1. Presented By:Team 1

2. Source http://www.softexpune.org
AEH- Madurai
Source
http://www.aravind.org

3.  Aravind Eye Care Hospital is an ophthalmological
hospital with several locations in India.
 Currently located at
 Madurai, Pondicherry, Coimbatore, Theni,
Tirunelveli, Kolkata & Amethi
 Founded by Dr G. Venkataswamy in 1976 at Madurai
 Awards (in 2008 -2009)
 Bill and Melinda Gates Award for Global Health
 Acknowledged by Clinton Global Initiative in Sep
2008
 Recognized by C.K.Prahalad in his book „The
fortune at the bottom of pyramid‟

4. Source http://www.aravind.org

5.  Mission
“Elimination of needless blindness”
 By the end of 2009 AECS had set up 31 Vision
Centres and 5 Community Eye Clinics (Outreach
Programme).
 Aravind Managed Eye Care Services (AMECS)
 Dr V had been succeeded by Dr P. Namperumalsamy
(Dr Nam)in 2006
 Its manufacturing arm Aurolab had moved to new
facility at Madurai.

6.  Established by Dr V as a 11 bed hospital at Madurai in 1976.
 Dr V served Army Medical Corps from 1944 to 1948
 Trained himself to do microsurgery and technique of Intraocular
Lens (IOL) insertion.
 AECS Policy
 To serve paying as well as free patients.
 Close control of costs, high productivity of doctors and
achieving high volumes
 AECS vital components - Values and spirituality
 Mr. R.D.
Thulasiraj (Executive & IT Director at LAICO)
“Our operational model is heavily dependent on work
culture values.The systems are built in our basic
values”.

7.  Focused on cataract surgery.
 Established 2 bed system of operation to increase
productivity of doctors.
 Productivity rate of doctor 25 surgeries/day/doctor in contrast to
general avg of 5-6 surgeries/day/doctor.
 High quality surgical and medical equipments used.
 Manufactured IOLs in house at Aurolab.
 Cost of Imported IOL $80 and Aurolab‟s IOL $5.
 60% of surgeries were done free or almost free.
 AECS grew quickly –
 In 1997 - 1,23,095 Surgeries and 9,75,868 Outpatients per year
 In 2003 - 2,02,066 Surgeries and 14,50,000 Outpatients per year

8.  AECS created surplus income despite providing free
treatment.
 In 2002-03 it had surplus of Rs 219 Mn out of total
income of Rs 423 Mn
Exhibit 1 : AECS , no of beds in different Hospitals
UNIT
Free/Subsidiz
ed Bed
Paying
Beds
Total
OT/Tables
Madurai
900
325
1225
13/49
Tirunelveli
482
158
640
5/16
Theni
123
40
163
2/8
Coimbatore
580
176
756
11/20
Pondicherry
600
136
736
8/21
Total
2685
835
3500
39/114
Source: Data supplied by

9.  AESC did not consider the number of beds to be an
important parameter as most of the cataract patients
were discharged the same day.
 Also, no. of mats had been converted to regular cost,
and the average stay of the patient had reduced.
 Hence the no. of surgeries done was a more
meaningful indicator of its impact than the no. of beds

10. Paying
2003
758,991
Free including
camp
Surgery OP visits
Surgery
78,487
688,548 123,579
2004
870,171
85,745
765,860
141,690
1,636,031
227,435
2005
928,785
93,134
793,113
154,101
1.721,898
247,235
Jan 2006 till 1,140,765
March 2007
104,108
1,037,57
2
147,989
2,178,336
252,097
April 2007
to March
2008
1,101,154
114,464
1,073,61
4
148,202
2,174,768
262,666
April 2008
to March
2009
1,182,137
131,295
1,273,81
1
138,282
2,455,948
269,577
Year
OP visits
Total
OP visits
1,447,575
Surgery
202,066
Source: Data supplied by Aravind eye care system

12.  AECS conducted a number of outreach
activities in accordance with its mission.
 EYE CAMPS were the most important for they
symbolized the organization‟s determination to
reach out to the people in the villages.
 COMPREHENSIVE EYE CAMPS was the
most important type of eye camp, where,
complete examination of eye was done,
spectacles were prescribed and delivered on
the spot in about 70% of the cases

13. Year
Patients seen
Surgeries of
“camp” patients
2003
No. of
camps
organized
1158
388,594
81,357
2004
1271
433,502
95,249
2005
2006
2007
1335
1442
1448
437,224
412,683
377,377
98,326
92,346
87,667
2008
1302
320,563
69,580
2009
1319
314,780
71,869
Source: Data supplied by Aravind Eye Care System

14.  AECS also organized diabetic retinopathy
(DR) camps, refractive error camps, eye
screening camps for school children, pediatric
camps, and mobile van DR screening camps.
 AECS had also setup its training institute,
Arvind Post-Graduate Institute of
Ophthalmology (APGIM) which offered PG
program, fellowship program for super
specialization and Ophthalmic Assistant‟s
training.
 Its manufacturing arm, Aurolab, produced IOLs
and medical consumables for eye care, like
sutures and medications at low cost.

15.  AECS achieved economies of scale by
providing medical consumables to other
hospitals and ophthalmologists outside AECS
since its inception.
 This was also in consonance with its mission of
elimination of needless blindness.
 This helped many hospitals not only in India but
also abroad to conduct surgeries at a much
lower cost.
 Some of the pioneering products from Aurolabs
are: Auroflex-EV, negative aspheric IOLs for
better contrast and visibility in low light
conditions, green laser photo coagulators etc.

16.  Aravind Medical Research Foundation expanded its
research activities dramatically with the commissioning of
Dr. G. Venkataswamy Research Institute on 1st October,
2008.
 It was engaged in cutting edge research in all the areas
connected to eye diseases.
 Some researches going here are:
1. Vision Rehabilitation
2. Glucoma Studies
3. Retina Services and Drug Trials
4. Orbit and Oculoplasty
5. Cornea Clinic

17.  AECS „ training arm, Lions Aravind Institute of Community
Ophthalmology (LAICO) offered training programs to
outside hospitals to improve their practices.
 LAICO provided programs both in techniques of surgery
and in management of doctors, hospital managers and
paramedics.
 LAICO provides training programs both at its facilities at
Madhurai, at customer sites and also in a number of foreign
countries.
 It also undertook consultancy for improving the
performance of hospitals, with need assessment, vision
building workshops, follow-up visits and monitoring.

19.  Cataract accounted for 62.6% of blindness.
 Increased awareness resulted in early
surgeries.
 Cataract Surgery Rate(CSR) ( average per
million of population)
 India : 5000
 Tamil Nadu : 9000
 Bihar : 600
 Increase in % of Intraocular Lens(IOL)

20.  High degree of operational efficiency enabled AECS to
provide free surgeries to as much as 60% of its patients.
Source : Aarvind Eye Care System(2009),activity report,2008-2009
Category of surgery
# Surgeries
Percentage
Cataract
204,672
66.23
Laser Procedures
57,958
18.76
Retina & Vitreous surgery
8,393
2.72
Trab & combined procedures
7,099
2.30
Lacrimal surgeries
5,218
1.69
Other orbit & Oculoplasty surgeries
6,336
2.05
Ocular injuries
1,164
0.38
Pterygium
3,565
1.15
LASIK refractive surgery
3,459
1.12
Other surgeries
9,458
0.55
Total surgeries
309,015
100

21.  General improvement in the living conditions.
 Expectation of patients going up.
 Multiple insurance schemes
 Private
 State sponsored

22.  Diabetic Retinotherapy (DR) – that included control
of diabetes,refraction correction and prevention
and treatment of glaucoma.
 Unlike cataract,DR was preventable
 Focus on prevention and early attention then cure,
effective screening for diabetes and monitoring of
the patients.
 Glaucoma if left untreated also lead to blindness.
 Refraction correction too had become an important
area of concern.

23. Cataract
Refractive errors
Corneal blindness
Glaucoma
others
Source : vision 2020 document
Percentage
62.6
19.7
0.9
5.8
11.0

24.  Doctor‟s salaries were becoming highly
competitive .
 They were looking for opportunities to
establish there name and in particular, looking
for opportunities to do research , publish
papers , to take part in conference and
network among peers .
 These would increase doctors competences
and also the hospital‟s visibility .

25.  New hospitals with better looking building and better room and
food facilities were coming up.
 New hospital enticed the doctor‟s with better pay but none of
them offered comparative scope for professional advancement.
 Most of the doctor‟s in these private chains were ex-AECS
personnel.

26.  Out of 45 million blind population in the world , 7 million were in
india .
 12 million bilaterally blind persons in india with VA less than 6/60
 11,000 eye surgeons in India
 1 for about 100,000 people
 50% qualified eye surgeons are “non operating “ surgeons
 Many of the operating surgeons could not perform IOL surgeries .
 These factor impacted the overall effectiveness of anti-cataract
campaign

27.  Paediatric blindness was also an area to be addressed . About
0.8 per 1000 children were estimated to have serious vision
problem .

29.  Absolute number still increased but as a percentage it
reduced.
 Laser surgeries = 20% of AESCS‟s surgeries
 Performed in smaller units too- like in Theni & Tirunelveli.
 Other areas gained importance

30. Four types of eye camps:
1.
Traditional comprehensive eye camps
2.
Diabetic retinopathy(DR) screening camps
(Mobile van screening camps)
3.
Refraction Camps
4.
School Eye Screening Camps
Camps provided a benefit of increased reach and number of patients
attended
Still only 8% of the people requiring screens were being screened

32. 3. ESTABLISHMENT OF A NETWORK OF
VISION CENTRES (VC) AND
COMMUNITY EYE CLINICS(CEC)
 VC: small unit staffed with an opthalmic technician and had
telemedicine support from the base hospital and an admin support
person with doctor available on video.
 31 VCs (plan to increase to about 50) with each serving a population
of about 50,000 operating from rented buildings. Patients were
charged Rs.20
 CECs: larger than VCs but smaller than hospitals with 1doctor visit
per day and one of each- optician, field organizer, optical shop
person, nurse. Had diagnostics facility, prescribe and delivery
spectacles. 5 CECs with around 60-70 patients/day & served a
population of about 3,00,000

33. 5. OTHER OUTREACH ACTIVITIES
•
School camps- 210,139 students (base) & 67,237 students (VCs)
•
Mobile screening vans.
•
Paediatric screening camps
•
Refraction camps
6. Arvind Managed Eye Care Services
(AMECS)
• Trained Doctors in other hospitals to improve their efficiency
• AECS neither provided any facilities nor made any investment
• Selected personnel were sent to supervise the activities
• 5 yr agreement.

35. 7. UPGRADING OF FACILITIES
•
•
•
Private rooms- new block @ AEH, Madurai
Floor mats for free patients
AECS‟ Centre for Patient Empowerment intended to improve
eye care awareness in patients and the community
8. Emphasis On Research
• Focus on research on- DR, transplantation of cells etc.
• Means of providing development opportunities to doctorsoptional 1 day/week off- international conferences etc.- a
“retention” strategy.
• Research- a source of funds: about Rs 15million (2008-09).
• Brand new research facility -in 2008- Dr.G. Venkataswamy
Eye Research Institute, Rs 290 mn.
• 25 research scholars in 2009.

36. Year
No. of Publications
2004
46
2005
49
2006
70
2007
65
2008
73
Total
303
Source: Data as supplied by AECS

37. 2004
4
2005
2
2006
8
2007
8
2008
12
Total
34
Source: Data as supplied by AECS

39.  “Our emphasis is to be at par with the best eye hospitals in the world
without diluting our vision....We see our activities in four broad areaspaediatric eye care, cataract, retinopathy, glaucoma, and refraction”
- Dr. Nam
 They have plenty resources and therefore various options are available.
 “We are a highly mission driven set of people. Resources are not the
only consideration in deciding the direction of growth”
- Dr. Kim

40. • There were a number of directions that AECS could take;
the real problem was one of prioritization.
The various
directions ,as suggested by the key personnel at Aravind
eye care, are as follows:
a) According to Dr. Nam:

Diabetes is a challenge. To reach 46 million diabetics in India ,
innovative methods are needed. E.g. Paramedic

Cataract prevention, refraction correction, glaucoma, etc. Will
become important.

Thus, Dr. Nam said, “We need to move in multiple directions.”

41. b) According to Mr. Thulasiraj:
 “ We have a tremendous opportunity in the treatment of refractive
errors.” “We can set up a network of Refraction Centers.”
 He also saw big opportunity in training. He saw opportunities in
LAICO.
 There will also be a Projects Division to manage research projects.
c) According to Dr. Aravind:
 “Resources are not a problem. The challenge today is our aspiration,
not our resources. How do we retain the same hunger and the same
passion?”
 Dr. Thulasiraj also shared similar concern- “ We have to address
mindset issues. We are diffident about moving out of our comfort
zone.”

42.  There were different views on whether and how to grow
beyond Tamil Nadu. They are as follows:
1.
Concerns about culture:
a)
Dr. Nam felt that expansion to other Indian states is an issue.
He said “ Culture is an important issue for us.” Speaking
about his concerns, he further said “We still have our doubts
on
the
feasibility
of
transmission
of
values
like
compassionate care”
b)
Dr. Kim
and Mr. Thulasiraj shared similar concern about
culture transferability. Dr. Kim said “Business models should
not obscure our hospital‟s growth model.”.

43. 2. AECS executives saw opportunities to expand globally in
certain activities
a)
According to Dr. Nam: “DR (Diabetes Retinopathy) can be
studied adopting a global approach.”
b)
Dr. Kim – “ We are moving into research , especially in
specialities. We have to give new services that are currently
not available but necessary for eye care to stay ahead of
competition .”
c)
Mr. Thulasiraj said “ We have a global opportunity. There are
135 countries in the world with a population of less than 20
million each.” “We can thus give our knowledge and offer our
services in many of these countries.”

44.  A major challenge was to develop a large cadre of
doctors, nurses and paramedics, especially because they
had to be imbibed with the right values. The various
challenges are:
1.
Training:
a)
Dr. Nam said “We need to train more ophthalmologists
in DR surgical procedures. Knowledge management is
important. We are doing this through our Virtual
Academy.”
b)
Dr. Kim said that MLOP (Middle Level Ophthalmic
Personnel) training is becoming an important activity.

45. 2. Developing next generation:
 Dr. Aravind said, “the older generation is
now in the sixties. And except for a few,
the younger generation is in forties. There
could be a situation when the younger
generation would have to take over
responsibilities before they are fully
ready.”
 AECS is preparing itself for the same. For
example, LAICO is developing a cadre of
managers for AECS.

46. • Change of metrics from no. of beds to
no. of surgeries.
• Standardization is helpful in achieving
efficiency.
• Prepared for problems and Ready for
the risk management.
• For the long run, the organization have
to take necessary steps to succeed.

47.  STANDARDIZATION
 MAKE AWARENESS
 RESEARCH AND DEVELOPMENT
 READY TO TAP OPPORTUNITIES
 LEARNING- TIME TO TIME
 GIVE BACK TO SOCIETY
 LASIK AND OTHER EYE SURGERIES