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Aravind Eye Care“restoring vision to millions”
Group No: 5
Abhishek Seth – G10063 Deepak Kumar Sinha – G10075Piyush Pati – G10094 Suresh Kumar Sharma – G10113Vipin 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.
• 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.
Genesis
Mission
“To eliminate needless blindness by providing high quality, high volume, compassionate eye care to all”
Guiding Values• Compassion/
Dignity• Equity • Transparency• Sharing
Translated to action• Eye care to all –
Equity• Standardization –
Transparency• Affordability• Accountability
Dr. G. Venkataswamy
Innovation• Market conditions
at the ‘bottom of the pyramid’
Building Blocks
The need to innovateMarket 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 CompetenceProcess 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.
o Aravind is the lowest-cost producer of IOLs in the world.
o It 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 CompetenceResource 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(1978-1987)
Setting up & developing hospitalsComing into existence Community outreachFocus on Cataract Services
2nd Decade(1988-1997)
Refining & Scaling up internallyMore Hospitals – TVL, CBEEstablishing Aurolab & LAICOEducation and Training
3rd Decade(1998-2007)
Foundation for scaling up externallyExtensive capacity building workExperimenting with Managed HospitalsRapid Growth in Specialty Care Focus on Research
Aravind Eye Care System, 2009
Eye Bank
Hospitals(5) Aurolab
Out Reach Research
“Aravind Eye Care System”
LAICOIT
Training
AMECS4
Hospitals
India
Aravind
Bangladesh
Thailand
Indonesia
0 500 1000 1500 2000 2500
Surgeon Productivity: A comparison
80-8
1
82-8
3
84-8
5
86-8
7
88-8
9
90-9
1
92-9
3
94-9
5
96-9
7
98-9
9
00-0
1
02-0
3
04-0
5
'06-
07
08-0
90
5
10
15
20
25
30
Expense
Revenue
Financial Results
Free (Camp) 33%
Paying 45%
Free (Direct) 22%
Surgery mix in 2008 -09
Year: 2008-09Income: 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
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 competitionMaking eye care affordable worldwide
Creating Competition “to eliminate needless blindness”
270 Eye Hospitals worldwide
Sharing makes you strongerLions 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 Sustainability with
social responsibility
Publications Capacity Building
Impact: Strengthen eye care programme capacity to deliver high quality, increase access and be financially viable
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
8% of global market
Broader Relevance?
Is it applicable to developed countries&outside of eye care?
NHS*-UK vs. Aravind
No. of eye surgeriesOphthalmologists graduating
annually
71%
59%
(*National Health Service – Main provider of Healthcare in UK)
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
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
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 . . .