ARvind Eye Hospital

A WHO Collaborating Centre for the Prevention of Blindness

Aravind Eye Care SystemManagement Concepts in Eye care

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


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


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 4

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

India: Population 110 Crores

1.2 Crore are blind & 20 Crore need eye care

– Glasses or otherwise –

India: Population 110 Crores

1.2 Crore are blind & 20 Crore need eye care

– Glasses or otherwise –


In a developing country with

competing demands on limited

resources, government alone cannot

meet health needs of all the poor.

Genesis

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”


Genesis

Began here- as an 11 bedded clinic in 1976

Small team with a big mission

Money

His Guiding Philosophy

‘Spirituality allows the divine force to work through each of us for a greater good’ - Sri Aurobindo


Tamil Nadu

Pondicherry (2003)

Coimbatore (1997)

Theni (1984)

Madurai (1978)Tirunelveli (1988)

Aravind Eye Hospitals (4000 Beds)

Amethi (UP) - 2005

Kolkatta (WB) - 2001


Managed Hospitals-Today – 4 in Northern Part of India

Priyamvada Birla Aravind Eye Hospital - Kolkata, West

Bengal

Indira Gandhi Eye Hospital & Research Centre - Amethi,U.P

Sudharshan Nethralaya - Amreli, Gujarat Indira Gandhi Eye Hospital &

Research Centre – Lucknow,U.P


Hospital Based Facilities


Core Principles in delivering health care

Giving ValueGiving ValueFinancial

Sustainability

Financial

Sustainability

Efficient Service

Efficient Service

Reaching the People

Reaching the People

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PATIENTCENTRED CARE

PATIENTCENTRED CARE

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Demand Generation Principles:

Market driving (reaching the unreached)

Removing barriers Community

participation Impact:

Creating access Growing the

market


Outreach for Speciality Services






Outreach in 2008

No.of Screening Camps

1,442

Patients examined 412,683

Surgeries 98,326


Only 7% of people with eye problems in village accessed care from eye camps

Utilization – Study at AECS


Innovation – exploring newer approaches to deepen the reach into the market


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


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

Unidirectional antenna Line of Sight 4 MBPS Up to 75 KM

Collaboration with Univ. of Berkeley (PhD students)


Wireless connectivity @ 4mbps

Marratech Software for tele-conferencing

collaboration

Examination by Vision Centre Technician

Each patient examined at the Vision Centre is discussed with the Ophthalmologist through videoconferencing

Consultation with Ophthalmologist at Aravind

Eye Hospital

Primary Eye Care IT Enabled Centers – 30 in Tamilnadu


Impact Dramatic Reductions in cost Access to good eye care Increased coverageScalability: 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


Aravind - Operational Model

Financial Sustainability

Financial Sustainability Giving ValueGiving Value

Efficient Service

Efficient Service

Reaching the People

Reaching the People

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PATIENTCENTRED CARE

PATIENTCENTRED CARE

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Patient Statistics 2007 - 08

Paying Free Total

Out Patient visits

1,321,317

(55%)

1,074,783

(45%)

2,396,100

Surgery 122,900 (43%) 162,845

(57%)

285,745

Cataract Surgery: 70% is free


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

ProductivityProductivity


Management Systems


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



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


Comparison of surgeon productivity

0 500 1000 1500 2000 2500

Bar 1

Bar 2


State-of-art technologies in surgery

Less energy required for doctor

Greater safety Ease of use


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





Efficient Service

Efficient Service

Reaching the People

Reaching the People

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PATIENTCENTRED CARE

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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) Subsidized rate : Rs. 750 (15$) Regular rate : Rs. 3,500 – 6,000 Phaco Surgery : Rs. 6,500 – 12,000

Affordable fees - Aimed at Middle Income group

53%22%

25%

Covering the entire spectrum

Covering the entire spectrum


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


Financial Viability achieved throughPricing 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





Efficient Service

Efficient Service

Reaching the People

Reaching the People

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PATIENTCENTRED CARE

PATIENTCENTRED CARE

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Quality – always current

Early adoption of relevant technologies

Skills & Perspectives upgraded through international visits and exchanges

QualityQuality

Exchange of Residents with the leading US institutions

Continuous improvements based on patient & employee feedback


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


Teaching & TrainingOphthalmologistsTechnicians Administrators

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

MGR Medical & MKU Universities


Turning apparent disadvantages into realized opportunities

Mission & Objectives Produce quality products Provide at affordable cost Support avoidable blindness

effort Self sustain and grow

•In eighties all surgical consumables were imported & expensive

•Aurolab was started in 1992 to produce intraocular lenses (IOLs)

Backward Integration


Intraocular Lens Division

Pharmaceutical Division

Suture Division Blades Division

InstrumentsDivision


Making Eye Care Affordable

Exported to 120 countries

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


Sharing makes you strongerLions Aravind Institute of community

Ophthalmology

To contribute to the prevention and control of global blindness through Teaching, Training, Consultancy, Research,

Publications & Advocacy


Aravind Medical Research Foundation

Community based

Genetics

Microbiology

Epidemiological surveys

Clinical trials


New Research Facility

•Inaugrated on 1st Oct 2008 by Past President APJ Abdul Kalam


Aravind Eye Care System

Eye Bank

Hospitals

Aurolab

Out Reach

Research

“Aravind Eye Care System”

LAICO

IT

Training


Commitment of leadership

Financial Discipline

Willingness to Learn & Change

Attitude for perfection

Passion to eliminate needless

blindness


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


Where change touches many lives … only superficially

Cou

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Pursuing Our MissionEliminating needless blindness

much has been done and much remains to be done . . .


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

Dr.V

ARvind Eye Hospital

Health & Medicine

eye care dr

eye clinic

thepeople s y s t e

aravind eye hospitals

high quality eye care

vision centre primary

sustainable eye care

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