aravind eye care system: eliminating needless blindless
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Aravind Eye Care System
Eliminating Needless Blindness
80%of blindness
is
treatable
80%of blindness
is
treatable
200 million need
eye care in India
Less than 10 %
have been treated
Patient Care: § 6 Eye Hospitals § 2 Surgical Centres § 7 Community Eye Clinics § 40 Vision Centres § 2 Managed Hospitals
Manufacturing
Research
Consultancy
Training
A Typical Day at Aravind...
§ 850 – 1000 surgeries § 6,000 Outpa3ents in hospitals § 5-‐6 outreach camps
§ 1500 examined § 300 transported to base for surgery
§ 500 – 600 Telemedicine Consulta3ons § Classes for 100 Residents/Fellows & 300 technicians and administrators
Making Aravind one of the largest providers of eye care services and trainer of eye care personnel in the world
Sight Restoring Procedures 4.3 Million as of Dec 2011
What it took to get there
The story of the Aravind Eye Care System
Building Blocks of Aravind
Dr. G. Venkataswamy
Value System
Delivery System
Innova3on
The value system
NONCUSTOMERS
Designing for
NONCUSTOMERS
Designing for
Making eye care accessible & affordable
The Perspective
Not charging a fee for care ≠ affordable cost to patient
Who covers these costs?
Designing a cost-effective solution
Reducing the Customers’ costs
Breaking the access barriers
Outreach in 2010 – 2011 No. of Screening Camps 1,381 PaJents examined 312,129 Surgeries 76,175
Effectiveness of screening camps?
• We reached only 7% of those in need of eye care1 • Those with rarer eye condiJons were not addressed
1 “Low uptake of eye services in rural India”; Fletcher et al; Archives of Ophthalmology Vol 117, Oct 1999
Primary Eye Care Centers § Staffed by technicians § Comprehensive eye examinaJon for each paJent
§ Each paJent receives telemedicine consultaJon
§ Spectacles are provided
Primary Eye Care Centers
§ 40 centers covering a populaJon of 2.6 million
§ 800,000 paJent visits § 40% penetraJon within the first year
§ 91% of problems are resolved locally
Impact of Outreach
§ Increased awareness § Influencing health-seeking behaviour § Creating access § Community participation § Growing the market (reaching the
unreached)
Stretching
Scarce
Resources
The delivery system
Managing the Bottleneck
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
500+ village high school girls selected each year
§ Perform most of the rou3ne clinical tasks § Doctors can focus on diagnosis & surgery § Higher quality and produc3vity, lower 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
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
2 “Fortune at the Bottom of the Pyramid” by C. K. Prahalad
§ The paJent decides which facility to use
§ Transparency -‐ fee structure and systems
A cataract patient today
A cataract patient in the 80s
Established in 1992 to address the high cost of ophthalmic supplies which had to
be imported
Making Quality Eye Care Affordable
§ 10 million people see the world through Aurolab’s lenses
§ Used in 120 countries § 7% of global market
Ensuring affordability: § For the patient & the community § For Aravind (to be sustainable) § When most can’t pay
What Aravind did: § Gave away a lot of it free § Charged market rates for those who
can pay § Were helped by market inefficiency § Had the MINDSET
Dealing with Competitive Advantage
Guard it zealously or give it away
Attaining the Vision “Eliminating needless
blindness”
Create Competition “to eliminate needless blindness”
280 Eye Hospitals worldwide
Not to dominate but to create a movement
Philosophy
LAICO – a dedicated facility
Impact of Capacity Building Process Cataract Surgery (40 Hospitals)
0
20000
40000
60000
80000
100000
1 yr Before 1 yr After 2 yrs After
52,506
Cost Recovery
60%
91,445
Cost Recovery
90%
76,995
Capacity Building
Estimated 750,000 surgeries annually added worldwide
0
5
10
15
20
25
30
35
40
80-‐81
82-‐83
84-‐85
86-‐87
88-‐89
90-‐91
92-‐93
94-‐95
96-‐97
98-‐99
00-‐01
02-‐03
04-‐05
'06-‐07
08-‐09
10-‐11
ExpenseRevenue
Paying49%
Free Direct27%
Free Camp24%
Doing Good, Doing Well
Redefining….
Cost Quality
Customer Constraints Competition
“When you grow in spiritual consciousness We identify with all that is in the world So there is no exploitation It is ourselves we are helping It is ourselves we are healing”
-‐ Dr. G. Venkataswamy