aravind eye care system · aravind’s complications are less than half of those in uk. 2...

Aravind Eye Care System

How we did it

Dr. Usha Kim Professor in Ophthalmology,

Head of Department for Orbit, Oculoplasty and Ocular Oncology

Services, Director of Mid-Level Ophthalmic

Personnel

a 10 minute cataract surgery will restore sight to 7.5 million

a pair of spectacles will help

another 2.4 million see

200 million need

eye care in India

Less than 10 %

have been treated

Aravind’s Vision

To eliminate needless blindness by providing high quality high volume compassionate eye care to all

52

5 Tertiary

66

Secondary

Care Centers

Care Centers

Outpatient Centers

Primary Care Centers

+

+

Specialty Care Research Training

Cataract Services Specialty Diagnosis

Comprehensive Eye Examination Treatment of Minor ailments

Comprehensive Eye Examination

1000 - 2000 patients

150 - 400 patients

100 -150 patients

15 -25 patients

A Day at Aravind 10,000 Patient Examinations 1,500 Surgeries 5-6 Outreach camps

• 1,500 examined • 300 transported to base

for surgery Classes for 100 Residents &

300 technicians and administrators

Aravind in 1976:

Aravind Eye Care System

Community Outreach Manufacturing Research Training Consultancy

Patient Statistics: Outpatient Visits Total Outpatient Visits till March 2015: 44 million

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

3,500,000

4,000,000 19

78

1980

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

Jan

06 - …

2008

- 09

2010

- 11

2012

- 13

2014

- 15

Paying Free

Surgeries & Lasers till Mar 2015: 4.63 million

0 50,000

100,000 150,000 200,000 250,000 300,000 350,000 400,000 450,000

Paying Free

Aravind in 2014…. 3,522,171 Outpatient Examinations

401,457 Surgical Procedures

50% for free / steeply subsidized

Building Blocks of Aravind

Dr. G. Venkataswamy

Value System

Delivery System

Innovation

Community Outreach

camps 2,518

89,079

outpatients

cataract surgeries

564,660

In 2015:

Outpatients

17%

27%

Cataract Surgeries

Effectiveness of Screening Camps

We reached only 7% of those in need of eye care1

Those with rarer eye conditions were not reached 1 “Low uptake of eye services in rural India”; Fletcher et al; Archives of Ophthalmology Vol 117, Oct 1999

Primary Eye Care Centers 51 centers covering

of 3.5 million

1million patient visits

40% reach within the

first year, rising to

75% by year 2

91% of problems are

resolved locally

Stretching

Scarce

Resources

Balancing of Resources

1 Surgeon

1 Tables

1 Scrub nurse

1 Instrument sets

1 Surgery/hour

1 1 Surgeon

1 2 Tables

1 2 Scrub nurse

1 6 Instrument sets

1 6 - 8 Surgeries/hour

Task shifting to improve efficiency

Create a workforce

• Enhancing the clinical skills to support the Ophthalmologist

• Improve the workflow • Promote patient

centered care • Carryout daily

planning & scheduling of work

Who could these be?

• Non- doctors, • Skilled Support staff,

− Should provide empathetic, compassionate care to rural poor

− that will be comfortable working in

rural areas which have – Large underserved

population – Dispersed

population – Low affordability – Poor logistics

Aravind (Wo)manpower

500+ village high school girls selected each year

Perform most of the routine clinical tasks

Doctors can focus on diagnosis & surgery

Higher quality and productivity, lower cost

The lives of these young women are vastly

improved

PRODUCTIVITY OF AN EYE SURGEON

Indonesia

Thailand

Bangladesh

Aravind

India

0 500 1000 1500 2000

Surgeries per year

Surgical Quality Adverse Events During Surgery

Aravind, Coimbatore

N=22,912

UK 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

2 “Fortune at the Bottom of the Pyramid” by C. K. Prahalad

Behind Aravind’s Patient Care

Staff cadre Number %

Doctors 181 5%

PGs / Fellow 256 7%

Paramedics 2,298 64%

Support Staff 864 24%

Total 3,599

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

be imported

Making Quality Eye Care Affordable

10 million people see the world through Aurolab’s lenses

Used in 120 countries 7% of global market

For the patient & the community For Aravind (to be sustainable) When most can’t pay

Gave it away for free Charged market rates for those

who can pay Had the MINDSET

Ensuring affordability

What Aravind did

LAICO : Creating Competition

Create Competition “to eliminate needless blindness”

280 Eye Hospitals worldwide

Impact of Capacity Building Process: Cataract Surgeries (40 Hospitals)

0

20,000

40,000

60,000

80,000

100,000

1 yr Before 1 yr After 2 yrs After

52,506

Cost Recovery

60%

91,445

Cost Recovery

90%

76,995

Capacity Building

Dr. G. Venkataswamy Eye Research Institute

Clinical research Basic Science research Epidemiology studies Operations research

Year Peer Reviewed Others

2014 57 29

2013 57 16

2012 54 7

2011 58 12

2010 61 17

2009 47 13

PUBLICATIONS

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400

600

800

1,000

1,200

1,400

1,600

1,800

2,000

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13

Toal Expenses

Total Income

Paying50%

Subsidized 23%

Free27%

2013-14 (in Rs. millions)

Income : Rs. 2645

Expenses : Rs. 1481

DOING GOOD & DOING WELL (in Rs.

millions)

Pursuing Our Mission Eliminating 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