Aravind Eye Care System

1. Aravind Eye Care System “restoring vision to millions”

2. What does it mean to be blind?

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

6. 200 million need eye care in India Less than 10% have been reached

7. Aravind Genesis

8. Aravind’s Vision • “To eliminate needless blindness by providing high quality, high volume, compassionate eye care to all”

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

11. Hospitals (7) Aurolab Training AMECS 2 Hospitals Eye Bank “Aravind Eye Care System” LAICO IT Out Reach Research Aravind Eye Care System, 2011

12. Total Surgeries & Lasers till March 2011: 4,018,295

13. 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

14. Building Blocks of Aravind • Value System • Delivery System • Innovation

15. How Dr. V built the Organization Guiding Philosophy “… 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 • Aravind’s Guiding Values: • Compassion/Dignity • Equity • Transparency • Sharing • Translated to action: • Eye care to all - Equity • Standardization - Transparency • Affordability • Accountability

16. 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)

17. Reaching the unreached

18. Breaking the access barriers 2010 Jan - Dec: • 2244 screening eye camps • 1384 Comprehensive • 316,148 patients examined • 58,665 spectacles dispensed • 74,764 surgeries performed

19. Effectiveness of screening camps? • We reached only 7% of those in need of eye care1 • 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

20. Solution 1: Primary eye care centers • 36 centers covering a population of 2 million • Approx. 400,000 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

21. Solution 2:Taking super-specialty care to villages

22. Impact – reaching the unreached • Increased awareness • Influencing health-seeking behaviour • Creating access • Community participation • Growing the market (reaching the unreached)

23. Addressing resource scarcity

24. Efficiency - Surgical Productivity

25. Aravind (Wo)manpower • 300+ village high school girls selected each year • Value fit over skill fit • 60% of Aravind’s 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

26. Surgeon Productivity: A comparison

27. Surgical Quality2

28. Making it affordable 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 • For the patient & the community • For Aravind (to be sustainable) • When most can’t pay

29. Surgery mix: 2009 -2010 Through a unique fee system & effective management, Aravind provides free eye care to 50% of its patients

30. “Eliminating needless blindness” requires going beyond Aravind

31. 270 Eye Hospitals worldwide Creating Competition “to eliminate needless blindness”

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

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

34. Genetics DrugTrials Epidemiology Proteomics OperationsResearch CellBiology GLPFacilities RCT Pharmacology Biostatistics Microbiology ProductDevelopment Immunology Information Technology Dr. G. Venkataswamy Eye Research Institute

35. Is it applicable to developed countries & outside of eye care? Broader Relevance?

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

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

38. Why is the cost 100 times more? • It is beyond the simplistic “UK isn’t India” • Consider: • Efficiency • Clinical process • Cost of supplies • Regulations • Defensive medicine

39. Insights • Cost control • Efficiency Compassion • Patient centered care Owning the Problem • Achieving scale • Focus on quality • Productivity Conditions Solutions • Large population • Cuts across all economic strata • Equity issues • Cost-effective interventions

40. 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

41. Pursuing Our MissionEliminating needless blindness much has been done and much remains to be done . . .

42. “Intelligence & Capabilities are not enough. There must be the joy of doing something beautiful..” Dr. V Thank You