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1991, there were around 20 million blind eyes in INDIA with 2 million added every year.
Main Cause of blindness: Cataract (~75% cases) Average per capita income: Rs 6800 with over
70% below Rs 2500 425 districts hospital : around 1 for every 2
million people. Surgeries
◦ 30% by Govt. Dept. ◦ 40% by private sector fully paid◦ 30% by volunteer groups and NGO’s
The Blindness Problem
Indian Name – Motiabind 2 Techniques used: ICCE & ECCE ICCE: Most widely used, use simple
instrument, take less then 20 minutes. Has longer recover period (3-5weeks), patient has to wear aphakic spectacles
ECCE: around 30 minutes, plastic intraocular lens required, no need of corrective spectacles, better then ICCE. Costs twice as much as ICCE
Cataract
Goal : Quality eye care at reasonable cost Founder: Dr. Venkataswamy born in 1918 in
small village near Madurai. Bachelor’s degree in medicine in 1944. Deeply influenced by Mahatma Gandhi Suffered from severe Rheumatoid Arthritis
for many years. After retirement he founded Aravind Eye
Hospital.
Aravind Eye Hospital
1976: 20 bed hospital opened. Performing all types of eye surgery
1981: 250 bed Main hospital, with specialty clinics
1984: 350 bed free hospital was opened, staffed by doctors and nurses from main hospital
1988 : Hospitals in Madurai(600 beds), Tirunelveli(400 beds) and Theni(100-beds)
1990: Opens Free hospital for walk in patients.
1992: 3.65 million patients screened and 335,000 cataract operations performed successfully.
History
Tamil Nadu
Pondicherry (2003) Coimbatore (1997)
Theni (1984)
Madurai (1978)Tirunelveli (1988)
Aravind Eye Hospitals (4000 Beds)
Amethi (UP) - 2005
Kolkatta (WB) - 2001
• First three surgeons were Dr Venkatswamy, Dr G Natchair(sister), Dr P Nampermualswany(Dr .Nam)(brother-in-law)
• In 1977, Heads of all clinics except one were family members of Dr V
•Was subsequently joined by other family members who helped in construction, financial management, hospital administration etc
•All senior staff member were highly qualified, experienced and were encouraged to participate in training and research
•Family members were committed and dedicated Aravind eye hospitals mission of providing eye care to the masses
•In 1992, total staff of 240 people including 30 doctors,120 nurses, 60 administrative and 30 housekeeping workers
•Employee were conditioned to work hard and put in 60 hour week to serve all patients
Principles:◦ Market driving
(reaching the unreached)
◦ Removing barriers◦ Community
participation Impact:
◦ Creating access◦ Growing the market
Financial Discipline Willingness to Learn & Change Attitude for perfection Passion to eliminate needless
blindness
Paying Free Total
Out Patient visits
1,321,317
(55%)
1,074,783
(45%)
2,396,100
Surgery 122,900 (43%)
162,845
(57%)
285,745
Cataract Surgery: 70% is free
6000 Outpatients in hospitals 4-5 outreach screening eye camps
◦ Examining 1500 people
◦ Transporting 300 patients to the hospital for surgery
850 – 1000 surgeries Classes for 100 Residents/Fellows & 300
technicians and administratorsMaking Aravind the largest provider of
eye care services and trainer of ophthalmic personnel in the
world
ProductivityProductivity
Practices Clinical Protocols Standardization of procedures Usage & Balancing of Resources Surgical Techniques & Technology Quality & reliability of resources Medical records Staff Training & Discipline
Early adoption of relevant technologies
Skills & Perspectives upgraded through international visits and exchanges
QualityQuality
Exchange of Residents with the leading US institutions
Continuous improvements based on patient & employee feedback
Using emerging technologies to reduce the response time to patient complaints
Quality Assurance process
Gathering evidence Regular review &
follow-up on decisions Use of Wi-Fi PDA’s by Housekeeping
staff
17
Yearly/Monthly Planning Planning for the next day –scheduling
patient, staff & equipment Planning for supplies & spares Ensuring that resources match expected
workload◦Expected Patient load◦Weekly report◦Monthly report
Consulting fee◦ Poor Patients : Rs. 0 (free)◦ Paying patient : Rs. 50 / US $ 1(valid
for 3 months) Cataract Surgery with IOL (70% of all
surgeries)◦ Poor patients : Rs. 0 (- Rs.250)◦ Subsidized rate : Rs. 750 (15$)◦ Regular rate : Rs. 3,500 – 6,000◦ Phaco Surgery : Rs. 6,500 – 12,000
Affordable fees - Aimed at Middle Income group
53%22%
25%
Covering the entire spectrum
Covering the entire spectrum
Trust – Focus on good care regardless of
paying capacity
Transparency in billing
70% of the paying patient know the
services through word of mouth
Comprehensive speciality eye Care
Pricing for paying services Market prices are driven by their costs – a
reflection of low utilization (inefficiency) – and that helps too
Aravind charges are at least 25% to 30% less than the market charges
Exported to 120 countries
Impact: Price of IOL came down from $ 80 to $ 4 making cataract surgery affordable
• ISO 9001/CE Mark/US FDA approval
• 7% of global market share in IOL
• 5 million people see the world through Aurolab implants
• Patents
Mission & Objectives Produce quality products Provide at affordable cost Support avoidable
blindness effort Self sustain and grow
Turning apparent disadvantages into
realized opportunities
•In eighties all surgical consumables were imported & expensive
•Aurolab was started in 1992 to produce intraocular lenses (IOLs)
Backward Integration
Aim had been to provide quality health care to the masses Funds for main hospital used for construction and equipment for Free hospital 90% of annual budget was self generated, other 10% came from sources
around the world Surplus was reinvested in modernizing and updating equipment and facilities Main hospital provided three different classes of rooms, mostly performed
ECCE surgery and had dedicated specialty clinics. Almost all patients paid for service
Free hospital was run on no frill method. Rooms were shared by many people and beds were 6`x3` coir mats. Most surgeries were ICCE
Process of service delivery at both hospitals was almost identical Same Staff was shared by both hospitals on a rotational basis to provide same
quality in both hospitals Dr V aimed to shift completely to ECCE and decided on vertical integration to
reduce costs of IOLs Auro Labs was setup in 1991 to produce IOLs, long term aim was to reduce
cost of manufacturing to Rs 100 per lens
Aim was to attract patients in rural areas to get regular eye check ups
Promoted by local sponsors( business enterprises, social service organizations)
Sponsors brought in funds, advertised through newspapers, marketplaces, information pamphlets one to three weeks in advance
Sponsors paid for publicity, transportation and food for selected patients ( ~ Rs 200 per patient)
Aravind provided medical expertise and bore cost of surgery and medicines
For increasing patient willingness for surgery, patients were provided food, transportation and moved in groups to provide a safer environment
Follow-up for patients was done by Aravind three months after surgery
Special 10 member team for camp organization
Each member was assigned a district Member toured extensively, but met once a
week to discuss plans with Dr V Members worked with sponsors and helped
in organizing camps, logistics and guided new sponsors
Smoothening Demand – Flow of patients was much higher on certain week days and unusually low on other
Keeping employee motivated to work extra hours on relatively lesser salaries. Can Aravind afford to loose talented employees to private sector or will training initiatives, research opportunities and satisfaction of serving humanity provide sufficient reason for people to stay ?
Achieving financial self-sufficiency in all centers. Can the model be sustainable in smaller cities or should operations be centralized ?
Switching completely to latest technology (ECCE). How can cost be reduced for ECCE ?
Attracting more patients from rural area to eye camps Spreading the model world-wide. What could be the best
method, Franchising Vs Expansion ?