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Taking Eye care to the Door Step

Aravind Experience
Dr. Aravind Srinivasan
Administrator

ARAVIND- EYE CARE SYSTEM

Challenges in reaching people

Accessibility to the service

Making it affordable

Lack of systems

Sustaining Quality

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Cost of Blindness in India: Rs. 13,500 Crores (US$ 3 Billion) per year

In a developing country with competing


demands on limited resources, government
alone can not meet health needs of all the
poor.

Dr.V, felt an urgent need to supplement the


government’s efforts to reduce needless
blindness by creating an alternate,
sustainable health care delivery system.
With very little money, started an eye clinic
with 11 beds in a rented house

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Aravind Business Model
Fee for service: 35% of patient care

Free/Subsidized service: 65% of patient care

Separate facilities for the paying and free patients

High Volume – High Quality eye care

The patient chooses where to get his/her care. The care


provided is of the same quality but the facilities
provided are different based on the pricing.

Accessibility to the service

3
Demand Generation –Reaching Out
Aravind initiated its community outreach programmes in
response to
Problems of inaccessibility

Extreme poverty, and

Under utilisation of eye care infrastructure

Through this programme, Aravind sought to make eye


care services more accessible by the community.

Holistic outreach services


Evolution from simple camps to comprehensive
camps.

Optical dispensing at camp site increased the


uptake of spectacles.

Taking tertiary care to the rural: advanced


screening unit.

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Community Outreach
20-25 screening camps/week

Community Participation

Free surgery, food & transportation

Performance of Outreach in 2003


No.of Screening Camps 1,150
Eye Camp Out-patient visit 4,33,227
Surgeries through Eye Camps 82,673

Leveraging
Technology
Information Technology

offers great opportunity to

reach the population, rich

and poor, rural & urban,

with facilities for good eye

care at appropriate cost

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N-Logue Kiosk Vision centre

Primary eye care


Post-op care
School screening
KIOSK – Internet
One per 35,000 population
Detailed demography of entire
household
Support I.E.F : Seva, Canada

Mobile Screening Unit


Screening by Ophthalmic Technicians
Expert opinion and consultation
through telemedicine

Mobile Screening Van

VSAT

Reading and Grading Centre


AEH Madurai

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BACKGROUND
Does the present model alone benefit the
rural mass?
Vision Base
Kiosks Camps Solution
Centers Hospital

Kiosk Vision Centers Camps Solution Base Hospital


Descriptor
Rural Rural Rural Semi-Urban Everybody
Reach
Medium Medium Medium Medium High
Education
Eye Care Level Consultation Primary Primary Primary,Secondary Tertiary, primary,
Non emergency Non emergency Non emergency Emergency cases
Secondary
Service offered
cases cases cases Emergency cases
Screening Quality None Low Low High High
Investment Medium High
Low Low Low
Price Rs. 10 < x < Rs. 50 Rs. 50
Rs.5 Rs.10 Free

Making it affordable

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Productivity (high volumes)
40% of all cataract surgeries
in Tamil Nadu are performed
in Aravind Eye Hospitals

A surgeon in Aravind
performs more than 2000
cataract surgeries a year which
Aravind Hospitals perform 150,000
is 5 times the number cataract operations in a year - more
than the whole NHS, UK - Mark Tully
performed by an average (BBC)

Indian ophthalmologist.

Volumes handled per day Surgeries from 1976 to 2003


200000
4000 outpatients
175000

700 surgeries 150000

125000
Resource utilised 100000 Paying
Free
75000
Total beds: 4000
50000

Total staff :2100 25000

0
1977
1980
1983

1986
1989
1992

1995
1998
2001

2002
2003

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A classic example of turning apparent
disadvantages into realized opportunities.

Aurolab was established in

1992 to produce intraocular

lenses (IOLs) to make quality

cataract surgery affordable in

developing countries.

Lack of systems:
An impediment to scaling up

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Evolution of Aravind eye hospitals

Madurai (1978)

Theni (1984)

Madurai (1976)

Tirunelveli (1988)

Coimbatore (1997)
Pondicherry (2003)

Scaling Up Services

LAICO :To contribute to the prevention and control of global blindness


through Teaching, Training, Consultancy, Research,
Publications & Advocacy

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Location of Participating Hospitals
as on November 2004
Other Countries:
Bangladesh
Bulgaria
Bolivia
Cambodia
Egypt
Indonesia
Kenya
Malawi Lions - 92
Nepal Sight Savers - 38
Zambia CBM - 21
Zimbabwe WHO, ORBIS,
Guatemala Seva, others - 26
El Salvador Total: 177
Tanzania

Capacity Building of other


Eye Hospitals

Vision Building Workshop


Needs Assessment Visit

Demand Generation
Quality
Cost Viability
Systems Refinement Follow-up Visit

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Partnering with like minded organisations
• Acumen, USA • Mission REACH

• SIDA, Canada • International Eye


Foundation
• Carl Zeiss, India
• Lighthouse International
• CBM, Germany
• Rotary International
• Combat Blindness Foundation • Seva, Canada
• International Federation of • ORBIS
Eye Bank
• Lions International
• World Diabetic Foundation
• Essilor

A
U
R
O
L • Five million see the world through
Aurolab intraocular lenses (IOL)
A • Exported to 120 countries.
B • 9% of global market share in IOLs.

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Sustaining Quality
Clinical quality Non-clinical quality
Training of doctors, Training of administrators
paramedics Packaging of services
Monitoring complication South to south collaboration
rate (developing countries sharing
Being at par with state of their expertise)
art technology
Benchmarking with
world class institutes:
Johns Hopkins hospital,
Wilmer institute.

Worldwide Distribution of IOL Microsurgery Trainees


from June 93 – August 2004

Europe Russia
North
America

Africa

South
No. of IOL America Australia
Trainees - 890

Nigeria - 12
Bangladesh - 19 Germany - 20 Sierra Leone - 1
Belgium - 1 India - 768 Spain - 1
Bulgaria - 1 Indonesia - 29 Switzerland - 11
Cambodia - 2 Israel - 1 Turkey - 1
Italy - 7 UAE - 1
China - 1
Latvia - 4 Uganda - 2
D.R.Congo - 1
Maldives - 1 U.K. - 2
Egypt - 2
Estonia - 1 New Zealand - 1

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Potential research areas
Scaling up of services.

Dearth of management manpower in the service


sector.

Lack of refinement in operations management.

Making the services more accessible at rural level.

much has been done and


much remains to be done . . .

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