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IEF
Optical Services as a Optical Services as a Critical Component of Critical Component of Eye Care and Eye Care and SustainabilitySustainabilityR Rahmathullah, J Barrows, W R Rahmathullah, J Barrows, W Shields, V SheffieldShields, V Sheffield
THE INTERNATIONAL EYE THE INTERNATIONAL EYE FOUNDATIONFOUNDATION
www.iefusa.org
IEF
AIMAIM► Importance of opticals Importance of opticals
to sustainable to sustainable ophthalmic servicesophthalmic services
►Options to establish Options to establish optical servicesoptical services
►Planning processPlanning process►Results to be expectedResults to be expected►Critical considerationsCritical considerations
www.iefusa.org
IEF
►RE services not serving all populationsRE services not serving all populations►Patients inconvenienced by going to Patients inconvenienced by going to
another location to get glasses madeanother location to get glasses made►Ophthalmology not taking advantage Ophthalmology not taking advantage
of optometry servicesof optometry services►Lost revenues to ophthalmologyLost revenues to ophthalmology
BACKGBACKGROUNDROUND
.
www.iefusa.org
IEF
► IEF SightReach® Management IEF SightReach® Management experience developing experience developing comprehensive and financially comprehensive and financially sustainable eye care servicessustainable eye care services
SETTINSETTINGG
.
www.iefusa.org
► Transitioning private sector to include social Transitioning private sector to include social service and government sector to be service and government sector to be business likebusiness like
► NGO role: invest in services serving all NGO role: invest in services serving all populations and create capacity for financial populations and create capacity for financial sustainabilitysustainability
► Optical services integral to modelOptical services integral to model
IEF
► Address large population with uncorrected Address large population with uncorrected refractive errorrefractive error
► Make services accessible, affordable, and Make services accessible, affordable, and convenientconvenient
► Ensure high quality – new spectacles, not used Ensure high quality – new spectacles, not used spectaclesspectacles
► Ensure financial sustainabilityEnsure financial sustainability► Provide percent of profit to “Sustainability Provide percent of profit to “Sustainability
Fund”Fund”
GOAGOALSLS
.
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IEF
Critical Questions Critical Questions - - before you start!before you start!
►Integrate optometry into ophthalmology?Integrate optometry into ophthalmology?►Private business to raise funds?Private business to raise funds?►For what purpose(s)?For what purpose(s)?
Support ophthalmology?Support ophthalmology? Subsidize services?Subsidize services? Expand/replicate services?Expand/replicate services? Provide training opportunities?Provide training opportunities? Support outreach services?Support outreach services?
►Short or long term involvement?Short or long term involvement?►What is the exit strategy?What is the exit strategy?
www.iefusa.org
IEF
PHASESPHASES – for setting – for setting up optical serviceup optical service►Planning – 2-3 monthsPlanning – 2-3 months
Assessment of capacity, commitment, Assessment of capacity, commitment, leadership, market potentialleadership, market potential
►Procurement – 3-4 monthsProcurement – 3-4 months Equipment, furniture, personnelEquipment, furniture, personnel
► Implementation – 6-18 monthsImplementation – 6-18 months Open the doors for businessOpen the doors for business
►NGO ExitNGO Exit Monitoring for quality, management, Monitoring for quality, management,
revenuerevenuewww.iefusa.org
IEF
PLANNING PLANNING PHASEPHASE
► Establish agreementsEstablish agreements Roles of stakeholdersRoles of stakeholders Who “owns” the business?Who “owns” the business? Inputs requiredInputs required
► Evaluate commitmentEvaluate commitment Commit time required to achieve defined Commit time required to achieve defined
resultresult www.iefusa.org
►Pre-assessmentPre-assessment Determine capacity, Determine capacity,
willingness, leadership, willingness, leadership, policies, market policies, market feasibilityfeasibility
IEF
BUSINESS BUSINESS PLANPLAN
► Define servicesDefine services Market - patient populationMarket - patient population Pricing strategy – cost vs. price; how much mark Pricing strategy – cost vs. price; how much mark
up to achieve purposeup to achieve purpose► Emphasize qualityEmphasize quality
Durable/ attractive inventory; convenience; Durable/ attractive inventory; convenience; range of offerings; customer service; pricingrange of offerings; customer service; pricing
► Evaluate environmentEvaluate environment Who/ what is the “competition”Who/ what is the “competition” Policies – optometry, taxes, customsPolicies – optometry, taxes, customs
► Model financial return/break even pointModel financial return/break even point► Identify inputs needed and budgetIdentify inputs needed and budgetwww.iefusa.org
IEF
PROCUREMPROCUREMENT PHASEENT PHASE
► Personnel neededPersonnel needed Optometrist, who does refraction?Optometrist, who does refraction? Sales, workshop, accounting, security staffSales, workshop, accounting, security staff
► Facility set upFacility set up Location, accessibility, visibilityLocation, accessibility, visibility Refraction, sales, workshop?Refraction, sales, workshop?
► Procure equipment, inventoryProcure equipment, inventory Appropriate equipmentAppropriate equipment How much inventory to have on hand?How much inventory to have on hand?www.iefusa.org
1 Optometrist2 Opticians
2 Sales People-also fit spectacles
IEF
COORDINACOORDINATED TED IMPLEMENTIMPLEMENTATIONATION►Management structureManagement structure
Establish clear lines of authority, Establish clear lines of authority, accountability, transparencyaccountability, transparency
Staff policiesStaff policies Accounting procedures and policiesAccounting procedures and policies Procurement procedures and policiesProcurement procedures and policies
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IEF
EXIT PHASEEXIT PHASE
►Monitor managementMonitor management►Monitor qualityMonitor quality►Monitor procurementMonitor procurement►Monitor growth in patient Monitor growth in patient
servicesservices►Monitor revenue generationMonitor revenue generation
www.iefusa.org
IEF
IEF OPTICAL IEF OPTICAL SERVICES MODELSERVICES MODEL
► 7 Opticals in 12 hospitals in Africa, India, 7 Opticals in 12 hospitals in Africa, India, Latin America - different approaches:Latin America - different approaches:
► Improve existing services: Guatemala, India Improve existing services: Guatemala, India (1), Honduras(1), Honduras Eye unit takes ownership vs. consignmentEye unit takes ownership vs. consignment Increase equipment, inventory and staffIncrease equipment, inventory and staff
► Start from scratch: Malawi (2), India (1)Start from scratch: Malawi (2), India (1) Identify spaceIdentify space Follow phases of planning, procurement, Follow phases of planning, procurement,
implementation implementation www.iefusa.org
IEF
COSTCOSTIEF IEF ModelModel
► Optical shop with workshop: equipment, Optical shop with workshop: equipment, stock, supplies, furniture only - $40,00-stock, supplies, furniture only - $40,00-$50,000 US$50,000 US
► 1-2 year period of IEF planning, site visits, 1-2 year period of IEF planning, site visits, technical assistance, monitoring, etc. – technical assistance, monitoring, etc. – average $20,000 USaverage $20,000 US
www.iefusa.org
IEF
Blantyre Penya OpticalBlantyre Penya Optical
► 20,240 examined, 20,240 examined, 8,109 refracted8,109 refracted
► 52% female, 7% 52% female, 7% childrenchildren
► 40 average 40 average refractions per dayrefractions per day
► 25 average pair 25 average pair glasses per dayglasses per day
► Contribute 15% of Contribute 15% of monthly gross sales monthly gross sales revenue to hospital revenue to hospital sustainability fundsustainability fund
0
20000
40000
60000
80000
100000
120000
140000
2006 2005
Financial
Revenue
Expenditure
Hospital acct
Equity
Stock
IEF
Percent contribution Percent contribution optical revenue of all revenueoptical revenue of all revenue
-
100,000
200,000
300,000
400,000
500,000
600,000
700,000
800,000
900,000
Malaw i 88%
El Salvador18%
India GNRC12%
Guatemala 30%
Patients
Optical
US $
IEF
Percent contribution optical Percent contribution optical revenue of all revenuerevenue of all revenue
Blantyre – LSFEU/ Blantyre – LSFEU/ Penya OpticalPenya Optical
Optical - Optical - 88%88% $127,176 $127,176
PatientsPatients 12%12% $17,968 $17,968
India – Gomabai India – Gomabai N&RCN&RC
Optical - Optical - 12%12% $51,422 $51,422
PatientsPatients 88%88% $373,440 $373,440
India – Vision India – Vision CentersCenters
Optical - Optical - 86%86% $10,515 $10,515
PatientsPatients 14%14% $1,669 $1,669
Guatemala – Guatemala – Visualiza (2 Visualiza (2 units)units)
Optical - Optical - 30%30% $255,355 $255,355
PatientsPatients 70%70% $599,507 $599,507
El Salvador - El Salvador - ClaraVisionClaraVision
Optical - Optical - 18%18% $48,534 $48,534
PatientsPatients 82%82% $220,412 $220,412
IEF
CHALLENCHALLENGESGES
► Procurement processProcurement process Supplier relationships; burdensome foreign Supplier relationships; burdensome foreign
exchange processexchange process Burdensome customs policies and proceduresBurdensome customs policies and procedures Devaluation Devaluation
► Transfer of profitsTransfer of profits Robbing Peter to pay PaulRobbing Peter to pay Paul
► Affordable pricing in crowded marketAffordable pricing in crowded market Affordable vs. freeAffordable vs. free
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IEF
WHY THIS WHY THIS MODEL?MODEL?►Why hire an optometrist?Why hire an optometrist? Capture patients not coming through eye clinicCapture patients not coming through eye clinic Ophthalmic staff dedicated to treatment and surgeryOphthalmic staff dedicated to treatment and surgery
www.iefusa.org
►Why 2 sales and 2 technicians?
Optical Service should be large enough to handle an Optical Service should be large enough to handle an increasing volume, be financially sustainable, and increasing volume, be financially sustainable, and earn profit for eye unit’s sustainability fundearn profit for eye unit’s sustainability fund
►Why have a workshop on site?Why have a workshop on site?
For patient convenience and rapid fulfillment of For patient convenience and rapid fulfillment of prescriptionsprescriptions
IEF
CONCLUSICONCLUSIONSONS
►Clear purpose is criticalClear purpose is critical►Run as a businessRun as a business►Commitment essentialCommitment essential►Need to manage agreementsNeed to manage agreements►Attention to quality is criticalAttention to quality is critical►Continuous management requiredContinuous management required
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IEF
ACKNOWLEDGEMENTSACKNOWLEDGEMENTS► MALAWI (Lilongwe): Drs. Moses Chirambo, Joseph Msosa, MALAWI (Lilongwe): Drs. Moses Chirambo, Joseph Msosa,
and optometrist Kiran Kumar.and optometrist Kiran Kumar.
► MALAWI (Blantyre): Drs. Gerald Msukwa, Khumba Kalua, MALAWI (Blantyre): Drs. Gerald Msukwa, Khumba Kalua, Nkume Batumba, and optometrist Navin Kumar.Nkume Batumba, and optometrist Navin Kumar.
► INDIA (GNRC): Mr. S. ParawalINDIA (GNRC): Mr. S. Parawal
► INDIA (Theni Vision Centers): Dr. P. Namperumalsamy, Mrs. INDIA (Theni Vision Centers): Dr. P. Namperumalsamy, Mrs. Preethi Pradhan, and Mr. R.D. ThulasirajPreethi Pradhan, and Mr. R.D. Thulasiraj
► GUATEMALA: Drs. Mariano Yee, Nicolas Yee, Mr. Juan GUATEMALA: Drs. Mariano Yee, Nicolas Yee, Mr. Juan Francisco Yee, and optometrist Dr. Kim YeeFrancisco Yee, and optometrist Dr. Kim Yee
► EL SALVADOR: Drs. Juan Miguel Posada Fratti, Julio EL SALVADOR: Drs. Juan Miguel Posada Fratti, Julio Caballero, and Mrs. Ena de Posada Caballero, and Mrs. Ena de Posada
► HONDURAS: Dr. Juan Odeh-Nasrala, Mr. Rene Arturo Lopez HONDURAS: Dr. Juan Odeh-Nasrala, Mr. Rene Arturo Lopez Torres, and Mrs. Odeh-NasralaTorres, and Mrs. Odeh-Nasrala