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Sustainability

Sustainability. Key Dimensions of Organisational Sustainability. Key Dimensions of Programme Sustainability. Programme design should help the organisation grow (services & activities). Mission Based Programme Design Process. Gap analysis: Assess unmet need in the community

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Sustainability

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  1. Sustainability

  2. Key Dimensions of Organisational Sustainability

  3. Key Dimensions of Programme Sustainability

  4. Programme design should help the organisation grow (services & activities)

  5. Mission BasedProgramme Design Process • Gap analysis: • Assess unmet need in the community • Assess current utilization of Infrastructure and Resources • Set Targets: • Based on community need • Lead to optimum utilization • Strategic approaches to achieve targets • Financial viability: what it takes to provide services/achieve targets and how to meet the expenditure

  6. Leadership should develop right perspective Assumptions about the environment Assumptions about the Mission Assumptions about the core competence Applying it to the “Present” and “Future”

  7. Scale of services helps organisations to build services

  8. Service Effectiveness • Relevance • Standardisation of processes and protocols • Ensure service uptake levels • Quality of diagnosis & treatment • Patient comfort • Outcome

  9. Standardisation Helps in: • Instrumentation • Training • Patient flow • Quality improvements • Patient’s understanding & co-operation

  10. Community: Encourage active community participation and build relationships to provide programme support and influence Health Behaviour

  11. Human resources – Build right mix and adopt team development

  12. Monitoring andInformation system • Performance • Addressing challenges • Monitoring changes & variations • Review effectiveness of the strategies & introduce necessary changes to programme implementation

  13. Financial Viability – Revenue Stream in an Organisation Cost Containment Revenue Generation Implement Low-cost Technologies Self Generated Other Sources Subsidy/Donation Improve Resource Utilization e.g. Rich patients, Support services, Spectacles e.g. Govt, Local NGO, Community e.g. Multilateral, Bilateral, INGO e.g. Sutures, Eye drops, IOL/Specs, Maintenance e.g. Surgeries/Surgeon Operations/bed/year Subsidy Other countries Patient Generated Revenue Subsidy National Variable Cost Fixed Cost Ext. Dependence Self-reliance Diversify the portfolio Continually refine pricing & management processes Sustainability Process

  14. Financial Viability Revenue > Cost of eye care services • Maximize Revenue • Minimize costs Tension: Social obligation Tension: Quality & Patient Satisfaction

  15. Drivers of unit Fixedcosts • Scale: Investment in infrastructure, size of the facility and staffing are the major determinants • Efficiency • Optimum utilization of the infrastructure • Seasonal variations in patient load • Staffing & Staff utilization pattern • Productivity

  16. Drivers of unit Variablecosts • Logistics driven • good inventory management • group purchasing for better price • Good materials management (reduce wastage in storage & pilferage) • Cost engineer your clinical protocol • Eliminating unnecessary investigations, procedures & medications

  17. What are Patient costs? Hospital’s perspective: • Hospital Charges • Medication ?? Patients’ perspective: • Cost of care • Transportation • Food • Lost wages • Cost of accompanying person • Family visits • Follow-up visits • Restrictions

  18. Aravind Eye Hospital - Theni • Location: 80 km, west of Madurai • Service area population • Theni District : 1 million • City Population : 111,500 • Kerala districts : 3.2 million • 55% of population in rural area Human Resources: Ophthalmologists : 2 Residents : 7 Clinical staff : 37 Administrative staff : 29 • Total Beds: 63 + 100 • Paying : 40 (22 %) • Free walk-in : 23 • Camp : 100 • Patient Fee Strucutre (US$): • OP Consultation: • Paying: 1.00; Walk-in: Free • Cataract: • Camp: US$ 0 (- US$ 6) • Subsidized: US$ 17 • Paying: US$ 30 - $ 380 Services offered: Cataract; Refractive Errors; Glaucoma; Medical Retina & Lasers

  19. Pricing as a strategy - Aravind Eye Hospital Theni All Financial figures are in US$

  20. Sustainability Doing Good and Doing Well- Creating a Win –Win Paradigm

  21. Cost – Definitions • Capital cost:Cost of Land, Building, major equipment, etc • Recurring cost: Ongoing cost of providing the services • Fixed Cost: Costs that have to be incurred regardless of the level of activity • Variable cost: Costs that vary directly with the level of activity • Unit cost:(Fixed cost + variable cost) per unit of service

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