Aravind Eye Care System

Management Concepts in Eye

care
Dr.R.D.Ravindran M.D.,
Joint Director
Aravind Eye Care System,
Madurai, India

A WHO Collaborating Centre for the Prevention of

Blindness
Named after
Sri Aurobindo Ghosh,
his teachings form the basis
for Aravind’s work

A WHO Collaborating Centre for the Prevention of Blindness

The problem……Magnitude of
Blindness
 Worldwide 4.5 Crore
people are blind
 1.2 Crore are in India
 300,000 of them are
children
 India has more blind
people than any
other country

A WHO Collaborating Centre for the Prevention of Blindness

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

Will restore vision to 75 Lakhs Will restore vision to 24

Lakhs
India: Population 110 Crores
1.2 Crore are blind & 20 Crore need eye
care
– Collaborating
A WHO GlassesCentre or forotherwise –
the Prevention of Blindness 4
 Genesis

In a developing country with

competing demands on limited
resources, government alone cannot
meet health needs of all the poor.

A WHO Collaborating Centre for the Prevention of Blindness

 Dr. G. Venkataswamy
 In 1976 …
Dr.V, feeling the urgent
need, started an eye
clinic with 11 beds, to
create an alternate,
sustainable eye care
system to supplement
the government’s efforts
…developed skills to perform 100
surgeries per day
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

 Genesis

Began here- as an 11
bedded clinic in 1976

Small team with a big mission

Money

A WHO Collaborating Centre for the Prevention of Blindness

His Guiding Philosophy

‘Spirituality allows the divine

force to work through each of
us for a greater good’
- Sri Aurobindo
Aravind Eye Hospitals (4000 Beds)

Amethi (UP) - 2005

Kolkatta (WB) - 2001

Pondicherry Coimbatore (1997)

(2003)

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

Indira Gandhi Eye Hospital &

Research Centre - Amethi,U.P

Sudharshan Nethralaya -
Amreli, Gujarat Indira Gandhi Eye Hospital &
Research Centre – Lucknow,U.P
A WHO Collaborating Centre for the Prevention of Blindness 12
Hospital Based Facilities

A WHO Collaborating Centre for the Prevention of Blindness 13

Core Principles in delivering
health
SS
yy care SS
yy
SS SS
TT TT
EE
Reaching the Efficient EE
M
M People Service M
M
SS SS
PATIENT
PATIENT
&
& &
&
CENTRED
CENTRED CARE
CARE
P
P P
P
R Financial
R
Giving Value R
R
O
O
C
C
Sustainability O
O
C
C
E
E E
E
S
S S
S
S
S S
S
A WHO Collaborating Centre for the Prevention of Blindness 14
 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 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 20
 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

 Line of Sight
 4 MBPS Up to 75 KM Univ. of Berkeley (PhD
students)
A WHO Collaborating Centre for the Prevention of Blindness 23
 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
EE
Reaching the Efficient TT
EE
M
M People Service M
M
SS SS
PATIENT
PATIENT
&
& CENTRED &
&
CENTRED CARE

P
P P
P
R Financial R
R
Giving Value R
O
O Sustainability O
O
C
C C
C
E
E E
E
S
S S
S
S
S S
S
A WHO Collaborating Centre for the Prevention of Blindness 26
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 27
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
andAtrainer of ophthalmic personnel in the
WHO Collaborating Centre for the Prevention of Blindness 28
world
Management Systems

A WHO Collaborating Centre for the Prevention of Blindness 29

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 30

A WHO Collaborating Centre for the Prevention of Blindness 31
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

ia
es
on
d

d
In

es an
il
Bar1
a
h

h
T

Bar2
ad
gl
an

d
n
B

avi
r
A

ia
d
In

0 500 1000 1500 2000 2500

A WHO Collaborating Centre for the Prevention of Blindness 33

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 35

Aravind - Operational Model
SS SS
yy yy
SS SS
TT TT
EE
Reaching the Efficient EE
M
M People Service M
M
SS SS
PATIENT
PATIENT
&
& CENTRED &
&
CENTRED CARE

P
P P
P
R Financial R
R
Giving Value R
O
O Sustainability O
O
C
C C
C
E
E E
E
S
S S
S
S
S S
S
A WHO Collaborating Centre for the Prevention of Blindness 36
 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)
 Poor patients : Rs. 0 (- Rs.250)
53%  Subsidized rate : Rs. 750 (15$)

22% Regular rate : Rs. 3,500 – 6,000



 Phaco Surgery : Rs. 6,500 – 12,000

25%
Affordable fees - Aimed at Middle Income
group
A WHO Collaborating Centre for the Prevention of Blindness
Financial Viability achieved
through
-Trust
 Trust - Attracts
– Focus paying
on good care patients
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 TT
EE
Reaching the Efficient EE
M
M People Service M
M
SS SS
PATIENT
PATIENT
&
& CENTRED &
&
CENTRED CARE

P
P P
P
R Financial R
R
Giving Value R
O
O Sustainability O
O
C
C C
C
E
E E
E
S
S S
S
S
S S
S
A WHO Collaborating Centre for the Prevention of Blindness 40
 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 decisions

Use of Wi-Fi PDA’s by Housekeeping staff

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

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 Exported to 120
• Patents countries
A WHO Collaborating Centre for the Prevention of Blindness 46
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 47
Aravind Medical Research
Foundation

Microbiology Community Clinical trials

based

Epidemiological
surveys

Genetics
A WHO Collaborating Centre for the Prevention of Blindness 48
New Research Facility

•Inaugrated on 1st Oct 2008

by Past President APJ Abdul
Kalam

A WHO Collaborating Centre for the Prevention of Blindness 49

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 50

Commitment of leadership
 Financial Discipline
 Willingness to Learn & Change
 Attitude for perfection
 Passion to eliminate needless
blindness

A WHO Collaborating Centre for the Prevention of Blindness 51

 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 52

Where change touches many lives … only
superficially

Courtesy: Dr Allen Foster

A WHO Collaborating Centre for the Prevention of Blindness
 Pursuing Our Mission
Eliminating needless
blindness

much has been done

and
much remains to be
Blindness
done . . .
A WHO Collaborating Centre for the Prevention of
“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