B A C K G R O U N D There are extensive social and economic costs associated with blindness. The WHO estimates that blind people are three times more likely to suffer from depression, as well as three times more likely to be unemployed1. The problem of sight loss is particularly pressing in developing countries where visual impairment is much more frequent and treatment is often much less accessible. In Bangladesh, 1.53% of the over 30 population is bilaterally blind. Cataracts are the cause of blindness for nearly 80% of these people2. In the UK, sight loss is estimated to cost the NHS £22 billion per year3. This is equivalent to the cost of employing around half a million specialist doctors each year. With an ageing population and an increasing number of people suffering from conditions which affect eye health, such as diabetes and dementia,this cost is likely to increase substantially in the coming years. The Aravind Eye Care System (AECS) is now the largest eye care programme in the world4. The system utilises a low-cost, high-volume business model forperforming eye surgery. In 2012, AECS conducted 2,841 community outreach campsthat served 554,413 patients and performed surgery on 90,547 patients5. This system utilises a sliding price structure that makes eye care affordable to patients on low incomes. By expanding this system, there is the possibility of alleviating blindness across the world in a way that is economically efficient as well as beneficial to the patient and their society. W H A T W E D ID Selfless sought to address the problems caused by blindness in Bangladesh by triallinga low cost, high volume, rural eye screening programme. Given that the majority of Bangladeshi health services are privately funded and placed in urban settings, poor rural communities (which account for approximately 20% of the total population of Bangladesh6) face significant barriers to accessing high quality, affordable healthcare. In 2014 Selfless’volunteersset up an eye care camp in Sylhet, northeast Bangladesh. The volunteers (both medical students and junior doctors) screened 500 patients. Patients with cataracts were referred to a high volume specialist eye centreor“focused factory” for cataract operations,At the camp, on-site pharmacists would dispense free medication. Those suffering from refractive errors were given a token for an eye test and spectacles, if required. Overall, 50 patients were selected for cataract surgery, 350 were given tokens for a check-up with an optician and 250 prescriptions were dispensed. Through this streamlined process, the volunteers were able to deliver cataract operations priced at only £30 per person, significantly less than the £900 cost that the NHS incurs with each cataract operation. W H A T T H IS M E A N S The high volumes, low cost approach has significant implications for development within Bangladesh. The economic costs of blindness include lost productivity (due to the likelihood of blind people to be unemployed) and higher levels of welfare payments. There are also substantial social costs, including the increased incidences of mental illness among blind people7. An Aravind Eye Hospital research study showed that, subsequent to their cataract removal surgeries, 85% of men and 58% of women were able to regain jobs that they had lost due to their cataracts. The study also presented evidence to show an increase in household income of fifteen times the cost of the surgery8. The cost-effectiveness of this method allows blind patients to substantially increase their welfare without damaging their personal finances.Thus, the wider implementation of a similar programme across rural Bangladesh could tackle the economic and social costs created by widespread visual impairment. The implementation of a low-cost, high-volume approach to eye care and cataract surgery within the UK would deliver better value healthcare – better outcomes at lower cost. 1 “Eye Care: The Facts.” World Health Organization, n.d. Web. 2 “Global Eye Health Statistics.” Unite For Sight. N.p., n.d. Web. 10 Aug. 2016. 3 NHS England (2011). The NHS belongs to the people – a call to action. NHS England Report. 4 Northeastern University. (2011). Arrived Eye Care System. Available: http://www.northeastern.edu/sei/2011/10/aravind-eye-care-system-case/. Last accessed 2nd Feb 2016. 5 “Outreach at Aravind.” Aravind Eye Care System.N.p., n.d. Web. 08 Aug. 2016. 6 “Population.” Data. World Bank, n.d. Web. 10 Aug. 2016. 7 “Eye Care: The Facts.” World Health Organization, n.d. Web. 8 Rangan, Kasturi V. The Aravind Eye Hospital, Madurai, India: In Service for Sight. Publication no. 9–593– 098. Harvard Business School, 2009. Print.

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REVERSE INNOVATION – WHAT CAN THE NHS LEARN FROM PROVIDING LOW COST, HIGH VOLUME EYE CARE IN BANGLADESH?