The Jaipur Foot

People Engagement Series

Case Study # 2
 The Jaipur Foot
“A true friend knows your weaknesses, but shows you your strengths;
Feels your fears, but fortifies your faith;
Sees your anxieties, but frees your spirit;
Recognizes your disabilities, but emphasizes your possibilities 1
- William Arthur Ward

Background
The Jaipur Foot is a low cost, artificial lower limb that is manufactured in India. It has
transformed the lives of innumerable amputees in India, Afghanistan, Bangladesh, Dominican
Republic, Indonesia, Kenya, Lebanon, Nigeria, Pakistan, Panama, Philippines, Rwanda, Somalia,
Sudan, Trinidad, Uganda, Zimbabwe, Zambia and other countries. 2 The origins of Jaipur Foot go
back nearly half a century to the capital city of the Indian state of Rajasthan, from which it derives
its name.
The story goes back to 1968 when Dr. Pramod Karan Sethi was working as an orthopedic surgeon
at the Sawai Man Singh (SMS) Hospital in Jaipur. The hospital’s rehabilitation centre provided
treatment to amputees. However, the available western limbs were too expensive and rigid to
allow the easy mobility and resilience that was needed by the common people of India.
At around the same time, an ace craftsman by the name of Master Ram Chandra Sharma (fondly
known as Masterji) was engaged by the SMS Hospital to teach the art of making handicrafts to
leprosy patients. Masterji felt frustrated by the expensive and impractical foreign-made prostheses
that he saw being fitted on to the amputees.
Masterji resolved to create a better alternative that would be strong and flexible enough to
withstand the rigours of manual labour, and also accommodate the full range of motions that were
required for daily prayer at the temple or mosque. To that end, he worked together with the SMS
doctors (including Dr. Sethi, Dr. S.C. Kasliwal, and Dr. Mahesh Udawat) to make a better
prosthesis.
Like every great innovation, their solution was simple and elegant. Instead of using costly alloys
and polymers, they opted for a core of high-density foam rubber and wood that was wrapped in
vulcanized rubber. When pressed in a metal mould and heated, these components were found to
bond together. They took on a form that was uncannily close to the shape of a real human foot. 3
This was then attached to a sturdy wooden leg.

Page 1 of 10
The resulting prosthetic foot consisted of a shell filled with sponge rubber, a stuffed piece for the
meta-tarsals, and microcellular rubber for the heel that was cut in places to allow for joint-like
4
movement. This design was flexible. It allowed the wearer to climb trees, pedal bicycles, and
use Indian-style toilets.
In 1971, Dr. P.K. Sethi presented the Jaipur Foot to orthopedic surgeons from Oxford University.
They were very impressed. During the early seventies, the Jaipur Foot transformed around 50
lives. But for Dr. Sethi’s involvement, the Jaipur Foot would not have been recognized by the
medical world.
By a stroke of serendipity, an Indian Administrative Services (IAS) officer by the name of
Devendra Raj Mehta was receiving recuperative physiotherapy at the SMS Hospital at that time.
This was after a debilitating accident in 1968 that had crushed his right femur bone and nearly left
him dead.
Seeing patients queue up for the few fittings of the foot provided there, D.R. Mehta came to the
conclusion that this simple prosthetic innovation had much greater potential for social good. He
became consumed by the idea of reaching this service out to as many people as possible.
In 1975, D.R. Mehta raised Rs. 4 lakhs in government aid and private donations – in order to start
the Bhagwan Mahaveer Viklang Sahayata Samiti (BMVSS) as a human welfare project to provide
the Jaipur Foot free of cost. In doing so, he turned a brilliant invention into the foundation of a
formidable charitable concern. 5

The Bhagwan Mahaveer Viklang Sahayata Samiti (BMVSS)

The BMVSS is a voluntary non-governmental, non-religious, non-sectarian, and non-political
Society. Popularly known as the Jaipur Foot Center, it is the world’s largest organization serving
the disabled and handicapped people, particularly those who lack adequate resources.
The mission of BMVSS is to facilitate the physical, social and economic rehabilitation of the
disabled population around the world. The institution seeks to help restore the glory of the
disabled person’s life, and help advance the person’s dignity, self-respect, mobility as well as
usefulness as a normal member of the community. The focus is particularly upon the poor
amputees, who remain deprived of these aids and appliances under the unaffordable modern
health care system.

Page 2 of 10
Over the last 43 years, BMVSS has grown into the world’s largest limb fitting society - without
having an articulated revenue model. It has transformed the lives of nearly 1.6 million people
across 26 countries in Asia, Africa, and Latin America.
BMVSS fits around 20,000 limbs every year. It also provides 65,000 other people with calipers,
hand-pedaled tricycles, wheelchairs, crutches, hearing aids, and other orthopedic aids and
appliances. The organization presently employs nearly 173 people - including doctors, therapists
& administrative staff.
Scores of patients visit the BMVSS campus in Jaipur daily. 95% of these people fall below the
poverty line. Most of the time, the security guard himself admits them.
The procedures for client admission, treatment, and prosthetic fitting have been kept simple.
Patients are provided with free lodging & boarding facilities till the time they are given prosthetic
limbs, calipers or other aids. The Jaipur foot is usually custom-fitted within twelve hours of the
patient-checking in. 5
Outside of its own centers, BMVSS holds regular on-site field camps at various places in different
parts of India. In addition, mobile clinics have been set up in 26 countries around the world.
Doctors and technicians travel with equipment and materials to these camps. 6 They provide on-
the-spot fabrication, fitment, and delivery of limbs and other aids to patients for whom distant
travel is otherwise difficult.
The mandate of BMVSS extends beyond medical care to include economic self-sufficiency.
Previously unemployed patients are provided with equipment to establish small businesses. For
instance, needy beneficiaries are provided with all the utensils that are necessary for setting up
“tea and snack” stalls.
The backbone of BMVSS’s steady growth is rooted in a suite of incredibly inexpensive
prosthetics, aids, and appliances, coupled with beneficiary-centric management practices. The
foundation of its philanthropic activity rests upon the twin pillars of compassion and scrupulous
expenditure policies.
For instance, in order to account for the grants received from the government, the Jaipur Foot
organization maintains a detailed spreadsheet that spans 17 columns of information about its
patients. Since the money is received from an external agency, the institution considers it as a
duty to be accountable for these funds.
As a humanitarian organization, BMVSS knows no frontiers. The organization treats all its
beneficiaries across the world equally. Assistance is provided to them without any geographical,

Page 3 of 10
gender or religious bias. BMVSS also undertakes research and development towards the
improvement in the quality and reduction in the cost of the artificial limbs, calipers, and other
aids. 7
Further, the grounds of its Jaipur campus serve as a hub for the local community. It provides a
quiet space where students often come to study their books.
The beneficiaries of BMVSS include the young and old alike, as also the rich as well as the poor.
One of the most celebrated cases is that of the Bharatanatyam dancer Ms. Sudha Chandran. In
1981, she met with a road accident. Her right leg had to be amputated at the tender age of 17
years.
Sudha overcame her disability with the help of a prosthetic Jaipur Foot. Subsequently, she went
on to become a highly acclaimed dancer as well as film and television actress. With the help of
the prosthetic, she performed at many international events. Sudha thus became an inspiration for
numerous people. 6

The Jaipur Foot Technology

Once an amputee enters the Jaipur Foot Center, a caretaker is assigned to each patient until the
Foot is fitted. Orthopedic specialists inspect the level of amputation, and prescribe the Jaipur Foot.
8
There is a trauma counseling session to help the person accept the idea of having to live with the
artificial limb.
Next, a foot technician takes correct measurements of the stump as well as the rest of the limb (for
reference) and proceeds to make a hollow cast. Plaster of Paris (POP) is poured into the cast to get
a model of the amputee’s limb. A pre-heated high-density polyethylene (HDPE) pipe is now
pressed around the mould. This results in an artificial limb assuming the natural shape of the
missing limb. 2
The POP mould is now broken and removed from inside, and a rubber or polyurethane foot is
attached. Finally, the artificial foot is attached to the stump with leather belts to hold it in place. It
looks just like a natural limb, and fits quite easily. The Foot is lightweight, and has a life of
around five years.
The person then learns many gait training exercises. This helps him or her to get used to the
artificial limb, and also build the required strength in the supporting muscles. Proper maintenance
and care of the foot is also taught to the amputees.

Page 4 of 10
The Jaipur Foot and its allied aids are made with the developing country lifestyle in view. Their
design provides for mobility in all the three planes: a) dorsiflexion and plantar flexion, b)
inversion and eversion, and c) transverse rotation. This allows the amputees to sit cross-legged,
squat, walk barefoot on uneven surfaces, climb trees, negotiate muddy terrain and even run
without shoes. 6
The performance of the Jaipur Foot provides users with an affordable natural gait. This prosthetic
may be worn with or without shoes. It has enabled many amputees to lead a nearly normal life.
Cycle-rickshaw operator amputees have been able to resume operations, while the farmer
amputees have got back to farming. Many other individuals who had lost their limbs are able to
participate in their previous vocations once again. 9
All this is made possible at just a fraction of the cost of the foot prosthesis available in the western
world. A Jaipur limb presently costs around Rs. 2,500 to prepare. It is made available to the
beneficiaries across the world totally free of charge. BMVSS believes that the moment a service
begins to be charged for, the most vulnerable parts of society are the first to be marginalized. And
that is precisely the segment of the population that the institution is most keen to serve.
The Jaipur Foot has been constantly improved upon. However, its essence remains intact - low
cost, quick fabrication out of locally available materials, crafted by local artisans, lightweight, and
suitable for working people across the developing world. 2

The Operational Strategy

In order to provide limbs, aids, and appliances to disabled beneficiaries at its centers, BMVSS
follows an operational strategy whose salient features are as follows:
a) An open-door policy: Any disabled person may visit and register at the BMVSS centre at any
time of the day or night, without any appointment. The admission system enables the patient as
well as an accompanying attendant to get immediate board and lodge facilities (free of cost too).
b) One-stop-shop: Its centers are one-stop providers of artificial limbs, calipers etc. The
beneficiary stays put at BMVSS for one to three days, until he or she satisfactorily receives the
medically advised prosthetics and other aids. 10
c) Assembly line method: The entire process, from measurement and fabrication to fitting and
training, resembles an assembly line approach. The design of the product and its manufacturing
processes are kept simple and practical. The product quality is never compromised.

Page 5 of 10
d) Procurement at concessional rates: To keep costs under control, most input materials are
sourced locally. On account of its demonstrated integrity and ethical dealings, many suppliers
provide raw material to BMVSS at highly concessional rates.
e) Reduction of Overheads: Special efforts are made to keep the overhead costs as low as possible.
To that end, the 22 BMVSS centers across India operate mostly from the local Government
Hospitals. The hospital premises are used for the production of the artificial limbs as well as for
service to the patients.
The society’s office bearers do not serve tea at their meetings. They even carry drinking water
from their homes. Travel is not reimbursed, unless it is inevitable towards the work at hand. At
around 4% of the total budget, the administrative expenses of BMVSS are among the lowest in
the world for any organization of its kind. 11
f) Recycling: The waste products generated during the manufacturing process are auctioned
through open bidding. The buyers often recycle the waste. The entire operation is very
environment-friendly.
g) Finances: BMVSS meets around one-third of its costs from the grants provided by the Ministry
of Social Justice & Empowerment of the Government of India. A portion of the cost is also met
out from the interest income earned from the BMVSS corpus that has been created over the last
four decades.6
The rest of the expenses are met through the donations made by generous and caring individuals
as well as institutions. A culture of scrupulous accountability has been inculcated, by means of
regular internal as well as statutory audits.

The Sustainability Challenge

In the light of its noble mission, the main issue for BMVSS through its four decades of existence
12
has been that of sustenance. Going forward, some specific challenges that BMVSS might face
are as follows:
(i) The Free of Charge model: Since BMVSS does not charge any money whatsoever from its
beneficiaries, no revenue accrues to it directly. Around half of its annual budget of Rs. 15 crores
is met through erratic donations and grants. Many of the donors, patrons, and experts are
concerned that the “free-of-cost” and “free-for-all” model may not sustain for long. They see
nothing wrong in doing “well” by doing “good.” However, this debate has only reinforced D.R.
Mehta’s faith in the present model.

Page 6 of 10
One way to improve finances is to increase the corpus. The stipulation in the Indian Companies
Act (2013) that requires organizations to spend at least 2 percent of their net profits on Corporate
Social Responsibility is likely to help bring in more funds.
(ii) No Patent: The prosthetic has not been patented due to the purely altruistic motivation behind
its creation. The technical know-how has been freely shared with centres in other geographies, so
as to serve the maximum possible number of people. As a result, cheap or inferior imitations have
come up in the past using the “Jaipur Foot” name. This spoils its brand value.
(iii) Quality and Technology: The lack of ISO and other Quality certifications has prevented the
spread of the Jaipur Foot among the developed countries. Being handcrafted, it also suffers on
consistency parameters. However, collaborations with Dow Chemicals and the Indian Space
Research Organization for polyurethane technology has helped to reduce the cost, weight and
fabrication time of the Jaipur Foot while increasing its durability.
(iv) Demand Growth: There has been an exponential increase in the need for artificial limbs
across the world. However, the Jaipur Foot centers are still very limited in number.
Representation gaps need to be identified. Suitable partners also need to be located in order to run
more branch offices. This may call for a drastic re-ordering of the institutional values and
priorities.
(v) Cost Escalations: As the organization scales up, the administrative expenses are likely to
increase. The rising costs of raw material and manpower also keep pushing the budget.
(f) Patient/Technician Ratio: In order to cater to the enormous volume of patients being served
daily, and adhere to the policy of admission and discharge within 12 hours as far as possible,
BMVSS is required to maintain a Patient to Technician ratio of 1:1. Most of its technicians are ex-
patients, who now earn a remuneration that is twice the Indian average per capita income. The
challenge is to find and retain a large number of employees who will faithfully abide by the
mission of the organization.
(g) Succession Planning: The Jaipur Foot initiative cannot be replicated very easily, because it is
driven by the extraordinary vision and passion of Devendra Raj Mehta. In order to sustain and
grow the organization in the future, BMVSS needs another person with the same charisma and
stature.
After ‘experimenting’ with young professionals, social activists, and retired bureaucrats, DR
Mehta has chosen a ‘distant’ relative Bhupendra Raj Mehta to succeed him. 13

Page 7 of 10
Accomplishments
Jaipur Foot is one of the most technologically advanced social enterprises in the world. It
represents the triumph of Gandhian engineering, or the frugal approach to innovation. 14
The Stanford-Jaipur Knee was developed as a result of the joint research between BMVSS and
Stanford University. It was hailed by the Time magazine (November 23, 2009 issue) as one of the
world's 50 best inventions for 2009. 19
BMVSS has been conferred with the National Award for being the best institution for the
handicapped in 1982, and for the best institution working in the field of rehabilitation of the
disabled in 1998. 15
D.R. Mehta has ceaselessly championed the cause of BMVSS for 43 years. During much of this
time, he was simultaneously engaged in an illustrious administrative career that included such
high-profile positions as the Deputy Governor of the Reserve Bank of India (RBI), the Director
General of Foreign Trade (DGFT) and the Chairman of the Securities and Exchange Board of
India (SEBI).
Thankfully, his efforts over the decades have not gone unrecognized. The Government of India
conferred the Padma Bhushan on D. R. Mehta in 2008. The prestigious Rajiv Gandhi National
Sadbhavana Award was presented to him in 2012. He was also conferred with the Clairmont
Lincoln Ahimsa Award for 2014 in California, among many others. 15
Further, the Parliament of Philippines felicitated his brother VR Mehta in 2010 for the efforts
towards providing Jaipur Foot and other prosthetics to the disabled in their country.
References
1.! Ward W. William Arthur Ward: A true friend knows your weaknesses but shows you your strengths; feels your fears but
fortifies your faith; sees your anxieties but frees your spirit; recognizes your disabilities but emphasizes your
possibilities. [Internet]. Quotes.net. [cited 26 May 2016]. Available from: https://www.quotes.net/quote/38924
2.! Artificial Limbs - Print [Internet]. Medindia.net. [cited 3 May 2018]. Available from:
https://www.medindia.net/patients/patientinfo/artificial-limbs-jaipur-foot_print.htm
3.! Stelfox D. Versatile and inexpensive, Jaipur Foot prosthesis is transforming lives. The National [Internet]. 2012 [cited 3
May 2018];. Available from: https://www.thenational.ae/lifestyle/wellbeing/versatile-and-inexpensive-jaipur-foot-
prosthesis-is-transforming-lives-1.388030
4.! Arya A, Klenerman L. The Jaipur Foot. The Journal of Bone and Joint Surgery (Br). 2008;90(B):1414-1416.
5.! The Case of Jaipur Foot [Internet]. Bottom of the Pyramid: Solutions for Social and Economic Development. 2004 [cited
4 May 2018]. Available from: http://bottomofpyramid.blogspot.in/2004/06/case-of-jaipur-foot.html
6.! Brochure 2017-18 [Internet]. Jaipurfoot.org; 2017 [cited 4 May 2018]. Available from:
http://jaipurfoot.org/images/Brochure%202017-18.pdf
7.! Prahalad C. The fortune at the bottom of the pyramid: eradicating poverty through profits. New Delhi: Pearson; 2014

Page 8 of 10
8.! Coutinho J. Jaipur foot [Internet]. Jaipurfoot.org. 2011 [cited 4 May 2018]. Available from:
http://jaipurfoot.org/media/feature_stories/tarabai_ingle.html
9.! Valentinuzzi M, Johnson A, King P, Mysore H. The “Jaipur Foot” [Internet]. Pulse.embs.org. 2016 [cited 4 May 2018].
Available from: https://pulse.embs.org/may-2016/the-jaipur-foot/
10.! Azael G. Sudha Chandran: Awarded Dancer Overcomes a Life Changing Experience - Rewordit [Internet]. Rewordit.
2013 [cited 4 May 2018]. Available from: https://www.rewordit.org/sudha-chandran-awarded-dancer-overcomes-a-life-
changing-experience/
11.! Jaipur foot [Internet]. Jaipurfoot.org. 2016 [cited 4 May 2018]. Available from:
http://jaipurfoot.org/media/feature_stories/partnering_technology.html
12.! D.R.Mehta - India Conference at Harvard [Internet]. India Conference at Harvard. 2014 [cited 4 May 2018]. Available
from: http://indiaconference.com/2014/speaker/d-r-mehta/
13.! Jaipur Foot | Patient-Centric Management | Patient Care [Internet]. Jaipurfoot.org. 2016 [cited 4 May 2018]. Available
from: http://jaipurfoot.org/how_we_do/patient_centric_management.html
14.! The Economic Times. Jaipur Foot patron D R Mehta to get Clairmont Lincoln Ahimsa award in US Read more at:
//economictimes.indiatimes.com/articleshow/43816081.cms?utm_source=contentofinterest&utm_medium=text&utm_ca
mpaign=cppst. [Internet]. 2014 [cited 4 May 2018];. Available from:
https://economictimes.indiatimes.com/news/politics-and-nation/jaipur-foot-patron-d-r-mehta-to-get-clairmont-lincoln-
ahimsa-award-in-us/articleshow/43816081.cms
15.! Impacting Lives with a No-Cost Business Model [Internet]. Jaipurfoot.org. 2016 [cited 4 May 2018]. Available from:
http://jaipurfoot.org/blog/impacting-lives-with-a-no-cost-business-model
16.! Thomas P. Can the Jaipur Foot survive after DR Mehta? [Internet]. News18. 2013 [cited 4 May 2018]. Available from:
https://www.news18.com/news/india/can-the-jaipur-foot-survive-after-dr-mehta-594624.html
17.! Khan R. How Frugal Innovation Promotes Social Sustainability. Sustainability. 2016;8(10):1034.
18.! India P. Jaipur Foot to be manufactured in Afghanistan too [Internet]. Business-standard.com. 2015 [cited 4 May 2018].
Available from: http://www.business-standard.com/article/pti-stories/jaipur-foot-to-be-manufactured-in-afghanistan-too-
115110700807_1.html
19.! Jaipur Foot | Awards & Recognitions [Internet]. Jaipurfoot.org. 2016 [cited 4 May 2018]. Available from:
http://jaipurfoot.org/who_we_are/awards.html

Additional Video Reference

Samatvam, (2016, January 24) The Jaipur Foot retrieved from
https://www.youtube.com/watch?v=VRYKoM_7ZCw&t=2s

Page 9 of 10