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“restoring vision to millions”

“restoring vision to millions”. Aravind. What does it mean to be blind?. Loss of Vision deprives one of the l ivelihood , economic independence, self-esteem & status in the community. Kuppammal is one of the…. 45 million blind, worldwide 12 million blind in India.

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“restoring vision to millions”

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  1. “restoring vision to millions” Aravind

  2. What does it mean to be blind?

  3. Loss of Vision deprives one of the livelihood, economic independence, self-esteem & status in the community

  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. 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 government’s efforts

  8. 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

  9. Aravind’s 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. Hospitals (5) Aurolab Training AMECS 4 Hospitals Eye Bank “Aravind Eye Care System” LAICO IT Out Reach Research Aravind Eye Care System, 2009

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

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

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

  18. 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

  19. 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

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

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

  22. Efficiency Surgical Productivity

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

  24. 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

  25. Surgeon Productivity: A comparison

  26. Surgical Quality2 2 “Fortune at the Bottom of the Pyramid” by C. K. Prahalad

  27. Making it affordable • For the patient & the community • For Aravind (to be sustainable) • When most can’t pay ARAVIND EYE CARE SYSTEM

  28. 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

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

  30. “Eliminating needless blindness” requires going beyond Aravind Creating competition Making eye care affordable worldwide

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

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

  33. 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

  34. Impact of Capacity Building ProcessCataract Surgery (40 Hospitals) Capacity Building 91445 Cost Recovery 90% 76995 52506 Cost Recovery 60%

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

  36. 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

  37. Intraocular Lens Division Pharmaceutical Division Suture Division Blades Division Instruments Division

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

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

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

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

  42. 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 ARAVIND EYE CARE SYSTEM

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

  44. Aravind’s Evolution

  45. 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

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

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

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

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