Arvind eye hospital

1. EYE HOSPITAL
Aravind
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VIRAJSINH MAHIDA
NMIMS

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3. Company Logo 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. 9

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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 Hospitals
THE 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. Billsare
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
rou- tine 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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37. Company Logo 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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38. Company Logo 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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45. Company Logo 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.45

46. Company Logo Various steps involved in an eye camp are as follows:
 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.46

47. Company Logo Various steps involved in an eye camp are as follows:
 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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48. Company Logo COMPREHENSIVE EYE SCREENING
PROGRAMMES
Screening Eye Camps
Diabetic retinopathy
screening camps
Workplace-based
screening eye camps
School children
screening eye camps
Paediatric screening eye
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49. Company Logo OUTREACH STATISTICS
PERFORMANCE 2011-2012
Outreach Activity Camps OP
All
surgeries
Eye
Glasses
DR &
Other
Condition
s
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
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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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54. Company Logo Working model of Aravind Vision Centre
Refraction Slit lamp examination
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55. Company Logo Working model of Aravind Vision Centre
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.
Working model of Aravind Vision Centre
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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 61

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EDUCATION AND TRAINING
EDUCATION AND TRAINING
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EDUCATION AND TRAINING
 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
……….LAICO64

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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
67

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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
Mission
Eliminating 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
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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 - Research79

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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 Teleophthalmology
Network - ATN
Aravind Teleophthalmology
Network - ATN
83

84. Company Logo 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.
84

85. Company Logo 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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87. Company Logo Taking eye care to doorsteps…
n-Logue: Internet Kiosks
Step 1 Step 2 Step 3
87

88. Company Logo 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 area
2. Exploiting IT for rural eye care service delivery
3. Tele-consultation: Vision centre technician with
ophthalmologists
4. Available on a permanent basis
5. Refraction and school screening
6. Community participation
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Tele-consultation
Screened by
paramedic at
Vision
Centre
Wireless connectivity
@ 4mbps
Consultation by
Ophthalmologist at
Aravind Eye Hospital
Theni
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Technology
 WiFi 802.11b
 Low cost
 Unidirectional
antenna
 Line of Sight
 Upto 25Km
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Eye Screening going mobile!!
93

94. Company Logo 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.
97

98. Company Logo 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
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100. 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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Patient Flow
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102. 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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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.
104

105. 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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BLUE OCEAN STRATEGY
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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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Six principles
109

110. Company Logo AEH and its Blue Ocean Business Model
 AEH’s Blue Ocean Business Model can be
understood by following points:
1. Untapped Market Place
2. Demand Creation
3. Opportunity for high growth
4. Value Innovation
5. 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
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Demand Creation
 Target Market- Rural areas, where Eye
problems are often neglected.
 Demand Creation by –
– Rural Camps
– Patient awareness programs
– Affordable pricing
112

113. Company Logo Tapping opportunity for high growth
 Target market expansion
– Not only remained in Madurai, but opened up
hospitals in other cities like…
 Theni
 Coimbatore
 Tiruneveli
 Amethi
 Kolkata
 Pondicheri
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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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ERRC Grid with reference to AEH
Eliminate
Emotional
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.
115

116. 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.

117. Company Logo
Mile stone
117

118. 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.
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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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120. 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
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