasibility and eventually scale it up to improve the chances of success and reduce risk.
  • Provide consultancy services to generate income: Often the volunteers of non-profit organizations may have various specialist skills. Such organizations can conduct various consultancy services (e.g., industrial hearing screening) in which volunteers will work for free and generate income that can be used to pay for key programs and services to meet the mission.
  • Conduct ongoing reviews and adaptation of goals and activities to ensure continuous work: Finally, one of the important elements of sustainability is to develop projects in such a way that there is continuity in work. Also, the goals and activities should be reviewed regularly  and necessary adaptations should be made to ensure the growth in the project meet service requirements.

ABOUT THE AUTHORS: Dr. Manchaiah is affiliated with Lamar University in Texas, as well as with Audiology India and the Manipal University in Karnataka, India. Ms. Thammaiah is affiliated with Lamar University in Texas, as well as with Audiology India. Dr. Krishna is affiliated with Audiology India and All India Institute of Speech and Hearing at the University of Mysore in India.