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“restoring vision to millions”Aravind
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What does it mean to be blind?
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Loss of Vision deprives one of the livelihood, economic independence, self-
esteem & status in the community
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Kuppammal is one of the…
• 45 million blind, worldwide• 12 million blind in India
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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
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200 million need eye care in IndiaLess than 10% have been reached
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GenesisIn 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
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“… 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
Guiding PhilosophyHow Dr. V built the Organization
Translated to action: Eye care to all - Equity Standardization - Transparency Affordability Accountability
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Aravind’s Vision
“To eliminate needless blindness by providing high quality, high volume,
compassionate eye care to all”
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Aravind Eye Clinic, 1976
11-bed clinicPost-retirement project of Dr. V
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Aravind Eye Care System, 2009
Eye Bank
Hospitals(5) Aurolab
Out ReachResearch
“Aravind Eye Care System”
LAICOIT
Training
AMECS4
Hospitals
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Aravind Eye Hospitals
4000 beds in5 eye hospitals
Tamil Nadu
A m e t h iL u c k n o w
A m r e l i
K o l k a t a
C o i m b a t o r e
M a d u ra i
Po n d i c h e r r y
T i r u n e l v e l i4 managed eye hospitals33 primary eye care centres
T h e n i
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Total Surgeries & Lasers till March 2009: 3,400,632
19781980
19821984
19861988
19901992
19941996
19982000
20022004
2006 - 07
2008 - 09
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
Paying Free
40% 60%
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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
administratorsMaking Aravind the largest provider of eye care services
and trainer of eye care personnel in the world
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Building Blocks of Aravind
Value System Delivery System
Innovation Dr. G. Venkataswamy
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The need to innovateMarket 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)
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Breaking the access barriers
2008-09:• 2131 screening eye camps• 676,281 patients examined• 61,021 spectacles dispensed• 70,798 surgeries performed
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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
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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
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Solution 2:Taking super-specialty care to villages
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Impact – reaching the unreached• Increased awareness• Influencing health-seeking behaviour• Creating access• Community participation• Growing the market (reaching the unreached)
ARAVIND EYE CARE SYSTEM
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Efficiency
Scenario A B
Surgeon 1 1
Tables 1 2Scrub nurse 1 2
Instrument sets 1 6Surgeries/hour 1 6 - 8
Surgical Productivity
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Aravind (Wo)manpower
• 300+ village high school girls selected each year• Value fit over skill fit
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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
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Surgeon Productivity: A comparison
India
Aravind
Bangladesh
Thailand
Indonesia
0 500 1000 1500 2000 2500
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Surgical Quality2
Adverse Events During SurgeryAravind, Coimbatore
N=22,912UK National Survey
N=18,472
Capsule rupture and vitreous loss 2.0% 4.4%
Incomplete Cortical Clean up 0.75% 1.00%
Iris Trauma 0.3% 0.7%
Persistent Iris Prolapse 0.01% 0.07%
Anterior Chamber Collapse 0.3% 0.5%
Loss of nuclear fragment into vitreous 0.2% 0.3%
Choroidal Haemorrhage ------ 0.07%
Loss of intra Ocular lens into vitreous 0.01% 0.16%Aravind’s complications are less than half of those in UK
2 “Fortune at the Bottom of the Pyramid” by C. K. Prahalad
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Making it affordable• For the patient & the community• For Aravind (to be sustainable)• When most can’t pay
ARAVIND EYE CARE SYSTEM
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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
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Financial Results
80-81
81-82
82-83
83-84
84-85
85-86
86-87
87-88
88-89
89-90
90-91
91-92
92-93
93-94
94-95
95-96
96-97
97-98
98-99
99-00
00-01
01-02
02-03
03-04
04-05
'05-06
'06-07
07-08
08-09
0
5
10
15
20
25
30
ExpenseRevenue
Free (Camp) 33%Paying 45%
Free (Direct) 22%
Surgery mix in 2008 -09Year: 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
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“Eliminating needless blindness” requires going beyond Aravind
Creating competitionMaking eye care affordable worldwide
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Creating Competition “to eliminate needless blindness”
270 Eye Hospitals worldwide
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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
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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
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Impact of Capacity Building ProcessCataract Surgery (40 Hospitals)
0
20000
40000
60000
80000
100000
1 yr Before 1 yr After 2 yrs After
52506
Cost Recovery
60%
91445
Cost Recovery
90%
76995
CapacityBuilding
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Established in 1992 to address the high cost of ophthalmic supplies which had to be imported
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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 Aurolab’s lenses
7% of global market
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Intraocular Lens Division
Pharmaceutical Division
Suture Division Blades Division
InstrumentsDivision
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Dr. G. Venkataswamy Eye Research Institute
RCT
Epidemiology
Operations Research
Biostatistics
Genetics
Proteomics
Cell Biology
GLP Facilities
Pharmacology
Microbiology
Immunology Information Technology
Drug Trials
Product Development
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Broader Relevance?
Is it applicable to developed countries&
outside of eye care?
ARAVIND EYE CARE SYSTEM
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NHS*-UK vs. Aravind
No. of eye surgeriesOphthalmologists
graduating annually
71%59%
(*National Health Service – Main provider of Healthcare in UK)
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Cost of delivering eye care< 1% of what it costs in UK
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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
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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
Conditions Solutions
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Aravind’s Evolution1st Decade(1978-1987)
Setting up & developing hospitalsComing into existence Community outreachFocus on Cataract Services
2nd Decade(1988-1997)
Refining & Scaling up internallyMore Hospitals – TVL, CBEEstablishing Aurolab & LAICOEducation and Training
3rd Decade(1998-2007)
Foundation for scaling up externallyExtensive capacity building workExperimenting with Managed HospitalsRapid Growth in Specialty Care Focus on Research
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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
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STILL… This is the Current Reality!
Courtesy: Allen Foster
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Pursuing Our MissionEliminating needless blindness
much has been done and much remains to be done . . .
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“Intelligence & Capabilities are not enough. There must be the joy of doing something beautiful..”
Dr. V