Aravind Eye Care System · Aravind’s complications are less than half of those in UK. 2...
Transcript of Aravind Eye Care System · Aravind’s complications are less than half of those in UK. 2...
Aravind Eye Care System
How we did it
Dr. Usha Kim Professor in Ophthalmology,
Head of Department for Orbit, Oculoplasty and Ocular Oncology
Services, Director of Mid-Level Ophthalmic
Personnel
a 10 minute cataract surgery will restore sight to 7.5 million
a pair of spectacles will help
another 2.4 million see
200 million need
eye care in India
Less than 10 %
have been treated
Aravind’s Vision
To eliminate needless blindness by providing high quality high volume compassionate eye care to all
52
5 Tertiary
66
Secondary
Care Centers
Care Centers
Outpatient Centers
Primary Care Centers
+
+
Specialty Care Research Training
Cataract Services Specialty Diagnosis
Comprehensive Eye Examination Treatment of Minor ailments
Comprehensive Eye Examination
1000 - 2000 patients
150 - 400 patients
100 -150 patients
15 -25 patients
A Day at Aravind 10,000 Patient Examinations 1,500 Surgeries 5-6 Outreach camps
• 1,500 examined • 300 transported to base
for surgery Classes for 100 Residents &
300 technicians and administrators
Aravind in 1976:
Aravind Eye Care System
Community Outreach Manufacturing Research Training Consultancy
Patient Statistics: Outpatient Visits Total Outpatient Visits till March 2015: 44 million
0
500,000
1,000,000
1,500,000
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4,000,000 19
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Paying Free
Surgeries & Lasers till Mar 2015: 4.63 million
0 50,000
100,000 150,000 200,000 250,000 300,000 350,000 400,000 450,000
Paying Free
Aravind in 2014…. 3,522,171 Outpatient Examinations
401,457 Surgical Procedures
50% for free / steeply subsidized
Building Blocks of Aravind
Dr. G. Venkataswamy
Value System
Delivery System
Innovation
Community Outreach
camps 2,518
89,079
outpatients
cataract surgeries
564,660
In 2015:
Outpatients
17%
27%
Cataract Surgeries
Effectiveness of Screening Camps
We reached only 7% of those in need of eye care1
Those with rarer eye conditions were not reached 1 “Low uptake of eye services in rural India”; Fletcher et al; Archives of Ophthalmology Vol 117, Oct 1999
Primary Eye Care Centers 51 centers covering
of 3.5 million
1million patient visits
40% reach within the
first year, rising to
75% by year 2
91% of problems are
resolved locally
Stretching
Scarce
Resources
Balancing of Resources
1 Surgeon
1 Tables
1 Scrub nurse
1 Instrument sets
1 Surgery/hour
1 1 Surgeon
1 2 Tables
1 2 Scrub nurse
1 6 Instrument sets
1 6 - 8 Surgeries/hour
Task shifting to improve efficiency
Create a workforce
• Enhancing the clinical skills to support the Ophthalmologist
• Improve the workflow • Promote patient
centered care • Carryout daily
planning & scheduling of work
Who could these be?
• Non- doctors, • Skilled Support staff,
− Should provide empathetic, compassionate care to rural poor
− that will be comfortable working in
rural areas which have – Large underserved
population – Dispersed
population – Low affordability – Poor logistics
Aravind (Wo)manpower
500+ village high school girls selected each year
Perform most of the routine clinical tasks
Doctors can focus on diagnosis & surgery
Higher quality and productivity, 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
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
Behind Aravind’s Patient Care
Staff cadre Number %
Doctors 181 5%
PGs / Fellow 256 7%
Paramedics 2,298 64%
Support Staff 864 24%
Total 3,599
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
For the patient & the community For Aravind (to be sustainable) When most can’t pay
Gave it away for free Charged market rates for those
who can pay Had the MINDSET
Ensuring affordability
What Aravind did
LAICO : Creating Competition
Create Competition “to eliminate needless blindness”
280 Eye Hospitals worldwide
Impact of Capacity Building Process: Cataract Surgeries (40 Hospitals)
0
20,000
40,000
60,000
80,000
100,000
1 yr Before 1 yr After 2 yrs After
52,506
Cost Recovery
60%
91,445
Cost Recovery
90%
76,995
Capacity Building
Dr. G. Venkataswamy Eye Research Institute
Clinical research Basic Science research Epidemiology studies Operations research
Year Peer Reviewed Others
2014 57 29
2013 57 16
2012 54 7
2011 58 12
2010 61 17
2009 47 13
PUBLICATIONS
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Toal Expenses
Total Income
Paying50%
Subsidized 23%
Free27%
2013-14 (in Rs. millions)
Income : Rs. 2645
Expenses : Rs. 1481
DOING GOOD & DOING WELL (in Rs.
millions)
Pursuing Our Mission Eliminating needless blindness
much has been done and much remains to be done . . .
“Intelligence & Capabilities are not enough. There must be the joy of doing something beautiful..” Dr. V