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Restoring vision to millions Aravind. Kuppammal is one of the… 45 million blind, worldwide 12 million blind in India.

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Presentation on theme: "Restoring vision to millions Aravind. Kuppammal is one of the… 45 million blind, worldwide 12 million blind in India."— Presentation transcript:

1 restoring vision to millions Aravind



4 Kuppammal is one of the… 45 million blind, worldwide 12 million blind in India

5 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


7 Genesis In a developing country with competing demands on limited resources, government alone cannot meet health needs of all the poor. In 1976 … Dr.V, feeling the urgent need, started an eye clinic with 11 beds, to create an alternate, sustainable eye care system to supplement the governments efforts

8 … 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 Aravinds Guiding Values: Compassion/Dignity Equity Transparency Sharing Guiding Philosophy How Dr. V built the Organization Translated to action: Eye care to all - Equity Standardization - Transparency Affordability Accountability

9 Aravinds Vision To eliminate needless blindness by providing high quality, high volume, compassionate eye care to all

10 Aravind Eye Clinic, 1976 11-bed clinic Post-retirement project of Dr. V

11 Aravind Eye Care System, 2009 Eye Bank Hospitals (5) Aurolab Out Reach Research Aravind Eye Care System LAICO IT Training AMECS 4 Hospitals

12 Aravind Eye Hospitals 4000 beds in 5 eye hospitals Tamil Nadu AmethiLucknowAmreli Kolkata Coimbatore Madurai Pondicherry Tirunelveli 4 managed eye hospitals 33 primary eye care centres Theni

13 Total Surgeries & Lasers till March 2009: 3,400,632 40% 60%

14 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 administrators Making Aravind the largest provider of eye care services and trainer of eye care personnel in the world

15 Building Blocks of Aravind Value System Delivery System Innovation Dr. G. Venkataswamy

16 The value system

17 The delivery system

18 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)

19 Breaking the access barriers 2008-09: 2131 screening eye camps 676,281 patients examined 61,021 spectacles dispensed 70,798 surgeries performed

20 Effectiveness of screening camps? We reached only 7% of those in need of eye care 1 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

21 Solution 1: Primary eye care centers 33 centers covering a population of 2 million 215,431 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

22 Solution 2: Taking super-specialty care to villages

23 Impact – reaching the unreached Increased awareness Influencing health-seeking behaviour Creating access Community participation Growing the market (reaching the unreached) ARAVIND EYE CARE SYSTEM

24 Efficiency ScenarioAB Surgeon11 Tables12 Scrub nurse12 Instrument sets16 Surgeries/hour16 - 8 Surgical Productivity

25 Aravind (Wo)manpower 300+ village high school girls selected each year Value fit over skill fit

26 60% of Aravinds 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

27 Surgeon Productivity: A comparison

28 Surgical Quality 2 Adverse Events During Surgery Aravind, Coimbatore N=22,912 UK National Survey N=18,472 Capsule rupture and vitreous loss2.0%4.4% Incomplete Cortical Clean up0.75%1.00% Iris Trauma0.3%0.7% Persistent Iris Prolapse0.01%0.07% Anterior Chamber Collapse0.3%0.5% Loss of nuclear fragment into vitreous0.2%0.3% Choroidal Haemorrhage------0.07% Loss of intra Ocular lens into vitreous0.01%0.16% Aravinds complications are less than half of those in UK 2 Fortune at the Bottom of the Pyramid by C. K. Prahalad

29 Making it affordable For the patient & the community For Aravind (to be sustainable) When most cant pay ARAVIND EYE CARE SYSTEM

30 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

31 Financial Results Free (Camp) 33%Paying 45% Free (Direct) 22% Surgery mix in 2008 -09 Year: 2008-09 Income: US$ 22 Million Expenses & Depreciation: US$ 13 Million EBITA: 39% Through a unique fee system & effective management, Aravind provides free eye care to 60% of its patients

32 Eliminating needless blindness requires going beyond Aravind Creating competition Making eye care affordable worldwide

33 Creating Competition to eliminate needless blindness 270 Eye Hospitals worldwide

34 Sharing makes you stronger Lions Aravind Institute of community Ophthalmology To contribute to the prevention and control of global blindness through Teaching, Training, Consultancy, Research, Publications & Advocacy

35 Promoting Best Practices Patient access Efficiency Patient care and quality Sustainability with social responsibility Publications Capacity Building Impact: Strengthen eye care programmes capacity to deliver high quality, increase access and be financially viable

36 Impact of Capacity Building Process Cataract Surgery (40 Hospitals) 52506CostRecovery60% 91445CostRecovery90% 76995 Capacity Building

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

38 Making Eye Care Affordable Used in 120 countries Price of IOL came down from $ 100 to $ 2 – making cataract surgery affordable 10 million people see the world through Aurolabs lenses 7% of global market

39 Intraocular Lens Division Pharmaceutical Division Suture Division Blades Division Instruments Division

40 Dr. G. Venkataswamy Eye Research Institute RCT Epidemiology Operations Research Biostatistics Genetics Proteomics Cell Biology GLP Facilities Pharmacology Microbiology ImmunologyInformation Technology Drug Trials Product Development

41 Broader Relevance? Is it applicable to developed countries & outside of eye care? ARAVIND EYE CARE SYSTEM

42 NHS*-UK vs. Aravind No. of eye surgeries Ophthalmologists graduating annually 71% 59% (*National Health Service – Main provider of Healthcare in UK)

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

44 Why is the cost 100 times more? It is beyond the simplistic UK isnt India Consider: – Efficiency – Clinical process – Cost of supplies – Regulations – Defensive medicine ARAVIND EYE CARE SYSTEM

45 Insights Large population Cost-effective interventions Cuts across all economic strata Equity issues Cost control Efficiency Focus on quality Patient centred care Productivity Achieving scale Compassion Owning the Problem ConditionsSolutions

46 Aravinds Evolution 1 st Decade (1978-1987) Setting up & developing hospitals Coming into existence Community outreach Focus on Cataract Services 2 nd Decade (1988-1997) Refining & Scaling up internally More Hospitals – TVL, CBE Establishing Aurolab & LAICO Education and Training 3 rd Decade (1998-2007) Foundation for scaling up externally Extensive capacity building work Experimenting with Managed Hospitals Rapid Growth in Specialty Care Focus on Research

47 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

48 STILL… This is the Current Reality! Courtesy: Allen Foster

49 Pursuing Our Mission Eliminating needless blindness much has been done and much remains to be done...

50 Intelligence & Capabilities are not enough. There must be the joy of doing something beautiful.. Dr. V

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