Aravind Eye Care System

“restoring vision to millions”

WHAT DOES IT MEAN TO BE BLIND?

Kuppammal is one of the…

• 45 million blind, worldwide• 12 million blind in India

80% of this is preventable or curable

• Cataract Surgery – a simple procedure – will give sight to 7.5 million

• A pair of spectacles will make another 2.4 million see

200 million need eye care in IndiaLess than 10% have been reached

ARAVIND GENESIS

Aravind’s Vision

• “To eliminate needless blindness by providing high quality, high volume, compassionate eye care to all”

Aravind Eye Clinic, 1976

• 11-bed clinic• Post-retirement

project of Dr. V

Aravind Eye Care System, 2011

Eye Bank

Hospitals(7) Aurolab

Out ReachResearch

“Aravind Eye Care System”

LAICOIT

Training

AMECS2

Hospitals

Total Surgeries & Lasers till March 2011: 4,018,295

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Paying Free

A day at Aravind...

• 850 – 1000 surgeries• 6,000 Outpatients in hospitals • 5-6 outreach camps

– 1500 examined– 300 transported to base for surgery

• 500 – 600 Telemedicine Consultations• Classes for 100 Residents/Fellows & 300 technicians and

administratorsMaking Aravind the largest provider of eye care services

and trainer of eye care personnel in the world

Building Blocks of Aravind

• Value System • Delivery System• Innovation

How Dr. V built the Organization Guiding Philosophy “… Spirituality allows the divine force to work through each of us for a

greater good

If work is approached from a spiritual perspective, then it becomes divine work. If in your actions, you allow the divine force to flow through you, you will accomplish things far greater than you might have imagined.”

- Sri Aurobindo

Aravind’s Guiding Values: Compassion/Dignity Equity Transparency Sharing

Translated to action: Eye care to all - Equity Standardization - Transparency Affordability Accountability

The need to innovate

Market conditions at the ‘bottom of the pyramid’:• Large underserved population • Resource scarcity (Capital and HR)• Dispersed population• Low affordability• Poor logistics

(Based on analysis by Prof. C K Prahalad)

REACHING THE UNREACHED

Breaking the access barriers

2010 Jan - Dec:• 2244 screening eye camps

– 1384 Comprehensive

• 316,148 patients examined• 58,665 spectacles

dispensed• 74,764 surgeries performed

Effectiveness of screening camps?

• We reached only 7% of those in need of eye care1• Those with rarer eye conditions were not addressed

1 “Low uptake of eye services in rural India”; Astrid E. Fletcher et al; Archives of Ophthalmology Vol 117, Oct 1999

Solution 1: Primary eye care centers

• 36 centers covering a population of 2 million

• Approx. 400,000 patients seen so far

• 40% penetration within the first year

• Everyone receives telemedicine consultation

• Online health records• 91% of them received full

care at the center

Solution 2:Taking super-specialty care to villages

Impact – reaching the unreached

• Increased awareness• Influencing health-seeking behaviour• Creating access• Community participation• Growing the market (reaching the unreached)

ADDRESSING RESOURCE SCARCITY

Efficiency - Surgical Productivity

Scenario A B

Surgeon 1 1

Tables 1 2

Scrub nurse 1 2

Instrument sets 1 6

Surgeries/hour 1 6 - 8

Aravind (Wo)manpower• 300+ village high school girls

selected each year• Value fit over skill fit• 60% of Aravind’s workforce• Perform most of the routine

clinical tasks• Thus allowing doctors do what

they are best at - diagnosis & surgery

• Results in higher quality, productivity and lowers cost

• The life of these young women are vastly improved

Surgeon Productivity: A comparison

India

Aravind

Bangladesh

Thailand

Indonesia

0 500 1000 1500 2000 2500

Surgical Quality2Adverse Events During Surgery Aravind, Coimbatore

N=22,912UK National Survey

N=18,472

Capsule rupture and vitreous loss 2.0% 4.4%

Incomplete Cortical Clean up 0.75% 1.00%

Iris Trauma 0.3% 0.7%

Persistent Iris Prolapse 0.01% 0.07%

Anterior Chamber Collapse 0.3% 0.5%

Loss of nuclear fragment into vitreous 0.2% 0.3%

Choroidal Haemorrhage ------ 0.07%

Loss of intra Ocular lens into vitreous 0.01% 0.16%

Aravind’s complications are less than half of those in UK

Making it affordable

• For the patient & the community

• For Aravind (to be sustainable)

• When most can’t pay

What we did• Gave away a lot of it free• Charged market rates for

those who can pay• Were helped by market

inefficiency• Had the MINDSET

Through a unique fee system & effective management, Aravind provides free eye care to 50% of its patients

80-8182-83

84-8586-87

88-8990-91

92-9394-95

96-9798-99

00-0102-03

04-05'06-07

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ExpenseRevenue

Surgery mix: 2009 -2010

Paying 47%

Free 26%

Camp 27%

“ELIMINATING NEEDLESS BLINDNESS” REQUIRES GOING BEYOND ARAVIND

Creating Competition “to eliminate needless blindness”

6/22/10

270 Eye Hospitals worldwide

6/22/10

Established in 1992 to address the high cost of ophthalmic supplies which had to be imported

Making Eye Care Affordable

• 10 million people see the world through Aurolab’s lenses

• Used in 120 countries• 7% of global market

Price of IOL came down from $ 100 to $ 2 – making cataract surgery affordable

Dr. G. Venkataswamy Eye Research Institute

RCT

Epidemiology

Operations Research

Biostatistics

Genetics

Proteomics

Cell Biology

GLP Facilities

Pharmacology

Microbiology

Immunology

Information Technology

Drug Trials

Product Development

BROADER RELEVANCE?Is it applicable to developed countries & outside of eye care?

NHS*-UK vs. Aravind

No. of eye surgeriesOphthalmologists graduating

annually

71%

59%

(*National Health Service – Main provider of Healthcare in UK)

Cost of delivering eye care< 1% of what it costs in UK

Why is the cost 100 times more?

• It is beyond the simplistic “UK isn’t India”• Consider:

– Efficiency– Clinical process– Cost of supplies– Regulations– Defensive medicine

Compassion

Owning the Problem

Insights

Large population

Cost-effective interventions

Cuts across all economic strata

Equity issues

Cost control

Efficiency

Focus on quality

Patient centered care

Productivity

Achieving scale

Conditions Solutions

Enhancing Better Eye Care

• Service Delivery– Increase from quarter million to one million

surgeries and serve 6 million outpatients a year – Increase presence in 100 locations (in areas of

need) • Clinical and Medical Research

– Dr. G.V Institute of Medical Research• Through Quality & Affordable Products

– Aurolab

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

Thank You