Aravind Eye Care System

by Monica Kacprzyk

The Gift of Sight

Muthu is a poor 60-year old man in a vil­lage in the Siva­ganga dis­trict with seven chil­dren. Ten years ago, he sus­tained a blow to his right eye that caused severe dam­age on the inner por­tion of his eye. Due to lack of aware­ness regard­ing avail­able eye care facil­i­ties and neg­li­gence to take proper care of his eyes, Muthu lost vision in his right eye. Recently when his left eye vision began to blur, Muthu informed his son-in-law who referred him to Aravind Eye Hos­pi­tal. After cataract surgery and one month of recov­ery, Muthu had regained clear vision. Although the hos­pi­tal could not save his right eye due to irrepara­ble dam­age, Muthu was grate­ful for the gift of sight.

Aravind Eye Care Sys­tem is located in a coun­try with the largest blind pop­u­la­tion in the world; 75% of these cases are due to cataracts which is treat­able with a sim­ple surgery that most Indi­ans can­not afford. Cataracts are the lead­ing cause of blind­ness in India, but glau­coma and dia­betic reti– nopa­thy are also preva­lent. Asia holds two-thirds of the blind peo­ple in the world, three-fourths of the blind reside in India.

An Unlikely Partnership

Across oppo­site ends of the world, a retired eye care prac­ti­tioner named Dr. Venkataswamy (Dr. V) and an entre­pre­neur in the US named David Green came together to rev­o­lu­tion­ize the eye care deliv­ery sys­tem in a coun­try with the high­est preva­lence of treat­able blind­ness in the world.

In 1976, Dr. V founded Aravind Eye Care Sys­tem, a hybrid busi­ness encom­pass­ing sev­eral eye hospi– tals in India, edu­ca­tional and train­ing pro­grams, and a research foun­da­tion. Dr. V was orig­i­nally moti­vated after retire­ment by a dream to start-up a non-profit eye hos­pi­tal. His desire was to serve God through human­ity as the great activist Gan– dhi and philoso­pher Sri Aurobindo did in their own lives.

The cul­ture of the orga­ni­za­tion Dr. V cre­ated was felt by the first Aravind employ­ees, as all of the orig­i­nal staff sac­ri­ficed their gov­ern­ment salaries for less pay and almost dou­ble the amount of work and effort. Now that Aravind has expanded and accu­mu­lated more profit over time, salaries are bet­ter but still not up to par with the pri­vate sec­tor salaries.

In 1992, David Green was a suc­cess­ful entre­pre– neur based in San Fran­cisco who the founded the non-profit orga­ni­za­tion Project Impact, which es– tab­lished Auro­lab in India, a major oper­at­ing part– ner of Aravind Eye Care Sys­tem. Auro­lab manu– fac­tures intraoc­u­lar lenses at about $4 each in India, com­pared to $100 each in the United States. As a non-profit char­i­ta­ble trust, Auro­lab pro­vides afford­able intraoc­u­lar lenses, suture, phar­ma­ceu­ti­cals, and eye­glasses that facil­i­tate over 300,000 eye surg­eries per­formed annu­ally at Aravind Eye Hos­pi­tals, mak­ing Aravind Eye Care Sys­tem the largest eye care pro­gram in the world.

A New Busi­ness Model Emerges

Dr. V part­nered with David Green to apply Aurolab’s low-cost, high-volume busi­ness model to eye surgery ser­vices. About 70% of eye surg­eries are per­formed for free or below cost, while 30% are per­formed for above cost with­out com­pro­mis­ing qual­ity of care on either side of the price range.

The highly effi­cient oper­a­tions cou­pled with this pric­ing struc­ture allow the hos­pi­tals to main­tain a 50% profit mar­gin. Prof­its are then rein­vested into Aravind for growth and expan­sion of the hos­pi­tals, as well as fund­ing other ven­tures like the research foun­da­tion. About 90% of the annual bud­get is self-generated and 10% comes from char­ity. Even if the busi­ness grows more suc­cess– ful and globally-acknowledged in the future and gen­er­ates more char­ity inter­est, Aravind does not plan on com­pro­mis­ing the cur­rent model. Aravind also makes invest­ments into edu­ca­tional and train­ing pro­grams espe­cially designed to teach peo­ple with a wide range of backgrounds.

Effi­cient Eye Care Delivery

Aravind’s model does not base qual­ity of ser­vice on the income of the peo­ple it serves. In the Ara– vind model, there is a stan­dard qual­ity of ser­vice for the surg­eries, which equal­izes the patients and keeps clients com­ing for their ser­vices from both sides of the eco­nomic spec­trum. Aravind has also stan­dard­ized and engi­neered cataract surgery for high vol­ume pro­duc­tion. About 900 oph­thalmic assis­tants are taken on and trained every year to assist spe­cial­ist doc­tors in pro­vid­ing effi­cient eye care. Recruit­ment, moti­va­tion, and inten­sive train­ing are all key com­po­nents that are rooted in mak­ing this busi­ness work. Dr. V is often rou­tinely quoted for com­par­ing Aravind to McDonald’s, the Amer­i­can fast food chain. Accord­ing to Dr. V,

McDonald’s core com­pe­tency is effi­ciency and mass pro­duc­tion, lead­ing to a busi­ness that is both highly scal­able and replicable.

A recent Aravind Eye Hos­pi­tal research study quan­ti­fied their eco­nomic and social impact on post-surgery Indian cataract patients. The study indi­cated that 85% of men and 58% of women regained the jobs they lost due to cataracts. This allowed fam­ily care­givers to go back to work as well. The study con­cluded an increase in house– hold income in the first post-surgery year of pa– tients that was equiv­a­lent to fif­teen times the cost of cataract surgery.

Aravind Today

Today, the Aravind Health Care Sys­tem includes five Aravind Eye Hos­pi­tals and two Aravind Man– aged Eye Hos­pi­tals. Aravind also reaches out to the pub­lic by pro­mot­ing spon­sors in local com– muni­ties to cre­ate Eye Camps for rural patients who can­not access the eye care facil­i­ties in major cities and hubs. At these rural Eye Camps, pa– tients are exam­ined, pro­vided trans­porta­tion to a nearby hos­pi­tal, and fed if they are qual­i­fied for surgery. While Aravind started as one small eye hos­pi­tal, through its inno­v­a­tive deliv­ery and busi– ness model with Auro lab, it has now grown to five eye hos­pi­tals and two man­aged eye hos­pi­tals in India. Aravind Eye Hos­pi­tal also has plans to estab­lish its eye hos­pi­tals in Tirup­pur, Udu­malpet, Tuti­corin, and Kovil­patti in the near future.

The Future of Aravind

Despite mil­lions of recov­ered patients, one of Aravind’s biggest obsta­cles to date is reach­ing nearly 70% of its patients in rural south­ern India. Many of the most need based patients must walk miles and spare entire work days in order to visit an Aravind camp or hos­pi­tal. Mobile clin­ics have been launched, but they require local spon­sors to host them and are cum­ber­some to plan. How can Aravind eye ser­vices bet­ter reach the rural poor? How can mod­ern tech­no­log­i­cal advances help to solve this dilemma?

 


Ref­er­ences

Auro­lab Staff List.” Wel­come to Aravind Eye Hos­pi­tals. World Health Orga­ni­za­tion Col­lab­o­rat­ing Cen­tre for Pre­ven­tion of Blind­ness. Web. 03 Nov. 2010. <http://www.aravind.org/aboutus/ aurolab_trust.asp>.

David Green. Case Study. Social Profit Net­work. Web. 03 Nov. 2010. <http:// www.socialprofitnetwork.org/pdfs/david.pdf>.

Health­care Panel.” SABA : India Con­fer­ence 2010. Har­vard Busi­ness School. Web. 03 Nov. 2010. <http://www.hbsindiaconference.com/panel-healthcare.htm>.

Ran­gan, Kas­turi V. The Aravind Eye Hos­pi­tal, Madu­rai, India: In Ser­vice for Sight. Pub­li­ca­tion no. 9–593– 098. Har­vard Busi­ness School, 2009. Print.

Vision Cen­tre Is a Boon for the Peo­ple — A Patient.” Wel­come to Aravind Eye Hos­pi­tals. World Health Organ-ization Col­lab­o­rat­ing Cen­tre for Pre­ven­tion of Blind­ness. Web. 03 Nov. 2010. www.aravind.org/patientcorner/cataract_exp.asp>

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