High Performance Eye Hospital

• Shalini Nehra (80)

• Sachin Nandanwar (75)
• Subhash Wagle (89)

A WHO Collaborating Centre for the Prevention of Blindness 1

•
Approximately 1.2 crore blind people in India
•
Of these around 20 lakh are corneally
blind and in need of corneal transplantation

A WHO Collaborating Centre for the Prevention of Blindness 2

Most of it is unnecessary …
Simple Cataract Surgery Refraction & a pair of spectacles

Will restore vision to 75 Lakhs Will restore vision to 24 Lakhs

A WHO Collaborating Centre for the Prevention of Blindness 3

Aravind Eye Care

 In 1976, Padmashree Dr. G. Venkataswamy founded

the Govel Trust (Aravind Eye Hospital)
 Started as an 11 bed hospital in a house

A WHO Collaborating Centre for the Prevention of Blindness 4

…developed skills to perform 100 surgeries per day

By 2005- Aravind Eye Hospitals (all the five centres together) have examined
19.5 million outpatients and performed around 2.5 million surgeries
A WHO Collaborating Centre for the Prevention of Blindness
Dr.Venkatasamy’s Vision

“To eliminate needless blindness

by providing appropriate,
compassionate and high quality
eye care to all”

A WHO Collaborating Centre for the Prevention of Blindness

 Aravind Eye Hospitals (4000 Beds)

 Amethi (UP) - 2005

 Kolkatta (WB) - 2001

Pondicherry (2003) Coimbatore (1997)

Tamil
Nadu
Theni (1984)

Madurai (1978)
Tirunelveli (1988)
A WHO Collaborating Centre for the Prevention of Blindness
 Managed Hospitals-Today –
4 in Northern Part of India

Priyamvada Birla Aravind Eye Indira Gandhi Eye Hospital &

Hospital - Kolkata, West Research Centre - Amethi,U.P
Bengal

Sudharshan Nethralaya - Indira Gandhi Eye Hospital &

Amreli, Gujarat Research Centre – Lucknow,U.P
A WHO Collaborating Centre for the Prevention of Blindness 8
Core Principles in delivering health
care
SS
y
S
S
y yy
SS S
S
TT Reaching the Efficient TT
EE E
E
M
M People Service M
M
SS S
S
PATIENT
PATIENT
&
& &
&
CENTRED
CENTRED CARE
CARE
P
P P
P
R
R Financial R
R
O
O Giving Value O
O
C
C Sustainability C
C
E
E E
E
S
S S
S
S
S S
S
A WHO Collaborating Centre for the Prevention of Blindness 9
 Demand Generation
 Principles:
 Market driving
(reaching the
unreached)
 Removing barriers
 Community
participation
 Impact:
 Creating access
 Growing the market

A WHO Collaborating Centre for the Prevention of Blindness

Outreach for Speciality Services

A WHO Collaborating Centre for the Prevention of Blindness

Outreach for Speciality Services

A WHO Collaborating Centre for the Prevention of Blindness

 Outreach in 2008
No.of Screening 1,442
Camps
Patients examined 412,683
Surgeries 98,326

A WHO Collaborating Centre for the Prevention of Blindness

Utilization – Study at AECS

Only 7% of people with eye problems in

village accessed care from eye camps
A WHO Collaborating Centre for the Prevention of Blindness 14
Innovation – exploring newer approaches
to deepen the reach into the market

A WHO Collaborating Centre for the Prevention of Blindness

 Vision Centre
(Primary Eye Care)

 Covers a population of
50,000
 Staffed by Ophthalmic
technicians
 Active case finding at
community level
 Linked to Base Hospital

A WHO Collaborating Centre for the Prevention of Blindness

Low Cost Wi-Fi 802.11b Connectivity (open
spectrum)

 Unidirectional antenna Collaboration with Univ.

 Line of Sight
 4 MBPS Up to 75 KM of Berkeley (PhD students)

A WHO Collaborating Centre for the Prevention of Blindness 17

 Primary Eye Care IT Enabled Centers – 30 in
Tamilnadu
Consultation with
Wireless connectivity Ophthalmologist at Aravind
@ 4mbps Eye Hospital

Examination by Vision
Centre Technician

Marratech Software for

tele-conferencing
collaboration

Each patient examined at the Vision Centre is discussed with the

A WHO Collaborating Centre for the Prevention of Blindness
Ophthalmologist through videoconferencing
Impact
 Dramatic Reductions in cost
 Access to good eye care

 Increased coverage

Scalability:
 Currently 12 – will become 26 by year end

 Replicated in
 Baramati, Maharashtra (Intel)
 Tripura (Govt. of Tripura & India) – will be scaling
it up to 60 locations

A WHO Collaborating Centre for the Prevention of Blindness

Aravind - Operational Model
SS SS
yy yy
SS SS
TT Reaching the Efficient TT
EE EE
M
M People Service M
M
SS SS
PATIENT
&
& CENTRED &
&
CENTRED CARE
CARE
P
P P
P
R
R Financial R
R
O Giving Value O
O
C
C
Sustainability O
C
C
E
E E
E
S
S S
S
S
S S
S
A WHO Collaborating Centre for the Prevention of Blindness 20
Patient Statistics 2007 - 08

Paying Free Total

Out Patient 1,321,317 1,074,783 2,396,100

visits (55%) (45%)

Surgery 122,900 (43%) 162,845 285,745

(57%)

Cataract Surgery: 70% is free

A WHO Collaborating Centre for the Prevention of Blindness 21
Productivity
Volume Handled Per Day
 6000 Outpatients in hospitals
 4-5 outreach screening eye camps
 Examining 1500 people
 Transporting 300 patients to the hospital for surgery
 850 – 1000 surgeries
 Classes for 100 Residents/Fellows & 300 technicians and
administrators

Making Aravind the largest provider of eye care services

and trainer of ophthalmic personnel in the world
A WHO Collaborating Centre for the Prevention of Blindness 22
Ensuring Efficiency & Quality
Practices
 Clinical Protocols
 Standardization of procedures
 Usage & Balancing of Resources
 Surgical Techniques & Technology
 Quality & reliability of resources
 Medical records
 Staff Training & Discipline

A WHO Collaborating Centre for the Prevention of Blindness 23

Resource Balancing

 Quantum & Quality of resources

 Balance between resources
 Appropriate use reduces cost
 Maintaining the resource quality (skill) - at the
required level
 Eliminate non-productive activities & waiting
time

A WHO Collaborating Centre for the Prevention of Blindness

Comparison of surgeon productivity

Bar 1
Bar 2

0 500 1000 1500 2000 2500

A WHO Collaborating Centre for the Prevention of Blindness 25

State-of-art technologies in surgery

 Less energy required for

doctor
 Greater safety
 Ease of use

A WHO Collaborating Centre for the Prevention of Blindness

Planning for Expected load & Monitoring

 Yearly/Monthly Planning
 Planning for the next day –scheduling patient,
staff & equipment
 Planning for supplies & spares
 Ensuring that resources match expected workload
 Expected Patient load
 Weekly report
 Monthly report

A WHO Collaborating Centre for the Prevention of Blindness

Aravind - Operational Model
SS SS
yy yy
SS SS
TT Reaching the Efficient TT
EE EE
M
M People Service M
M
SS SS
PATIENT
&
& CENTRED &
&
CENTRED CARE
CARE
P
P P
P
R
R Financial R
R
O Giving Value O
O
C
C
Sustainability O
C
C
E
E E
E
S
S S
S
S
S S
S
A WHO Collaborating Centre for the Prevention of Blindness 28
 Covering the
entire spectrum Aravind Patient Fee Structure

 Consulting fee
 Poor Patients : Rs. 0 (free)
 Paying patient : Rs. 50 / US $ 1(valid for 3
months)
 Cataract Surgery with IOL (70% of all surgeries)
53%  Poor patients : Rs. 0 (- Rs.250)
22%  Subsidized rate : Rs. 750 (15$)
 Regular rate : Rs. 3,500 – 6,000
25%  Phaco Surgery : Rs. 6,500 – 12,000
Affordable fees - Aimed at Middle Income group
A WHO Collaborating Centre for the Prevention of Blindness
Financial Viability achieved through
- Trust - Attracts paying patients
 Trust – Focus on good care regardless of paying
capacity
 Transparency in billing
 70% of the paying patient know the services through
word of mouth
 Comprehensive speciality eye Care

A WHO Collaborating Centre for the Prevention of Blindness

Financial Viability achieved through
Pricing for paying services
 Market prices are driven by their costs – a

reflection of low utilization (inefficiency) – and

that helps too
 Aravind charges are at least 25% to 30% less than

the market charges

A WHO Collaborating Centre for the Prevention of Blindness

Aravind - Operational Model
SS SS
yy yy
SS SS
TT Reaching the Efficient TT
EE EE
M
M People Service M
M
SS SS
PATIENT
&
& CENTRED &
&
CENTRED CARE
CARE
P
P P
P
R
R Financial R
R
O Giving Value O
O
C
C
Sustainability O
C
C
E
E E
E
S
S S
S
S
S S
S
A WHO Collaborating Centre for the Prevention of Blindness 32
 Quality Quality – always current
 Early adoption of relevant
technologies
 Skills & Perspectives upgraded
through international visits and
exchanges
 Exchange of Residents
with the leading US
institutions
 Continuous
improvements based
on patient & employee
feedback
A WHO Collaborating Centre for the Prevention of Blindness
Giving value
 Using emerging
technologies to
reduce the response
time to patient
complaints
 Quality Assurance
process
 Gathering evidence
 Regular review &
follow-up on Use of Wi-Fi PDA’s by Housekeeping staff
decisions

A WHO Collaborating Centre for the Prevention of Blindness

Teaching & Training
Technicians Ophthalmologists Administrators

Affiliations: MCI, NBE, RCO-UK, JACHPO-USA,

MGR Medical & MKU Universities
A WHO Collaborating Centre for the Prevention of Blindness
Backward Integration

Mission & Objectives • In eighties all surgical

consumables were
 Produce quality products imported & expensive
 Provide at affordable cost
• Aurolab was started in
 Support avoidable blindness effort 1992 to produce
 Self sustain and grow intraocular lenses
(IOLs)

Turning apparent disadvantages into

realized opportunities
A WHO Collaborating Centre for the Prevention of Blindness
Intraocular Lens Pharmaceutical
Division Division

Suture Division Blades Division

Instruments
Division

A WHO Collaborating Centre for the Prevention of Blindness

 Making Eye Care Affordable
Impact: Price of IOL came down from $ 80 to $ 4
making cataract surgery affordable

• ISO 9001/CE Mark/US FDA

approval
• 7% of global market share in IOL
• 5 million people see the world
through Aurolab implants
• Patents
Exported to 120 countries
A WHO Collaborating Centre for the Prevention of Blindness 38
Sharing makes you stronger
Lions Aravind Institute of community Ophthalmology

To contribute to the prevention and control of global blindness through

Teaching, Training, Consultancy, Research, Publications & Advocacy

A WHO Collaborating Centre for the Prevention of Blindness 39

Aravind Medical Research Foundation

Microbiology Community based Clinical trials

Epidemiological
surveys

Genetics
A WHO Collaborating Centre for the Prevention of Blindness 40
New Research Facility

• Inaugrated on 1st Oct 2008 by

Past President APJ Abdul
Kalam

A WHO Collaborating Centre for the Prevention of Blindness 41

Aravind Eye Care System
Hospitals

Training Aurolab

Eye Bank
“Aravind Eye Care
System”
LAICO

IT
Out Reach

Research

A WHO Collaborating Centre for the Prevention of Blindness 42

 Recognitions
 WHO Collaborating Center
 National Resources Center for the Govt of India for
paramedical training
 Resource & Training center for International Agency
for Prevention of Blindness
 Champalimaud Award, Portugal - 2007
 Bill Gates – Global Health Award - 2008

A WHO Collaborating Centre for the Prevention of Blindness 43

Pursuing Our Mission
Eliminating needless blindness

much has been done and

much remains to be done . . .

A WHO Collaborating Centre for the Prevention of Blindness

“Intelligence & Capabilities are not
enough. There must be the joy of
doing something beautiful..”
Dr.V

A WHO Collaborating Centre for the Prevention of Blindness