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

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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

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►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

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► IEF SightReach® Management IEF SightReach® Management experience developing experience developing comprehensive and financially comprehensive and financially sustainable eye care servicessustainable eye care services

SETTINSETTINGG

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► 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

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► 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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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?

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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

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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

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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

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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

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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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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

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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

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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

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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

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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 $

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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

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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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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

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►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

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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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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