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“Innovative Designs for Providing Health Care: Systems Approaches”
Dr.R.KimAravind Eye Care System
Madurai,India
Blindness Magnitude
•
45 million blind, worldwide
•
12 million blind in India
Most of the blindness is avoidable …
Simple Cataract Surgery A pair of spectacles
Will restore vision to7.5 million
Will restore vision to 2.4 million
India: Population 1.1 Billion 200 million need eye care
India: Population 1.1 Billion 200 million need eye care
Conditions at the ‘bottom of the pyramid’
•
Large underserved population
•
Poor logistics
•
Low affordability
•
Resource scarcity (Capital and HR)
(Based on analysis by Prof. C K Prahalad)
Dr.Venkatasamy, feeling the urgent need, started an eye clinic in 1976 on his retirement with 11 beds, to create an alternate, sustainable
eye care system to supplement the government’s efforts
In a developing country with competing demands on limited
resources, government alone cannot meet health needs of all.
Tamil Nadu
Pondicherry (2003)
Coimbatore (1997)
Theni (1984)
Madurai (1978)
Tirunelveli (1988)
Aravind Eye Hospitals
5 eye hospitals4000 beds37 primary eye care
centers 2 managed eye
hospitals
5 eye hospitals4000 beds37 primary eye care
centers2 managed eye
hospitals
Out Patient Visits - 2,390,958
Our Challenges
•
Creating access
•
Ensuring quality
•
Making it affordable
Universal concerns ?? - variable levels
Addressing the access barriersCommunity Outreach
•
40‐45 screening camps/week
•
Community Participation
•
Free surgery, food & transportation
Performance of Outreach in 2008-09No.of Screening Camps 2,131
Eye Camp Out-patient visit 676,281
Surgeries through Eye Camps 70,798
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
Solution 1: Primary eye care centers
• 37 centers covering a population of 2
million
• 40% penetration within the first year
• Everyone receives telemedicine
consultation
• Online health records
Performance – 37 Centers
•
Every day we do video‐consult 600 patients
•
70 to 80 are given corrective glasses•
35 to 40 patients are advised
surgery•
35 to 40 diabetics are counselled
regarding DR
•
Goes to remote places
•
Known diabetic pts. Fundus images are taken
•
Recorded in a specialized software and transmitted to the Reading Grading Center at the Base Hospital
Solution 2: Taking advanced care to villages
Impact – reaching the unreached
•
Increased awareness
•
Creating access
•
Influencing health‐seeking behaviour
•
Community participation
•
Growing the market (reaching the unreached)
ARAVIND EYE CARE SYSTEM
Quality - Dimensions
Ensuring good outcomes overall
Good Medicine
Monitoring Complication
Clinical Protocol
Patient Compliance
To treatment
or surgery
To follow-upTo
treatment or
surgery
To follow-up
Complication Score Over a Time Period
Patient is an equal partner in the treatment process
Patient counselling
•
Clinical procedure / pamphlet
•
Length of stay & cost
•
Post op. Instructions
•
SMS reminders
Ensuring QualityEnsuring Compliance
Making it Affordable
When most can’t pay
Making it Affordable - Dimensions
Making it Affordable
Hospital
Cost Efficient & Quality
Pricing - Willingness to
pass on the savings
Patient
Holistic Perception of
Costs & Systems
Design of
Services
Achieving Cost-efficiency
•
Managing Bottlenecks
•
Eliminating waste–
Idling of resources
–
Inappropriate use of resources
•
Ensuring high quality–
Doing it right every time
–
Building patient trust & compliance
Efficiency
Scenario A B
Surgeon 1 1
Tables 1 2
Scrub nurse 1 2
Instrument sets 1 6
Surgeries/hour 1 6 - 8
Surgical Productivity
Aravind (Wo)manpower
•
300+ village high school girls given job specific training each year
• Perform most of the routine clinical tasks
•
Results in higher quality, productivity and lowers cost
Surgeon Productivity: A comparison
Processes to minimize “Patients’ Costs”
•
Completing all investigations on a
single visit
•
Eliminating unnecessary tests
•
No waiting list
•
Minimizing length of stay
Costs of Access, Lost wages, & incidental expenses can be significant
NHS*-UK vs. Aravind
No. of eye surgeries
59%
(*National Health Service – Main provider of Healthcare in UK)
Cost of delivering eye care< 1% of what it costs in UK
Summary
•
Addressing these issues –
of access
–
ensuring quality, resulting in high productivity
•
helped us to bring down the cost and make the eyecare affordable in our
setting.
“When you grow in spiritual consciousnessWe identify with all that is in the worldSo there is no exploitationIt is ourselves we are helpingIt is ourselves we are healing”
‐
Dr. G. Venkataswamy
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