arvind eye hospital by virajsinh mahida m.pharm+mba

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EYE HOSPITAL

Aravind

VIRAJSINH MAHIDANMIMS

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The Problem…….Magnitude of Blindness

World wide 4.5 crore people

are blind

1.2 crore are in India

300,000 of them are children

India has more blind people

than any other country

4.5 Crores blind

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Most of it is unnecessary

Will restore vision to 75 lakhs

Simple Cataract Surgery

Will restore vision to 25 lakhs

Refraction and pair of Spectacles

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ARAVIND EYE HOSPITAL

• Aravind Eye Hospitals are the expression of a vision quest, a response to the silent

call of thousands who have lost their sight.

• Under the leadership of Dr. G. Venkataswamy, Aravind Eye Hospital was founded in

Madurai in 1976 with the mission to eliminate needless blindness in Tamil Nadu.

• Today, Aravind’s innovative eye care delivery system is recognized as a model for

other developing countries. Much importance is given to ensure that all patients are

accorded the same care and high quality service, regardless of their economic status.

• As a result of a unique fee system and effective management,

Aravind is able to provide free eye care to 60% of its patients

from the revenue generated from the other 40% from its paying

patients.

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Mission Statement

“To eradicate needless blindness by providing appropriate,

compassionate and high quality eye care to all.”

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Guiding Philosophy

Aravind Eye Hospitals are named after Sri

Aurobindo, one of the 20th century’s most revered

spiritual leaders. In essence, Sri Aurobindo’s

teachings focus on mankind’s transcendence into a

heightened state of consciousness through service, as

an instrument of, what he called, the Divine Force.

At Aravind one finds, combined with modern

technology and management practices, a measure of

compassionate spirituality, awareness beyond the

matter-of-fact, and the impetus of a mission.

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Govindappa Venkataswamy (October 1, 1918 – July 7, 2006) was an

Indian ophthalmologist and 1973 recipient of Padma Sri award. Dr

Venkataswamy was the founder of Aravind Eye Hospitals, which are

one of the biggest network of ophthalmology hospitals in the world

and perform nearly 5 percent of all eye surgeries in India.

Born in 1918 in Vadamalapuram, Tamil Nadu, India, Ravilla

Govindappa Venkataswamy was educated at American College,

Madurai and Stanley Medical College, Madras, before qualifying with

a MSc in Ophthalmology at the Government Ophthalmic Hospital,

Madras.

He served with the Indian Army as a Physician during 1945-48 when

he was discharged due to rheumatoid arthritis. During this time Dr V,

as he is referred as, was practically bed-ridden, unable to perform

basic functions such as standing on his own.

Founder Of Aravind Eye Hospital

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Continue..

It is a pure testimony to his willpower and diligence that he was not

only able to hold a pen again but also perform delicate surgeries. He

then joined the Government Madurai Medical College as the Head

of Department of Ophthalmology and the Government Hospital,

Madurai as eye surgeon. He held these posts for 20 years and

contributed to research, clinical service and community

programmes.

He became the Head of the Department of Ophthalmology at the

Government Madurai Medical College in 1956. He performed over

100,000 successful eye surgeries, and this despite having fingers

that were badly affected with a rare disease. During this period, Dr

V addressed the problem of preventable blindness by initiating

mobile clinics in far-flung villages and rural areas

As a young man he followed the teachings of Gandhi and Sri

Aurobindo Ghosh.

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Continue..

Dr V met Sir John Wilson, founder of the Royal Commonwealth Society for the

Blind(later known as Sight Savers International), an organization that was

supporting eye camps in India, during his first visit to USA in 1965 and this was

the beginning of a lifelong friendship. The duo approached the then prime

minister of India, Mrs Indira Gandhi, to establish a national level organisation to

control blindness.

In 1977, at the mandatory retirement age of 58, Venkataswamy founded the

Aravind Eye Hospital at Madurai. Begun as an

eleven-bed hospital manned by four medical officers,

it is now one of the largest facilities in the world for

eye care.

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He declared that the mission of the hospital was “to eradicate needless blindness”

and developed mass marketing and surgical processes resembling an assembly line

in order to assist with the estimated 12 million blind people of India, 80 per cent of

whom suffer so because of cataract. While working for the government, Dr V

oversaw the growing number of eye camps in the state of Tamil Nadu and

developed a big network of friends and well wishers who would join in or support

his cause in later years. His system enabled Aravind to provide free eye care to two-

thirds of its patients from the revenue generated from its one-third paying patients.

Venkataswamy was conferred Padma Shri by the Government of India in 1973.

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In 1976…..

Dr.V feeling the urgent

need ,started an eye clinic

with 11 bed , to create an

alternate eye care sytem

to supplement the

government’s efforts

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McDonald‘s of cataract surgery

With the aim of providing affordable eye care services to a country which has about 20 million

blind citizens and 80% of it due to curable cataracts, at the age of 58, Dr. V. Started, the Aravind

Eye Hospital.

Popularly known as the McDonald‘s of cataract surgery, with a bed strength of more than 4000

beds and serving 0.25 million patients every year, this is one of the world‘s largest eye care systems

catering largely to the poor population.

Poor people with cataract can regain their eye-sight at a price as low as $40 or even free, if they

can‘t afford. It was demonstrated by this non-profit system that it is practically possible to combine

high quality, low cost, world scale and sustainability.

It has been seen as a unique business model by many Organizations and has proven that care

provided at low cost can also yield sustainability and even profitability.

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Dr. V. created a system for sight-saving cataract surgeries that

produces enviable medical outcomes in one of the poorest regions of

the globe

His model became the subject of a Harvard Business School case

study, and is being copied in hospitals around the subcontinent.

The cheap, high-quality implantable lenses the system manufactures

are exported to more than 80 countries around the world.

Dr. Venkataswamy's basic insight was that health care can be

marketed to the poor if a program is closely tailored to a local niche,

something that has come to be known as social marketing

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Dr. V commented to the Harvard Business School researcher who conducted a case

study in 1994. "Can't we do what McDonald's and Burger King have done in the

United States?"

He found inspiration in McDonalds, the fast food company which has managed to

spread its golden-arched empire across the planet based on systematic, high volume

production of a range of meals offered at low cost.

Central to their success is the idea of reproducibility – despite huge variations in the

context in which they are located, all Mc Donalds outlets operate on the same model,

and staff are trained in a core set of skills which are common to all its operations.

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Aravind Eye Hospitals

THE BEGINNING

The problem of avoidable blindness rapidly escalating remained a major cause of

concern in the Indian healthcare scenario. In a developing country the government

alone cannot meet the health needs of all owing to a number of challenges like

growing population, inadequate infrastructure, low per capita income, aging

population, diseases in epidemic proportions and illiteracy.

Realizing this, Dr. Venkataswamy wished to establish an alternate health care model

that could supplement the efforts of the government and also be self-supporting.

Following his retirement at age 58 in 1976, he established the GOVEL Trust under

which Aravind Eye Hospitals were founded.

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aravind Eye HospitalsTHE BEGINNING

The GOVEL Trust was created as a non-profit trust, with Dr V as

Chairman and his two brother, two sisters and their spouses and an ex

officio member, the Madurai Main Rotary President as trust members. Dr

V started with a modest 11-bed hospital, in Dr V brother's home at

Madurai, after most banks refused to lend him money because of his age

and eccentric model.

In this hospital six beds were reserved for people who could not afford to

pay while the remaining five were for paying patients. He had to mortgage

all the jewellery of his family members to raise funds to start the first

hospital. The hospitals were named after Sri Aurobindo, one of the 20th

century's most revered spiritual leaders.

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Growth

1977- First 30 Bed Hospital opened at Madurai,

the third largest city in Tamil Nadu

1978- 70 Bed Hospital, exclusively for free

patients

1981- Existing paying hospital building expanded

to 250 beds and 80,000 sq. ft. of space over five

floors

1984- A new 350-bed hospital opened exclusively

for free patients in Madurai

1985- 100-bed hospital at Theni, a small town 80

km west of Madurai

1988- 400-bed hospital at Tirunelveli, a town 160

km south of Madurai

1997- 874-bed hospital at Coimbatore

2003- 750-bed hospital at Pondicherry

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aravind Eye care System

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HOSPITAL SERVICES

HOSPITAL SERVICES

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HOSPITAL SERVICES

Main Hospital– Independent functioning

– ICCE surgery cost – Rs 500 to Rs 1000

– ECCE surgery cost – Rs 1500 to Rs

2500

– Expenses include surgery, stay,

medicines etc

– Patients guided at each step by several

support staff

– Experienced doctors and support staff

– Hassle free check ups, diagnosis and

surgery

Free Hospital

– Completely free

– Mostly ICCE surgeries

– ECCE if medically recommended

– Dealt with more patients

– Doctors and staff experienced and

compassionate

– Complications, if any, monitored

carefully

– People from same communities placed

together

A unique model of eye care service gives free medical and surgical treatment to 60% of the patients from the revenue, generated by the remaining 40% who can pay.

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FEE STRUCTURE

• Fee for service: 35% of patient care

• Free/Subsidized service: 65% of patient care

• Separate facilities for the paying and free patients

• High Volume – High Quality eye care

• The patient chooses where to get his/her care.

• The care provided is of the same quality but the facilities

provided are different based on the pricing.

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FEE STRUCTURE

Consulting fee Poor Patients : Rs 0 Paying Patients : Rs 50

Cataract Surgery with IOL Poor Patients : 0 (*250 Rs) Subsidized rate : RS 750 Regular rate : Rs 3,500 - 6,000 Phaco surgery : Rs 6,500 - 12,000

Includes cost for 3 days stay and medicine.

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Sign Board outside Hospital

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OUTPATIENT PROCEDURES

Eye Examination Procedures There are many different eye conditions; you will need to have a detailed eye examination which could take

upto hours,depending on the complexity of tests required. The durations indicated below are an average.

Registration (5 minutes)

On arrival you will be asked to fill in a registration card. Please give your complete permanent address with

telephone number. You will be asked to take a seat until our receptionist accompanies you to your vision test. If

the patient is below 15 years, you will be taken directly to the Paediatric ophthalmology.

Vision test (10 minutes)

Every patient has a simple test to check your level of vision from an eye chart.

Refraction (10 minutes)

A refractionist will place a series of lens in front of your eyes and will ask which looks clearer. This test

determines your exact eye power and determines your level of sight.

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Continue…

Preliminary examination (20 minutes)

An eye doctor will carry out an initial examination of your eyes, please advise the doctor of any previous medical history.

Blood pressure / Eye tension / Sugar test ( 30 minutes)

This is only for patients aged 40+, we will check your blood pressure, intraocular pressure and a urine test for diabetes.

Stages 3 – 5 may happen in any order depending on the patient load.

Dilation (30 minutes)

The doctor in some cases may ask the refractionist to instil eye drops in the eye. This is to make the pupils bigger in order

to get a better view of the inside of the eye. It may take 30 minutes for dilation, you will be asked to wait in the waiting

room during this time. You will experience blurred vision for 2 – 3 hours following dilation.

Final examination and diagnosis (5 minutes)

After all the tests have been carried out the doctor will carry out a final examination and depending on the results you will

be guided to the speciality clinics

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INPATIENT PROCEDURES

Patients who require surgery or monitoring will be asked to get admitted in the hospital. Patients can choose from the

different types of rooms based on the availability. At the time of counseling, the counselors assist in selecting the room,

surgical techniques and implants available. Based on convenience, one can choose the package of choice. Cashless

facilities and reimbursement certificates can be availed as applicable.

Many of the surgeries are being done as day care procedures. Patients undergoing day care procedures need not stay in the

hospital after the surgery. The package charges vary based on the type of accommodation selected for procedures other than

the day care. Following are the different types of accommodation facilities available:

Suite

A Special A/C

A Class(Non A/C)

B Class

C Class

General Ward

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Room types

Suite A Special A/C A class (Non A/C)

B class C class Common ward

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Payment

On admission, a deposit equivalent to or approximate to the treatment or surgery charges will be collected. The balance if any, will

be collected / refunded at the time of discharge based on the surgery / treatment and the type of accommodation chosen. Bills are

payable by cash, with insurance claims, if any. Credit cards are accepted, a 2.3% service charge will be collected.

Discharge Procedure

Patients are requested to vacate the room before 10.00 am on the day of discharge. Instructions regarding post operative care,

medication, discharge summary will be explained by the ophthalmic assistants at the time of discharge.

Room Reservation Facility

Aravind offers a facility for advance room reservation following the doctor's advice to get admitted for surgery or treatment at a later

date.

Support Services

Catering services

Restaurant is located on the ground floor and is open from 6.30 am – 9.00 pm. Breakfast, lunch and dinner are available there.

Medical shop and Optical shop

The medical shop is located on the ground floor, which functions from 7.30 am – 8.00 pm on all working days (Monday to

Saturday) and on Sundays from 9.00 am – 1.00 pm and 3-30 – 5.00pm.

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Assembly line approach

Henry Ford standardised and streamlined automobile production to lower the cost

of his cars enough so that everyone could afford one. Aravind Eye Care Hospitals

has done the same for cataract surgery in India.

The Aravind system relies on intensive specialisation in every part of the workflow

to generate efficiencies. A surgeon, for example, typically performs 150 surgeries

every week, six times the number common among Western specialists

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Assembly line approach

Operation theater- two table side by side(reduces surgery time from 30 minutes, industry standard, to 10 minute).

High surgeon productivity: 2600 surgeries/doctor/year

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At each operating table, there were multiple sets of

instruments and support staff to ensure that the

waiting time between surgeries was almost zero.

The same principle is also applied in the outpatient

examinations: trained support staff carry out all the

routine diagnostic procedures, some of which

tend to be quite time consuming.

ophthalmologists perform only those tasks, such as

surgery or diagnosis, which require good clinical

judgment based on their medical knowledge.

This process not only enhances the utilization but

also improves the quality.

Both of these in turn reduce the cost of care.

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Aravind’s process of readying the patient for surgery, performing the surgery, and

getting the patient through recovery is all configured like a modern assembly line.

So while the average ophthalmologist in India performs about 400 cataract

surgeries a year, an Aravind doctor performs about 2,000.

Much of the efficiency can be attributed to the superbly constructed assembly-line

process, even though the Aravind surgeons, because of their training and long work

hours, perform more surgeries compared to their Indian counter- parts.

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Volume Handled Per Day

6000 outpatients in hospital

4-5 outreach screening eye camp

-examining 1500 patient

-Transporting 300 patient to hospital for surgeory

850-1000 surgeories

This makes Aravind the largest provider of eye care service and trainer of opthalmic personnel in the world

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ENSURING EFFICIENCY AND QUALITY

Practice

Clinical protocol

Standardisation of procedure

Usage and balancing of resource

Surgical technique and technology

Quality and reliability of resource

Medical records

Staff training and discipline

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PLANNING FOR EXPECTED LOAD AND MONITORING

Yearly/monthly planning

Planning for next day-scheduling patient,staff and equipment

Planning for supplies and spares

Ensuring that resources match expected worload

-Weekly report

- Monthly report

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Factors behind level of efficiency

Listed in the order of importance : steady flow of patients—keeping patient supply line busy;

surgical flow, which ensures minimal waiting time between surgeries;

well-trained surgical assistants and adequate staffing;

detailed logistics planning ensuring zero downtime for want of supplies or equipment;

daily micro-planning to match the surgical load to staffing and supply require-ments;

and

surgeons’ skill and stamina.

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Aravind eye hospital

COMMUNITY OUTREACH

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Need for outreach camps

Despite the magnitude of the problem of avoidable blindness in developing

countries, studies have shown that only a small percentage of the people needing

cataract surgery or other treatment actually seek it. Moreover, eye care in the

developing world still suffers from:

Financial and logical barriers to access

Low patient awareness of services available

Low doctor/patient ratio

In other words, it is necessary for eye care institutions to reach out to potential

patients – the "unreached" in order to provide their services to the people who need

them most.

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Screening eye camps

The Aravind Eye Care System considered its community outreach

programmes as absolutely vital to its mission. The only way people in

many rural areas could get access to eye care was through eye camps.

Each Aravind Hospital had its own set of camp organizers who planned

their activities for each calendar year. Generally each district had a camp

organizer who set a target for the year based on the population, estimated

percentage of blind people, estimated turn out at the camps and percentage

needing surgeries.

The camp organizers then had to find the needed sponsors.

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Screening eye camps

Generally, local NGOs, Lions and Rotary Clubs, local industrialists and businessmen and

philanthropists were the sponsors. Sponsors took care of the expenses connected with

publicity such as posters, pamphlets, banners, and announcement from vehicles, and the

organization of the camps (usually in some school or public place).

The camps were held usually on Saturdays and Sundays and started early in the morning.

Lunch arrangements were made for those who were to go for surgery to the hospital. These

expenses were also borne by the sponsors.

Patients requiring surgery were provided free transportation to and from the hospital in

addition to the free surgery, stay, and food in the hospital. This expense is borne by the

hospital. All medication that was needed for 40 days after surgery was also provided free by

the hospital.

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Process:

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Various steps involved in an eye camp are as follows:

Step 1:Patient registration: The camp team, composed of ophthalmologists and paramedical staff, proceed to the campsite. With support from local community, local volunteers (usually students with legible handwriting) record the patient details - name, age and address - in the OP register and case sheet. Patients are given identity cards, which may be used for any future follow-up.

Step 2:Preliminary vision test: Preliminary vision test is performed by ophthalmic assistants. Vision charts, such as the Snellen (in the local language) and E type charts, are used.

Step 3:Preliminary examination: Ophthalmologists perform the preliminary examination. Clinical conditions such as external eye infections, vision loss caused by nutritional deficiency and the incurably blind are examined. After this basic examination with the help of torch light and direct ophthalmoscope, the patients are directed to further steps.

Step 4:Tension and duct examination: Patients above the age of 40 have their intraocular pressure tested. Senior level ophthalmic assistants administer topical anaesthetic drops and measure the intraocular pressure with a Schiotz tonometer. Lacrimal passage is also tested by syringing for the patients with cataract in operable condition. Facilities for the patients to lie on, additional benches for waiting patients, and adequate lighting are ensured.

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Step 5:Refraction: Refraction is performed on patients who have refractive errors, presbyopia, outdated glasses. This process occurs in a simple, prefabricated, dark cubicle which is equipped with one or more foldaway partitions, trial lens sets, and mirrors. Well-trained ophthalmic technicians conduct refraction while volunteers control the patient flow.

Step 6:Final examination: Senior Ophthalmologists evaluate the test findings, perform the final examination (which includes fundus examination on needy patients), review the patient records, make the final diagnoses and prescribe required management which could be , medication, eye glass prescription, surgery or treatment. (In a small camp, one doctor conducts both the preliminary and the final examination.)

Step 7:Counseling: Patients advised for surgery or further specialty interventions are educated by the counsellors to uptake the relevant eye care. Patients who are advised for cataract surgery undergo blood pressure measurement and sugar test. Those who fit for surgery are counselled at the campsite are registered in Inpatients register and transported to the base hospital for surgery. These patients receive surgery, postoperative care, meals, and round-trip transportation all free of cost.

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Step 8:

Optical Services : Opticians (sales person and technicians from optical division)

also attend the screening camp as part of the medical team. A set of frames and

required indent of power glasses are taken to the camp venue. Patients advised to

wear eye glasses may use this opportunity as it is available at affordable price and

receive eye glasses in the camp venue itself. The optician finishes the lens on a

grinding machine, mounts the lens in the frames chosen by the patient.

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COMPREHENSIVE EYE SCREENING PROGRAMMES

Screening Eye Camps

Diabetic retinopathy screening camps

Workplace-based screening eye camps

School children screening eye camps

Paediatric screening eye camps

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OUTREACH STATISTICS PERFORMANCE 2011-2012

Outreach Activity Camps OP All surgeries

Eye Glasses

DR & Other

Conditions

Comprehensive Eye Screening Camps 1,381 312,129 76,033 58,644 -

Diabetic Retinopathy Camps 319 60,335 - - 3,264

Work Place Screening Camps 255 55,276 - 14,243 -

Mobile Refraction Camps 84 6,405 - 1,550 -

Children Screening Camps (in Schools) 468 455,623 - 14,069 -

Children Screening Camps (in Community) 132 29,132 - 569 845

Total 2,639 918,900 76,033 89,075 4,109

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VISION CENTRES

Screening eye camps, conducted with limited infrastructure requirements, is mainly

focused upon reaching out efficiently to more people in rural areas and also encouraging

active involvement of the community.

At Aravind, this allows for the organization of 1300 – 1500 eye camps every year. In

spite of the enormous amount of work done through these outreach camps, recent studies,

clearly show the gross under-utilization of eye care services provided through eye camps.

A mere 7% of the needy population access eye care through screening eye camps though

these camps create a short term access. This shows a strong need for developing

permanent primary eye care services especially in the rural areas to ensure easy access.

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Concept of Vision Centre

The model of vision centre is envisaged by the Vision 2020 – The Right to Sight, a

global initiative of International Agency of Prevention of Blindness (IAPB – a global

machinery working across the world for the prevention of avoidable blindness).

IAPB has unveiled four tier pyramid model to provide eye care for the needy population

where vision centres are at the primary level. Aligning with this initiative, Government

of India is planning to set up at least 20,000 vision centres across the country.

For providing basic eye care services on a permanent basis in villages Aravind has

established more than 40 IT enabled Vision Centres providing telemedicine facility in

various districts of Tamil Nadu.

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Vision Centre

Vision centres are small, permanent facilities set up

to extend eye care service delivery to remote and

rural communities, with the objective of increasing

the uptake of comprehensive primary eye care.

Aravind’s Vision Centres offer innovative internet-

based information technology (IT) that allows

patients in rural areas to be remotely diagnosed by

ophthalmologists at the base hospital. Via high-speed

wireless video-conferencing, doctors can consult with

hundreds of rural patients per day, providing high

quality eye care while eliminating the need for

patients to travel to hospital (unless more advanced

treatment is needed).

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Vision centre

The objective of the vision centres are to

Provide comprehensive care by integrating information technology

effectively that would facilitate providing quality care at the doorsteps of

the rural population.

Collaborate with the community and promote eye health education and

create awareness proactively.

Change the health seeking behaviour of the community and thereby

slowly move away from camps to a sustainable centre based approach.

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Working model of Aravind Vision Centre

Refraction Slit lamp examination

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Videoconferencing software The software used for the tele-

consultation collaboration is Marratech that is built conforming to audio and video (H.263) standards to ensure smooth video and audio transmission, along with data (case sheet data and images).

This software is based on a spoke and hub model whereby all the Vision Centres could interact with each other by logging into the Marratech Manager edition software installed at the base hospital.

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Using a digital camera A regular digital camera, attached to the slit lamp’s eye piece using an adapter ring

(developed at Aravind), is used to capture the images.This arrangement allows for the capture of Retinal Fundus images of the suspected patients.

To a certain extent, these images also allow measurement of disc cupping in order to understand Glaucoma related eye problems. Thus this imaging would help in identifying patients affected by diabetic retinopathy or glaucoma at a very early stage.

Detecting these conditions at an early stage is very crucial to avoid permanent vision loss. The Vision Centre Technician is given extensive training to master the art of capturing images using the digital camera.


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Key achievements of the vision centre

Influencing better health seeking behaviour in the community

These Vision Centres are providing eye care at the door steps of the rural areas -

which ensures compliance to the treatment advice and active follow-up of the

treatment. Previously patients preferred to wait for next camps which is after 3 or 6

months and will have to wait further if they miss one particular camp for any

reasons.

Comprehensive eye care to the community

The conventional camps screen cataract cases and not other eye diseases like Diabetic

Retinopathy, Glaucoma and others, but these centres are permanent and could

provide comprehensive (Preventive, Promotive, Curative and rehabilitative) eye care

to the community. Availability and supply of medicines and spectacles at the centre

ensure the compliance rate of treatments advised.

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Key achievements of the vision centre

Better market penetration The routine eye camp could reach only to 7% of those who need eye care but in

the same area these vision centers could attract 70 to 80% of the people those who need eye care.

Reduction in the health care expenditure Only 7 to 10% of the people gets referred to Base Hospital for further treatment.

Otherwise nearly 90% of the people get treatment at these tele-centres. The patient can thus save the cost towards loss of wages, travel and other incidental expenditures. The vision centres are of great help to older patients who need not wait for an attendant to take them to the base hospitals which is quite far. They can access eye care at these vision centres which will be much more closer to their place.

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Performance of vision centre

Established 40 centres and Reaching nearly 2 million people in rural areas.

• Covering 421 Panchayats.

• 500 to 600 telemedicine consultations each day and treating over 1.5 lakh patients

annually.

• Correcting Refractive Error for 19,000 people per annum.

• Operating for Cataract - 9000 people through Vision Centre per annum.

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COMMUNITY EYE CLINICS

Community eye clinics offer a permanent access point for comprehensive primary

(nonsurgical) eye care, in an underserviced suburban or semi-urban setting less than one

hour’s drive (30 to 60 kilometres) from a base hospital. The community eye centre model is

intended to replace regional eye camps and to manage primary eye care in order to enable the

base hospital to focus on secondary and tertiary care.

The main difference between a community eye centre and vision centres (besides its bigger

size of about 1000 square feet) is the presence of a full-time ophthalmologist in the former set

up. The staff consists of one doctor, five paramedics (2 senior ophthalmic assistants and 3

junior), and one paramedically trained receptionist.

Services offered:

Lab services (urine, blood sugar)

Optical shop

Medical shop

Treatment follow-up

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EDUCATION AND TRAINING


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Aravind Eye Care System is a collaborating centre for the World Health

Organization with a mandate to design and offer training programmes to eye care

personnel at different professional levels, from around the world, in the

development and implementation of efficient and sustainable eye care programs

Aravind’s training programmes cater to all levels of ophthalmic personnel – these

are intended not only for ophthalmologists but also for ophthalmic technicians,

opticians, clinical assistants, outreach coordinators and health care managers.

Aravind offers several structured training programmes

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Institutes:

Lions Aravind Institute of Community Ophthalmology (LAICO)

... through teaching, training, capacity building, advocacy, research and publications

……….LAICO

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LAICO

• LAICO, established in 1992 with the support of the Lions Club International Sight First Programme and Seva Sight Programme.

• Asia's first international training facility for blindness prevention.

• It contributes to improving the quality of eye care services through teaching, training, research and consultancy.

• The objective of LAICO was to improve the planning, efficiency, and effectiveness of eye hospital Activity of LAICO

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LAICO• LAICO offered long term courses in hospital management as well as short

duration skill development courses in the area of community outreach and social marketing and instruments maintenance.

• These courses were offered at very reasonable prices.

• LAICO had already worked with 149 eye hospitals in India, Africa, and South East Asia.

• LAICO had made interventions in UP, West Bengal, Orissa, Delhi, and a few other states in India.

• It had also made interventions abroad in different countries among which were Malawi, Kenya, Zimbabwe and Zambia.

• LAICO in collaboration with International Agency for Prevention of Blindness (IAPB) had committed to achieving the “Vision 2020

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Training Courses offer & Fees

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AUROLAB

AUROLAB

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AUROLAB

the cost of surgery was always a central concern at AEH. As noted earlier, AEH had decided on the IOL

technique as the standard technique to be adopted in all cases (except in those where this could not be

done).

But in the eighties, the cost of IOL lenses (all of which were imported) was very high, about $80-100,

and this made the cost of surgery quite high. Hence in 1991, AEH set up a facility to manufacture

lenses.

Named Aurolab, this was set up as a separate no-profit trust with the mission of achieving “local

production at an appropriate cost”. Some of the members of the Aurolab Board were common with

Govel Trust. The technology was obtained from “IOL International”, Florida, USA., with a one-time fee

paid to the company for technology transfer along with a buy back arrangement. This helped in

maintaining quality using the feed back given.

This venture was also supported by Seva Foundation, Sight Savers International, the Combat Blindness

Foundation USA, Canadian International Development Agency (CIDA) through Seva Service Society

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Raw material for the lenses was imported from US/UK. The rigid IOL were sold for less than US $5

at Aurolab.

In 2002, Aurolab produced about one sixth of the total number of low end lenses produced in the

world. However, it also produced rigid and foldable lenses as well as superior categories such as

acrylic lenses. Aurolab had been able to get the CE Mark (a mark of quality) and ISO 9002

certification. As on 2003, Aurolab produced about 600,000 lenses per year (with single shift working).

Large nongovernmental organizations such as CBM, Lions and Rotary also bought IOL lenses from

Aurolab and supplied it to various eye hospitals all over the world. This increased sales worldwide

and 33 percent of the IOL’s produced were exported. Of the remaining 67 percent of the lenses

produced, 20-25 per cent was consumed by AEH and the rest were sold in open markets in India.

Since inception Aurolab had supplied more than 2 million lenses to non-profit organizations in India

and 120 countries.

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MISSION- PURPOSE -VALUES

MissionEliminating needless blindness by making high quality ophthalmic products affordable and accessible to vision impaired world wide.Purpose

To address relevant societal healthcare needs in an exemplary and sustainable manner

Core Values

• Innovative solutions

• Emerging opportunities

• Excellence

• Nurturing employees

• Simplicity

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Intraocular lens

Instruments Sutures and Ring Blades

Pharmaceuticals

http://www.aurolab.com/

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Eye Bank

EYEBANKS

I am still alive….please use me!!

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Eye Bank

In India, the need for corneas for sight restoring surgeries is one lakh per year.

According to the Eye Bank Association of India, the number of eyes collected in

2010 is 41,549.

Started in 1998 at Madurai with just a collection of 253 eyes, now the eye banks

across the Aravind Hospitals procure more than 4000 eyes and perform about 1400

corneal transplants annually. Eye balls which cannot be used for transplants are

effectively used for various research and development programmes.

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Eye Bank

Aims & Objectives

To procure, process and distribute corneal tissues of the highest

quality for transplantation

Provide eye tissues for research and training

Provide support and grief counseling to donor families

Promote awareness programmes among the public

Functions of Eye Bank

Procurement of eyes

Processing of eyeballs

Distribution of Corneal tissues

Training to Eye Bank technicians & corneal surgeons

Promote public relation activities

Provide eye tissues for Training & Research

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PUBLIC AWARENESS - EVENTS

Promotion of Public Awareness through

Mass Media: Cable TV, Cinema slides, Newspaper articles

Awareness Lectures to clubs, voluntary organisations, teaching institutions and

other service organisations

Posters display

Distribution of pamphlets

National Eye Donation Fortnight celebration

Pledging or Registration

In house exhibits

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Honoring the donor family

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Honoring the donor family

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……by providing evidence through research and evolving methods to translate existing evidence and knowledge into effective action

AMRF - Research

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• A number of clinical, population based studies and social and health systems research were conducted using the data readily available in the hospitals and the community outreach programs.

• The Aravind Medical Research Foundation coordinated the research needs. Many of these research projects were supported by different agencies and some by AEH itself.

• The combination of high clinical load, extensive community participation, and access to a large network of eye hospitals provides ideal opportunities for conducting clinical, laboratory, population-based studies and social and health systems research.

• Dr. VR. Muthukkaruppan, provide leadership to the research efforts of Aravind Medical Research Foundation.

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Rotary Aravind International Eye Bank.

• This Eye Bank established in 1998, was one of the four eye banks in the country affiliated to the International Federation of Eye Banks.

• Till 2003, the Bank had processed 4383 eyes; the hospitals had conducted 2181 transplants.

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Aravind Centre for Women, Children and Community Health

• The centre, started in 1984, aimed at reducing nutrition related blindness in children through programs of preventive health care.

• It worked with government public health programs of immunization, education programs on nutrition and training programs to create awareness.

• It conducted regular village health programs and training programs for village health care workers.

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Aravind TeleophthalmologyNetwork - ATN

Aravind TeleophthalmologyNetwork - ATN

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Objectives of Tele-Ophthalmology

To make eye care service accessible and affordable by reducing travel cost and time

for the patients.

To enable people at remote areas have access to specialized eyecare facility

To act as an interface between doctors to share their experiences.

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TELEMEDICINE LEVELS OF EYE CARE DELIVERY

Primary eye care- Screening

for common eye diseases

Secondary

Tertiary

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Primary eye care

Internet Kiosks Multiple internet kiosks have been set in

rural villages. Have internet access through

WLL( Wireless Local Loop) Run by local person trained for this

purpose Income generation

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Taking eye care to doorsteps…n-Logue: Internet Kiosks

Experts replies to the patient by mail

Public Internet

Kiosks sends patient information through email

Step 1 Step 2 Step 3

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Taking eye care to doorsteps…n-Logue: Internet Kiosks

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Secondary care

Vision Centres

Mobile screening Unit

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Aravind Vision Centres

1. Comprehensive primary eye care in rural area2. Exploiting IT for rural eye care service delivery3. Tele-consultation: Vision centre technician with ophthalmologists4. Available on a permanent basis5. Refraction and school screening6. Community participation

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Tele-consultation

Screened byparamedic at VisionCentre

Wireless connectivity@ 4mbps

Consultation by

Ophthalmologist at

Aravind Eye Hospital

Theni

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Technology

WiFi 802.11b Low cost

Unidirectionalantenna

Line of Sight Upto 25Km

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Eye Screening going mobile!!

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Advanced Eye Screening Unit – Mobile Van

Mobile Clinic has a VSAT antenna provided by Indian Space Research Organization (ISRO). This antenna can be used for voice, data transmission and Video conferencing.An ophthalmic technician takes the retinal images of the diabetic patients using a special digital fundus camera.

The fundus (retinal) images are stored in a software-DRAGON (Diabetic Retinopathy Assessment & Grading Over Network) designed for this along with patients’ demographic data.Video conferencing facility is also available by which the retina specialist at the base hospital can see and talk to the patient in the van directly.This data is then transmitted to the Reading and Grading Centre at the base hospital in Madurai.

The Reading centre at the base hospital in Madurai has multiple terminals to receive the images. The Grader grades by using the special software. The software supports the grader to elicit the severity level of Diabetic Retinopathy and suggests further management. This is verified by the Retina Specialist.

The diagnosis and advice will be given in a report format and sent to the van.At the van this report is printed and given to the doctor/ patient for further followup. This advanced eye screening unit will benefit the diabetic patients to get the experts opinion immediately and also the patients need not travel to the tertiary center for screening.

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Leveraging Technology

Information Technology

offers great opportunity to

reach the population, rich

and poor, rural & urban,

with facilities for good eye

care at appropriate cost

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Eyestalk

Recent advancements in tele-medicine break through barriers of distance and time

and in the field of eye care they present a whole new array of exciting possibilities!

Riding the wave of this new revolution is eyesTalk, free software that enables

ophthalmologists anywhere in India and the rest of the world to receive second

opinions/expert diagnoses from medical professionals of the Aravind Eye Care

System.

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What is eyesTalk and what can it do?

Basically eyesTalk is dynamic software that makes it safe and simple to send

complete patient consultation records along with images from ophthalmic

diagnostic equipment like slit lamps, fundus imaging, ultrasound etc. to specialists

at Aravind for diagnosis/second opinion.

The software allows you to maintain complete confidentiality of patient

information and creates a database for these consultations that automatically

updates itself in your system. To use eyesTalk all you need is a regular telephone

line and a computer with a dial up modem.

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Salient Features of eyesTalk

Uses conventional Internet Protocol (IP) for data transmission

Ensures privacy and security of patient data through appropriate encrytion

Allows comprehensive patient data entry through specialty-specific templates

(separate entry sheets for retina, uvea, glaucoma, cornea etc)

Does not require system to be constantly online

Provides automated uploading and downloading of data when connected to the

Internet

Company Logo Flow Chart explaining eyesTalk work flow

eyesTalk is software which uses Store and Forward technology. This software

supports the integration of digital ophthalmic imaging equipments to capture

images. With the help of this software all the clinical data pertaining to a patient

can be sent to AEH along with eye images.

A specialist sitting in AEH will diagnose the problem and send back the treatment

advice to referrer immediately. At the Referrer end the doctor requires a computer

attached to the ophthalmic equipment to capture images and a dial-up internet

facility to transfer the captured information to the experts.

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Company Logo Patient Flow

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Company Logo Adres - Aravind Diabetic Retinopathy Examination Software

The current gold standard for diagnosing the condition is through fundus photography; comparing the fundus pathology with that seen on stereoscopic viewing of seven standard photographs for grading retinopathy or through flourescein angiographic diagnosis.

Telemedicine has resulted in new possibilities such as capturing images at a remote location and transmitting them to a skilled grader at a specialist center.

While reducing costs and maintaining good quality care,4 this intensifies the need to validate digital images as a tool for diagnosing diabetic retinopathy and following its progression

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Company Logo TELE EDUCATION

Aravind’s Online Virtual Ophthalmic Academy was inaugurated on January 19, 2008 by Dr. A.P.J Abdul Kalam, former President of India.

Aravind is working with ISRO which provides support for the development of the complete software and systems that would facilitate the functioning of the Virtual Academy. A data centre has been set up at Aravind-Madurai with high capacity servers (comprising of minimum 5 servers) that have the following as components:

- Virtual Tele-education delivery system - Content management system - Digital library: virtual library server - E-learning system - E-governance suite

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A full fledged multimedia studio with video cameras, video and audio mixers etc., have

been deployed for live transmission of interactive lectures over the virtual academy

network. The synchronised delivery output of audio and video will be fed into the

streaming server which is further interfaced with the tele-education delivery system

components. This set - up provides a means for the VSAT based education programmes to

be broadcasted from the studio. The classes conducted at Aravind Eye Hospital, Madurai

is telecast live to other connected centres. The transmission is recorded simultaneously in

software which could be utilised later at the convenience of the students.

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Company Logo ARAVIND BUSINESS MODEL Three key elements define the Aravind business model

Economies of scale—With excellent management and high patient volume,

Aravind keeps productivity high, with surgeons performing 25–40 procedures

daily; unit costs are maintained at the very low level of about $10 per cataract

operation.

Cross-subsidies—Aravind provides free or very low-priced care to two thirds

of its patients with the revenue derived from the one third of patients who are

able to pay moderate prices. The only difference in the treatment of those who

do and don’t pay is in the amenities, such as the air conditioning in the

recovery room.

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Vertical integration—Recognizing that the imported intraocular lenses constituted a major component of the total surgical costs, Aravind obtained a transfer of technology through the US-based Seva Foundation, and additional support from the Combat Blindness Foundation, to permit it to manufacture these lenses at a fraction of the cost.

The manufacturing activity scaled up quickly, from 35,000 in 1992–1993 to nearly 600,000 lenses today. Now, at the Aurolab subsidiary established for this purpose, a workforce of about 200 young women from rural backgrounds produces lenses to a global standard of quality that are used at Aravind, as well as at facilities throughout India.

The affordably priced intraocular lenses are exported to some 85 countries around the world, providing another source of revenue for Aravind.

The system of eye hospitals also is considered one of India’s premier ophthalmic training institutions, providing a steady flow of well-prepared professionals and support staff.

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Company Logo BLUE OCEAN STRATEGY

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Company Logo Blue ocean strategy Red oceans represent all the industries

in existence today – the known market space. In the red oceans, industry boundaries are defined and accepted, and the competitive rules of the game are known. Here companies try to outperform their rivals to grab a greater share of product or service demand. As the market space gets crowded, prospects for profits and growth are reduced. Products become commodities or niche, and cutthroat competition turns the ocean bloody; hence, the term red oceans.

Blue oceans, in contrast, denote all the industries not in existence today – the unknown market space, untainted by competition. In blue oceans, demand is created rather than fought over. There is ample opportunity for growth that is both profitable and rapid. In blue oceans, competition is irrelevant because the rules of the game are waiting to be set. Blue ocean is an analogy to describe the wider, deeper potential of market space that is not yet explored

The cornerstone of Blue Ocean Strategy is 'Value Innovation'. A blue ocean is created when a company achieves value innovation that creates value simultaneously for both the buyer and the company. The innovation (in product, service, or delivery) must raise and create value for the market, while simultaneously reducing or eliminating features or services that are less valued by the current or future market.

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Company Logo Six principles

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Company Logo AEH and its Blue Ocean Business Model

AEH’s Blue Ocean Business Model can be understood by following points:

1. Untapped Market Place2. Demand Creation3. Opportunity for high growth4. Value Innovation5. All the six rules followed.

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Untapped market Place

Increasing occurrence of needless blindness in India.

No infrastructure available at that point of time. No government initiatives. No patient awareness

Company Logo Demand Creation

Target Market- Rural areas, where Eye problems are often neglected.

Demand Creation by – – Rural Camps– Patient awareness programs– Affordable pricing

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Company Logo Tapping opportunity for high growth

Target market expansion– Not only remained in Madurai, but opened up

hospitals in other cities like…TheniCoimbatoreTiruneveliAmethiKolkataPondicheri

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Company Logo Value Innovation

“Providing affordable healthcare with marginal profits, so that maximum number of patients

can be benefited” Innovative Pricing policy. Establishment of Aurolab to further reduce the

price of lenses. World class training institute for Paramedical staff

(Nurses, Technicians etc.) Post graduate institute for Ophthalmology to meet

the demand of Ophthalmologists.

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Company Logo ERRC Grid with reference to AEH

EliminateEmotional

Raise

Quality Benchmark

Facility for Masses

Focus on Primary health care

Reduce

Cost

Price

Create

Manufacturing own eye care equipment and lenses

Create eye care Professional team

Research industry for Eye and Diabetes.

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Company Logo HOW THIS MODEL MAKES BUSINESS SENSE?

This model makes very sound business sense because it‘s fundamentally built on a few core

principles. The first one is in terms of market development and through that demand

generation. This is a process of converting a need in to a demand

The second core principle is excellence in execution of ensuring a high level of efficiency in

providing the treatment, including outpatient services and surgeries.

The third core principle is one of quality. The aim is to ensure that the patient regardless of

whether he is a free or a private patient gets value for his investment in money or time.

The fourth principle is of sustainability wherein they set the prices not so much based on

what it costs us but on how much the various economic strata of the community can afford

to pay. It then work backwards to contain the costs within these estimates. This leads to not

just financial viability but a higher order of management, as well as inculcating a certain

culture in the organisation.

Company Logo Mile stone

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Company Logo Major Research Projects Completed and Ongoing

Major Projects Completed

1984: Study of Eales’ disease

1986: Operations Research for Effective Delivery of Cataract Services

1986: Rapid Survey Techniques for Blindness and Cataract Assessment

1987: Effect of Small Doses of Vitamin A in Children Under Five Years of Age

1989: Safety and Efficacy of Vanadium Stainless Steel (VSS) Sutures in Cataract Surgery

1989: Study on Salt Pan Keratitis

1992: Madurai IOL Study

1993: Childhood Cataract in South India

1994: Aravind Comprehensive Eye Survey

1994: Series of Drug Trial with Ofloxacin on Patients with Suppurative Keratitis

1998: Vitamin A Supplementation in Newborns (VASIN) Study.118

Company Logo Major ongoing projects

1. Role of antioxidants in prevention of cataract

2. Molecular genetics for hereditary glaucoma

3. Paediatrics parasitic eye diseases

4. Trial study of lensectomy vs. lens aspiration and primary capsulotomy in children

5. Culture of rubella virus from proven cases of congenital rubella syndrome

6. Molecular and genetic basis of congenital contract

7. Trials on paediatric glaucoma

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Company Logo AWARDS AND RECOGNITION

Conrad N. Hilton Humanitarian Prize in 2010

2008 Gates Award for Global Health

India’s Most Innovative Hospital Award at India Healthcare Awards 2011

FICCI award for the Best Private Hospital in India

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Awards

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CONCLUSION

Aravind has proved that by using Human Resource efficiently and by bringing in

innovation in Healthcare, affordable services with high standards can be provided

even at the remotest part of the country.

It has also brought this concept for debate that the techniques and interventions

used in any Industry can be successfully employed in the Healthcare Industry.

Ultimately, it revives the concept that if an Organization is willing to serve the

masses with quality product and services, it is bound to generate revenue and earn

profits

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REFERENCES The Aravind Eye Care System: Delivering the Most Precious Gift‖ in C.K.

Prahalad (2004), The Fortune at the Bottom of the Pyramid. N.J.: Wharton Publishing.

Adopt a Business Partner Case Study: Aravind ARAVIND EYE CARE SYSTEM: GIVING THEM THE MOST PRECIOUS

GIFT Compassionate, High Quality Health Care at Low Cost Volume 16, Number 3

Article by Janat Shah & Murty LS September, 2004 http://online.wsj.com/article_print/SB115474199023727728.html http://www.aravind.org/ Treating Cataracts in India V. Kasturi Rangan and R.D. Thulasiraj Making Sight Affordable Innovations

Case Narrative: The Aravind Eye Care System World Health Organization. Global Initiative for the Prevention of Avoidable

Blindness. Geneva, Switzerland: World Health Organization; 1997. WHO/ PBL/97.61.

www.wileyeurope.com/college/tidd