Lessons from India: The Aravind Eye Care System

Dr RD Ravindran is the Chair of the Aravind Eye Care System, which has pioneered new ways of delivering eye care in Tamil Nadu, India, He was a keynote speaker at our Annual Conference 2011.

Why was the Aravind Eye Care System set up?

In the early 1970s, the prevalence of blindness in India was around 1.5 per cent, with 80 per cent of India's population in rural areas and most of the medical services based in urban areas. For the rural population, there were several barriers to accessing eye care services.

We designed a model for community outreach work to screen patients in rural areas and then provide their transport, food, surgery and medicines free of charge. We partnered with an extensive network of community-based organisations and government agencies, creating awareness, managing costs, improving productivity and training the required manpower.

What do you differently at the Aravind Eye Hospitals?

We don't have any eligibility criteria for our free services and we do not fundraise. The patients decide for themselves whether or not to pay. We treat more than two thirds of our patients at no charge or at an affordable cost using the surplus generated from our paying patients.

Our marketing targets those who can't pay, and we invest tremendous energy in taking eye care services to villagers who are too poor to seek out services themselves. When this is done with community support, it attracts not just the poor, but hundreds of individuals who have the means to pay and have a choice of other service providers.

We delegate a wide range of clinical activities which are largely repetitive to paramedical staff, allowing physicians to focus on areas where they are uniquely equipped to make a difference. This ensures a steady flow of patients, and we constantly monitor and improve our productivity.

Allowing physicians to manage clinical and non-clinical issues enables better problem solving and identification and implementation of decisions. They are also provided with management training.

What are the particular successes?

We have challenged the assumption that quality surgery cannot be performed at high volumes.

Dr RD Ravindran, Chair, Aravind Eye Care System

Aravind is one of the most productive eye care providers in the world. During the past 35 years, we have treated more than 32 million patients and performed more than 4 million eye surgeries.

We have created access for rural patients through outreach screening camps and primary care centres, all of which have a low-cost telemedicine facility offering real-time consultations with opthalmologists in the base hospitals.

Our model of high-quality, high volume and sustainable eye care services has been replicated across India and other developing countries. We have trained several hundred eye care professionals from 69 countries, and our manufacturing division has helped to bring down the cost of surgical supplies in the developing world.

How will you develop the system in the future?

We plan to:

  • sustain this growth and double our delivery capacity in the next five years in new locations
  • create better systems for the diagnosis and management of chronic eye diseases
  • become centres of excellence in specialty eye care services, residency education and fellowship training
  • contain to develop cost-effective solutions to keep eye care affordable to all.

What advice would you give to British health professionals?

Affordable health care is important to every nation. At Aravind it costs only a fraction of the amount that is spent in developed countries. While the local economy can explain some of the differences, the cost of supplies, regulations, the extent of defensive medicines and the work flow process may also be factors.

The involvement of physicians in finding cost-effective solutions, a willingness to challenge assumptions and seeing problems from a different angle have helped Aravind to innovate.

Everything we do is done with a broader sense of compassion and commitment towards those who are needlessly blind. We believe the strong conviction and commitment of those in leadership can help to create innovations in the delivery of health care.

Watch Dr Ravindran's international keynote on the Aravind Eye Care System at our Annual Conference.