An approach to Universal eye health ARAVIND EYE CARE SYSTEM 5 - - PowerPoint PPT Presentation

ARAVIND

EYE CARE SYSTEM

Vision Centres

• An approach to

Universal eye health

59

5

Tertiary

6Secondary

Care Centers Care Centers

6

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

• 12,000 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

• Patient care
• Community Outreach
• Manufacturing
• Research
• Training
• Consultancy

Aravind in 2015-16

3,727,387 Outpatient Examinations 408,220 Surgical Procedures 50% for free / steeply subsidized

• 200

400 600 800 1,000 1,200 1,400 1,600 1,800 2,000

1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Toal Expenses Total Income

Paying 50% Subsidized 23% Free 27%

2014-15 (in Rs. millions) Income : Rs. 2645 Expenses : Rs. 1481

DOING GOOD & DOING WELL

(in Rs. millions)

LAICO : Creating Competition

Create Competition

“to eliminate needless blindness”

310 Eye Hospitals worldwide

Impact of Capacity Building Process: Cataract Surgeries (40 Hospitals)

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

Community Outreach

camps

2,590 88,774

• utpatients

cataract surgeries

570,921

In 2016:

Outpatients

16% 33%

Cataract Surgeries

Outreach Camps

Camps – Patient Segments

Annual Performance: Outreach Camps

Pediatric Camp

• 46 camps
• 8,420

children

• 94 specs
• 428 children

with other defects identified School Screening

• 302 schools
• 288,219

children (screened by teachers)

• 91,893 seen

by eye doctor

• 19,365

children found to have defects

Workplace Camp

• 213 camps
• 50,602

workers

• 13,806

spectacles DR Camps

• 276 camps
• 16,621

diabetics

• 2,269 DR

patients identified Comprhnsv. Camps

• 1,531 camps
• 347,053

patients

• 63,401

spectacles

• 92,816

cataract surgeries

From Outreach… …to Universal Coverage

Aravind Eye Care System

Considerations for

Universal Coverage…

• Accessible & affordable:

– to everyone in the service area

• Coverage for all eye diseases
• Quality of care

– right diagnosis & treatment

• Completion of full treatment cycle

– locally or through referral network – ensuring high levels of compliance – Easy access to medicines & glasses

Uptake of eye care at

• utreach camps

Study of uptake in eye camps

No of villages covered 47 Population studied 22,047 No of people with eye problem 749 % of people with eye problem 3.4% Of the above, attended the eye camp 51 % attending camp 6.8%

Effectiveness of screening camps?

• We reached only 7% of those in need of eye care1
• Those with rarer eye conditions were not addressed

1 “Low uptake of eye services in rural India”; Astrid E. Fletcher et al; Archives of Ophthalmology Vol 117, Oct 1999

Aravind Vision Centers

Electronic Medical Records in VCs

Coverage in Service population

(inception till 31st March 2015)

Estimated coverage calculation: assuming that 20% of the population in need of eye care

VC Age

• No. of

Centres Population Unique Patients Population covered Estimated coverage

<1 year 5 308,390 6,000 2% 10% 1-2 years 5 258,247 15,402 6% 30% 2-3 years 3 232,621 24,698 11% 53% 3-4 years 3 226,184 42,648 19% 94% 4-5 years 5 313,939 67,331 21% 107% >5 years 30 2,021,752 764,049 38% 189% Total 51 3,361,133 920,128 27.4% 137% From outside the service area 373,751 Grand Total 1,293,879

Uptake Comparison Eye camps vs. Vision Centres

Camp “Study” 51 Vision Centres* No of villages covered 47 1,909 Population studied/covered 22,047 3,361,133 No of people with eye problem 749 % of people with eye problem 3.4% Attended eye camp/V. Centre 51 % of those in need 6.8% % of the population 0.23%

* From inception till end Mar 2015

* Inception till 31st March 2015

25% 840,000 >100% 920,128 27.4%

Primary Eye Care Centers

• 58 centers ~4 million

population

• 40% reach within the first

year

• rising to 75% by year 2
• 91% of problems

resolved locally

Vision Centre: Services

• Comprehensive eye

Examination

• Refraction
• Blood sugar test
• Blood pressure
• Consultation with
• phthalmologist through

tele-consultations

• Eye health education

through counseling

• Glasses & medicines

dispensing services

11/3/2016

Key Components Planning to Execution

Village/Town & Site selection:

• 50,000 population in a radius of 5 Kms.
• Accessible by road transport

Standardization:

• Infrastructure, Human Resources, Layout, …
• Operational practices

Support system:

• Management Structure for Support & Control
• Tele-Consultation and eye care for the referred

Demand Generation:

• Baseline information, outreach initiatives
• Community involvement & ownership

Vision Centre: Infrastructure

• Ophthalmic Equipment

– Slit Lamp, Tonometer – Trial set, Torch light – Ophthalmoscope – BP Apparatus, Ht./Wt. scale – Glucometer

• Computers - 2 (one with

webcam, speakers & printer)

• Internet Connectivity
• Optical & Medicines

dispensing unit

• Sterilizer
• UPS - Invertor

11/3/2016

Space of about 300 to 600 sq. ft. With furniture for clinical work and patient waiting

11/3/2016

Vision Centres – Infrastructure & Equipment

Local HR – Value Fit Over Clinical Competency

Vision centre Technician: 3+ years Experience at Hospital

• Do refraction and dispense eye glasses
• Capacity to diagnose common eye problems,
• Able to handle slit lamp and fundus photography
• Facilitate video conf. with ophthalmologist using IT
• Giving care and Support to the patients

Vision centre Coordinator: 3+ years Experience at Hospital

• Patient registration , patient flow management, counseling
• Optical – medicine sales, accounts, statistics & inventory
• Interpersonal coordination (community -hospital)
• Follow up on referrals

Eye Health Field Worker (shared):

• Community mobilization (survey, key informant methods…)
• Identify and referring curable and incurable blind people
• Outreach initiatives in association with Outreach department
• Community based follow-up

Clinical support

• Tele consultation with each patient
• Continually upgrading the skills of OA
• Clinical quality monitoring
• Surgery, advanced investigations or
• ther care for the referred patients

Investments per Vision Centre

Capital Cost USD INR Ophthalmic Equipments 6,100 400,000 Instruments (BP app., needle sterilizer…) 75 5000 Computer accessories 2,000 1,32,000 Eye glass dispensing unit (edging kit…) 350 23,100 Set up cost (promotion, furniture,

invertor…)

3,300 217,800 Overhead / Incidental 600 40,000 Total investment cost 12,425 820,050 Recurring Expenditure per month (HR, rent and maintainance etc.) 600 40,000

Management support

• Supervision
• Ensuring supplies
• Maintenance – of equipment & computers
• Monthly visits
• Centralized patient experience assessment
• Quarterly review meetings

Vision Centres: Performance April 2015 - March16

59 Vision Centres (3.7 Million) Outpatient Visits 440,625

60,763 Eye Glasses (86%) 14,326 Cataract Surgeries (68%) 22,504 Specialty referred (73%) Acceptance 65%

Paying 3,829- 27% Subsidized & Free 10,497 (73%)

Uptake

Bought - 91% Attended Hpl - 70%

Aravind Vision Centre Locations Map

What makes it possible?

Generating demand

Access: Permanent set up providing services six days

• f a week in a

location easily accessed by community Referral and follow up at secondary & tertiary eye care centres Generating demand:

• Door to door

screening & follow up

• School screening
• Screening for low

vision

• Diabetic retinopathy

screening camps

• Screening eye

camps for children Awareness

• Health education
• Involving volunteers

to promote eye care

• Promoting eye

donation

Ensuring quality of care

• Electronic Medical Records & Tele

Consultation

• Evaluation based on qualitative and

quantitative parameters once in 6 months

• Data based monitoring to improve

efficiency in service

• Follow up on referrals
• Monthly visit by a team with an
• phthalmologist

<=10% 11-20% 21-25% >25% % Population covered

Studying patient distribution

Technology Patient Registration- Unique ID

Technology Registry for cataract

Accountable process

Months Kariyapatti T.Kallupatti Kalayarkovil

January DR Follow-up 29.01.15 School Screening Camp 21.01.15 NIL School Screening Camp 23.01.15 February Awareness Programme (05.02.15) Glaucoma Follow up 20.02.15 Low Vision Camp (01.02.15) March Glaucoma Follow up (27.03.15) Glaucoma Follow up 20/03/2015 Awareness Programme 12.03.15 April Work Place Camp Awareness Programme 17.04.15 Awareness Programme 18.04.15 May Awareness Programme 19.05.15 DR Follow-up 22.05.15 Awareness Programme 15.05.15 June DR Community Camp 27.06.15 Awareness Programme 23.06.15 Awareness Programme 03, 27.06.15 Awareness Programme 26.06.15 July Paediatric Camp Awareness Programme 16.07.15 Awareness Programme August Awareness Programme 11.08.15 Awareness Programme 07.08.15 DR Follow-up School Screening Camp September Glaucoma Follow up Camp Glaucoma Camp

Central Patient Feedback System – pulse on patient experience

• 10% Sampling of patients from VCs
• Standard questionnaire
• Call patients next day of service

delivered

• Helps to track and respond to the

concerns immediately

மரூத௎தூவமனை ஊழியர௎கள௎ உங௎களிடம௎ அக௎கனையூடனூம௎ மரீயானையூடனூம௎ நடந௎தூ ககாண௎டார௎களா?

Did the staff treat you with dignity and concern

21% 29% 26% 23% 20% 24% 18% 23% 14% 19% 3% 16% 13% 100% 24% 25% 15% 15% 23% 24% 79% 71% 74% 74% 78% 76% 75% 69% 86% 81% 97% 84% 84% 0% 76% 75% 85% 82% 78% 73% 0% 0% 0% 2% 2% 0% 8% 8% 0% 0% 0% 3% 0% 0% 3% 0% 3% மிக நன௎ைாக நன௎ைாக பரவாயில௎னை மமாசமாக

Very Good Average Good Poor

Focus on sustainability

• Ensuring a daily average outpatients of 25+
• Comprehensive care at Vision centre
• Focus on completing the loop – advice to

uptake

• Revenue generation opportunities –

dispensing of spectacles, basic medications, blood tests, etc.)

• Support from surgical centre for referrals
• Uninterrupted supply chain
• Cost control through financial reviews
• Staff – Competent & committed; retention
• Strong community support

Sustainability:

Revenue Generation

• Spectacles: 65%
• Consulting fee:20%
• Medicine and lab investigation: 15 %
• Aravind vision centers together break

even in 2014-15 (106%)

* Aimed at 100% cost recovery on recurring cost by the end of 2 years

Coverage in Service population

(inception till 31st March 2015)

Estimated coverage calculation: assuming that 20% of the population in need of eye care

Age of VC

• No. of

Centres Population Unique Patients Population covered Estimated coverage

<1 year 5 304,588 10,529 3% 17% 1-2 years 5 273,814 21,085 8% 39% 2-3 years 3 240,825 23,848 10% 50% 3-4 years 4 374,305 51,665 14% 69% 4-5 years 4 243,144 61,896 25% 127% >5 years 30 2,117,286 692,877 33% 164% Total 51 3,553,962 861,900 24% 121% From outside the service area 403,301 Grand Total 1,265,201

Economic Impact for a patient

#

Transport Other Expenses Lost Wages T

• tal

If the patient visits base hospital Patient 1 50 120 200 370 Attendant 1 50 120 200 370 T

• tal

50 100 200 740 If the patient visits Vision Centre Patient 1 20 40 100 160 Attendant 0.5 10 20 50 80 T

• tal

15 30 75 240 INR saved per patient – Rs. 500 INR Saved for 440,625 patients – Rs.220 Million US$ Saved per patient – US$ 8 for 440,625 patients – US$ 3.4 million

Lessons learned in our journey with VCs Gives confidence to say that

• We are on track to reach all those in

need of eye care

• people are willing to accept care that

is accessible and affordable

Thank you