Preethi John, Aravind Hospital

“ restoring vision to millions” Aravind

200 Million need eye care in India Less than 10% have access

Aravind Eye Clinic Founded in 1976 Aravind Eye Clinic Founded in 1976

Aravind Eye Care System, 2011 Madurai Theni Tirunelveli Pondicherry Coimbatore 4000 beds in 4 tertiary eye hospitals 36 primary eye care centers 2 managed eye hospitals 3 secondary eye hospitals Tamil Nadu

40% 60% 300,000 surgeries 2.5 million patient visits

A day at Aravind...
850 – 1000 surgeries
6,000 Outpatients in hospitals
5-6 outreach camps
1500 examined
300 transported to base for surgery
500 – 600 Telemedicine Consultations
Classes for 100 Residents/Fellows & 300 technicians and administrators
Making Aravind the largest providers of eye care services and trainer of eye care personnel in the world

Building Blocks of Aravind Dr. G. Venkataswamy Value System Delivery System Innovation

The Value System

The Delivery System

The need to innovate
Market conditions at the ‘bottom of the pyramid’:
Large underserved population
Resource scarcity (Capital and HR)
Dispersed population
Low affordability
Poor logistics
(Based on analysis by Prof. C K Prahalad)

Breaking the access barriers
2010:
1384 screening eye camps
316,148 patients examined
58,665 spectacles dispensed
74,700 surgeries performed

Effectiveness of screening camps?
We reached only 7% of those in need of eye care 1
Those with rarer eye conditions were not addressed
1 “Low uptake of eye services in rural India”; Astrid E. Fletcher et al; Archives of Ophthalmology Vol 117, Oct 1999

Primary Eye Care Centres
36 centers covering a population of 2 million
300,000 patients seen so far
40% penetration within the first year
Everyone receives telemedicine consultation
Online health records
91% of them received full care at the center

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

Efficiency Surgical Productivity Scenario A B Surgeon 1 1 Tables 1 2 Scrub nurse 1 2 Instrument sets 1 6 Surgeries/hour 1 6 - 8

Aravind (Wo)manpower
300+ village high school girls selected each year

60% of Aravind’s workforce
Perform most of the routine clinical tasks
Thus allowing doctors do what they are best at - diagnosis & surgery
Results in higher quality, productivity and lowers cost
The lives of these young women are vastly improved

PRODUCTIVITY OF AN EYE SURGEON Indonesia Thailand Bangladesh Aravind India 0 500 1000 1500 2000 2500 Surgeries per year

Surgical Quality 2 2 “Fortune at the Bottom of the Pyramid” by C. K. Prahalad Adverse Events During Surgery Aravind, Coimbatore N=22,912 UK National Survey N=18,472 Capsule rupture and vitreous loss 2.0% 4.4% Incomplete Cortical Clean up 0.75% 1.00% Iris Trauma 0.3% 0.7% Persistent Iris Prolapse 0.01% 0.07% Anterior Chamber Collapse 0.3% 0.5% Loss of nuclear fragment into vitreous 0.2% 0.3% Choroidal Haemorrhage ------ 0.07% Loss of intra Ocular lens into vitreous 0.01% 0.16% Aravind’s complications are less than half of those in UK

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

What we did
Gave away a lot of it free
Charged market rates for those who can pay
Were helped by market inefficiency
Had the MINDSET

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

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

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

Impact of Capacity Building Process Cataract Surgery (40 Hospitals) 52506 Cost Recovery 60% 91445 Cost Recovery 90% 76995 Capacity Building

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

Making Eye Care Affordable
Used in 120 countries
Price of IOL came down from $ 100 to $ 2 – making cataract surgery affordable 10 million people see the world through Aurolab’s lenses 7% of global market

Sustainability
Core Services
Leadership
Financial Viability Community Support

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

“ Intelligence and capability is not enough There must be the joy of doing something beautiful” - Dr. G. Venkataswamy

Preethi John, Aravind Hospital

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