Aravind Eye Care

“restoring vision to millions”

Group No: 5

Abhishek Seth – G10063 Deepak Kumar Sinha – G10075

Piyush Pati – G10094 Suresh Kumar Sharma – G10113
Vipin Chand – G10119 Yatendra Kumar – G10120
What does it mean to be blind?
Loss of Vision deprives one of the
livelihood, economic
independence, self-esteem &
status in the community
 200 million need eye care in India
Less than 10% have been reached

What is government doing?

In a developing country with competing
demands on limited resources, government
alone cannot meet health needs of all the poor.
 Genesis
•In 1976, Dr.Venkataswamy, feeling the urgent need, started
an eye clinic in Madurai with 11 beds, to create an alternate,
sustainable eye care system to supplement the government’s
efforts.
Mission
“To eliminate needless blindness by providing high quality, high
volume, compassionate eye care to all” Dr. G.
Venkataswamy

Building Blocks
Guiding Values Translated to action Innovation
•Compassion/Dignity •Eye care to all – Equity •Market conditions at the
•Equity •Standardization – ‘bottom of the
•Transparency Transparency pyramid’
•Sharing •Affordability •
•Accountability
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)
Importance of Business Knowledge for Non
Profit Organization
• Constraints
▫ Resources
▫ Funds
▫ Time
• Issues
▫ Sustainability
▫ Lack of financial incentives for Leadership Team and Employees
▫ Too Small to Justify or Pay for Expensive Outside Advice
▫ Efficiency and Quality Management
▫ How to carry out a high quality process at low cost
▫ Scalability
▫ Standardization of service offered at different centers
▫ Market conditions at the ‘bottom of the pyramid’
▫
▫
Aravind Eye Care - Creating value for society

• Marketing
▫ Community participation
▫ Growing the market (reaching the unreached)
▫ Brand Value creation by providing quality service to all its
customer
▫ Increased awareness
▫ Influencing health-seeking behaviour
▫ Creating access to health service
▫ Marketing Research
▫
• Operations
▫ Use of latest technology
▫ Aravind Eye Camp model
▫ Backward Integration- IOL Factory, Ophthalmic products
▫ Economy of scales
▫ Resource Optimization
▫ Process Optimization
▫ Cost Optimization

Aravind Eye Care - Creating value for society

• Finance
▫ Self sustainable innovative financial model
▫ Integration of Free and Paid Hospital
• Human Behavior
▫ Employee Motivation
▫ Employee Training
▫ Proper resource (internal and external)
allocation
▫ Value fit over skill fit
Value Creation
Management Competencies needed for this value creation :
1.Optimization Competence
2.Governance Competence
3.Orientation Competence
4.Reception Competence
5.Communication Competence
Optimization Competence
Process and Cost optimization
•Aravind has borrowed concepts like economies of scale and assembly
lines from the industrial sector and applied them in health care to bring
down costs without sacrificing quality.
•Economies of scale : Aurolab produce intraocular lenses (IOLs) at $5
whereas global prices are about $80.
oAravind is the lowest-cost producer of IOLs in the world.
oIt exports almost 50% of its production to other eye-care
hospitals, both in India and abroad.
•Paid vs. Free Service - Aravind lowers its cost position by reducing bells
and whistles without compromising on the quality of its equipment or
medicines or the competence of doctors and nurses.
Optimization Competence
Resource optimization
•Nurses are 60% of Aravind’s workforce. They perform most of the
routine clinical tasks thus allowing doctors do what they are best at -
diagnosis & surgery . This results in higher quality, productivity and
lowers cost.
•Extraordinary productivity- Aravind doctors average about 25 cataract
surgeries per day (actually, over six hours), whereas other eye-care
hospitals do six to eight surgeries per doctor. Aravind achieves this by
having a highly streamlined, innovative, and efficient system and a highly
trained paramedical staff.
Governance Competence
•Organization Structure
•Employee Policies
•Training Policies
•Employee Motivation
•Aravind Eye Camp model
Orientation Competence
•Aravind Ideology Foundation
§Dr. V’s Vision.
§ To eliminate needless blindness by providing appropriate,
compassionate and high quality eye care to all
§ Patient Centered Care.
§Value creation for all stakeholders: Patient, Employee, Society at large
•
 Reception Competence
•In-depth interviews for identifying the reason for low turnout of people to
screening camps
• Study Results
•Still have vision, however diminished 26 %
•Cannot afford food and transportation 25 %
•Cannot leave family 13 %
•Fear of surgery 11 %
•No one to accompany 10 %
•Family opposition 5%
•Others 10%
•Informal sessions between doctors and patients.
Communication Competence
•Counseling sessions
•Marketing of Aravind brand through word of mouth
•Interactions with
•Employees
•Patient
•Society
Aravind Eye Care – Service Model
There is nothing in this model that cannot be replicated in any
country — developing or developed.
The keys are simple:
•Pay close attention to operational efficiency,
•Work on separating the core from the frills,
•Maximize the productivity of the costliest resources (doctors and
equipment),
•and utilize the sheer power of volume.
 Aravind’s Evolution
1st Decade Setting up & developing hospitals
(1978-1987) •Coming into existence
•Community outreach

•Focus on Cataract Services

2nd Decade Refining & Scaling up internally

(1988-1997) •More Hospitals – TVL, CBE
•Establishing Aurolab & LAICO

•Education and Training

3rd Decade Foundation for scaling up

(1998-2007) externally
•Extensive capacity building work
•Experimenting with Managed

Hospitals
•Rapid Growth in Specialty Care

•Focus on Research
Aravind Eye Care System, 2009
Hospitals
(5) Aurolab

Training

Eye Bank
“Aravind AMECS
4
Eye Care System” Hospitals

LAICO
IT

Out Reach
Research
Surgeon Productivity: A comparison
Financial Results
Year: 2008-09
Income:
Surgery US$
mix in22 Million
2008 -09
Expenses & Depreciation: US$ 13 Million
Paying 45% Free (Camp) 33%
EBITA: 39%

Free (Direct)
22%

Through a unique fee system & effective management, Aravind

provides free eye care to 60% of its patients
Learning's from Aravind
• Aggressively streamline repeating processes. Aravind identified high volume, repeatable
processes like cataract surgeries and developed highly efficient and consistent approaches. Aravind
surgeons carry out an average of 2,000 procedures a year, way ahead of the average 125 procedures
achieved in the US.
• Limit the need for high-cost personnel. Aravind recruits young paramedical staff from local
villages and trains them to carry out a wide range of duties from eye refraction testing to counseling
and preparing patients for surgery. This leaves the surgeons free to operate, predominantly removing
cataracts and inserting intraocular lenses.
• Get creative about differentiated service. Paying patients receive extra comforts such as air
conditioning and greater privacy, but Aravind staff are rotated between free and paying hospitals so
as not to compromise treatment quality.
• Blend centralized and distributed resources. Aravind uses a network in rural vision centers. The
technology allows doctors in central hospitals to consult with clinicians at the vision centers in real
time via webcam, making quality eye care accessible to the rural poor who don’t have the time or
money to travel to big cities for examinations.
• Don’t trade-off humanity for profits. According to David Green, a US consultant who setup a non-
profit arm of Aravind for manufacturing ophthalmic products at affordable prices: ”You can have a
form of humanized capitalism and you can do it in a way where you don’t cannibalize your
margins.”
“Eliminating needless blindness”
requires going beyond Aravind

Creating competition
Making eye care affordable worldwide
Creating Competition
“to eliminate needless blindness”

270 Eye Hospitals worldwide

 Sharing makes you stronger
Lions Aravind Institute of community
Ophthalmology

To contribute to the prevention and control of global blindness through

Teaching, Training, Consultancy, Research, Publications & Advocacy
 Promoting Best Practices

Patient access
Efficiency

Patient care and quality Publications

Sustainability with Capacity Building

social responsibility

Impact: Strengthen eye care programme capacity to deliver high

quality, increase access and be financially viable
Making Eye Care Affordable
10 million people see the world through Aurolab’s lenses

• Used in 120
countries

8% of global market
Price of IOL came down from $ 100 to $ 2 –
making cataract surgery affordable
Broader Relevance?

Is it applicable to developed countries

&
outside of eye care?
NHS*-UK vs. Aravind
(*National Health Service – Main provider of Healthcare in UK)

71%

59%

Ophthalmologists graduating annually

No. of eye surgeries
Cost of delivering eye care
< 1% of what
it costs in UK
Why is the cost 100 times more?

• It is beyond the simplistic “UK isn’t India”

• Consider:
▫ Efficiency
▫ Clinical process
▫ Cost of supplies
▫ Regulations
▫ Defensive medicine
§§Productivity
Cost
Patient
Efficiency
Focuscontrol
on
centred
qualitycare

Insights
Conditions Solutions

§Large population
§Cuts across all
Compassion
economic
strata Owning the
§Equity issues
Problem
§Cost-effective
interventions §Achieving scale
Suggestions – In capacity of Independent Director
•Focus on increasing the market share of IOL as Aravind currently holds only 8%
of total IOL market share.
•Aggressive marketing strategy at global level to collaborate with other like minded
institutions in other parts of the world.
•Need to address the issue of doctor retention rate due to lesser pay package.
•Only 7% of people with eye problems in village accessed care from eye camps
•Even spread of occupancy rate of free hospitals over the week.
•Sponsorship from corporate for Eye camps.
•Eliminate non-productive activities & waiting time
•Need to develop new partnerships with community based organization in different
parts of the world.
•Increase in paid service charges as the current charges are 25%-30% less than
market charges
•Focus on increasing revenue through trainings and consulting
•Focus on Developed countries in addition to developing countries like UK.
“Intelligence & Capabilities are
not enough. There must be the
joy of doing something
beautiful..”
- Dr.G Venkataswamy
STILL… This is the Current Reality!

Courtesy: Allen Foster

much has been done and

much remains to be done . . .