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Dr. P. Namperumalsamy
Recipient of the 2008 Gates Award for Global Health
Aravind Eye Care
I am very much honored, delighted and privileged to receive this prestigious Gates Award for Global Health on behalf of our institution, Aravind Eye Care System. Indeed, it is a memorable and wonderful occasion.
The Gates Award for Global Health was established by the Gates Foundation and is given each year to an organization that has made a major and lasting contribution to the field of global health. The selection process of the award winners is facilitated by the Global Health Council. What started as a small non-profit membership organization with public health professionals has, over a period of 35 years, become the world's largest membership alliance dedicated to saving lives by improving health throughout the world.
On behalf on Aravind Eye Care System, I have the intense pleasure in thanking the Gates Foundation, with its co-chair, Bill Gates Sr., and the CEO and board of directors of the Global Health Council, and the awards jury for having selected us for this award and the confidence expressed by giving recognition to our institution.
Aravind Eye Care System started as 11 bed clinic in 1976 by a small team with a big mission. Aravind has now evolved into a world-class eye care system consisting of five major tertiary care eye hospitals, 24 village vision centers, five community hospitals and four managed care hospitals. Aravind also helps to improve the productivity of more than 230 hospitals in India and around the world.
Worldwide, 45 million people are blind - 12 million in India alone. Most of these cases are preventable or curable. In a developing country with limited resources and competing demands, the government alone cannot meet health needs of the poor. With this in mind, Dr. G. Venkataswamy, our founder, felt an urgent need for an alternate system, an affordable and sustainable eye care system to supplement the efforts of the government. After retirement from his government position at the age of 58, Dr. Venkataswamy wanted to continue his mission of service to the poor. In 1976 he founded Aravind with four doctors and a few support staff. Banks could not give him a loan because he was already retired and thus not creditworthy. He had to mortgage his house and pledge the family jewels until a small bank loan was obtained.
Dr. Venkataswamy also initially had a problem with fund raising even though his mission was respected and he was known for his work. After going through the bitter experience of getting meager contributions through fundraising, we realized that it is an art by itself, and not suitable for us.
The whole working pattern and success of Aravind Eye Care System can be viewed from three angles:
- Service Model:
Large volume, high quality, affordable, yet self-sustainable
- Business Model:
Demand-generation, social marketing, systems and procedures to make Aravind a service model
- Spiritual Basis:
Divine drive from Sri Aurobindo and the Mother; total surrender to reach greater heights, to do more and to do better.
Community-based eye care with modern technology that is of quality, affordable to all and under an efficient management system are the core principles of Aravind. Reaching the unreached through eye camps, removing the barriers in accessing eye care facilities, and community participation are again the principles in developing the market demand. About 100,000 surgeries per year are done through eye camps - totally free of cost to the patients. From its inception in 1976, Aravind Eye Care System has done 3 million surgeries; 300,000 annually. This is about 45 percent of the eye surgeries done in the whole state by a single institution. A good 70 percent of them are done free of cost and only 30 percent pay for the services. Yet it is financially viable and sustainable.
The Aravind Model works on service cum business. If you consider the global market as a pyramid of consumers based on economic strength, according to C.K. Prahalad, the opportunity is in the lower segment in developing countries. Serving this market will dramatically influence the management process. Create a "consumer market." Capture the poor market and there is profit.
A sense of compassion and commitment and strong leadership are key elements of the model. But what makes it a viable business proposition is the central principle that productivity is fundamentally related to demand. Volume brings down the cost and ensures the viability of the enterprise. Volume, in turn, is ensured by the combination of low cost, high quality and efficient procedures as well as appropriate uses of information technology in spreading awareness among the people. The model can be replicated and some of its principles are universally accepted and applicable; the appropriate use of manpower, reducing the time and costs, sharing innovative practices to improve quality, etc.
In a period of three decades, Aravind has developed into a system having a group of hospitals, an academic teaching institute, a manufacturer of low cost eye care products, a model for other parts of the country as well as other developing countries, and a research facility.
Aurolab
Quality eye care goes hand in hand with the development of eye care products at a cost and of the quality acceptable and affordable by all - rich and poor - for all developing countries. Stepping into the 15th year of its establishment, Aurolab has come a long way in terms of not only volume and diversity of products manufactured, but also the impact it has on the eye care market in developing countries. The prices have been brought down from $75 - $100 per intraocular lens (IOL) to $2 for those of the same quality and certified by an ISO and CE mark. Now these are being exported to more than 120 countries. Pharmaceuticals, sutures, surgical blades and small instruments have been added to the product inventory. The market share for IOL is around 7 to 8 percent in the global arena, but with affordable prices, it is accessible and available to all developing countries.
LAICO: The Spirit of Sharing
The Aravind model of large volume, high quality care, financially viable, affordable to all, is promoted in other parts of the country as well as to other countries of the world through the Lions Aravind Institute of Community Opthamology (LAICO). LAICO is working with more than 235 eye hospitals to enhance their capacity, essentially in cataract services. While most of these hospitals are in India, about 40 are in other countries, including Tanzania, Sri Lanka, Nepal, China, Indonesia, Bolivia and sub-Saharan African nations. Studies have shown that on average, the participant hospital’s productivity has jumped by 50 percent on most factors a year after the appropriate lessons have been implemented in each of these hospitals.
Making An Impact
The positive results of LAICO’s efforts to promote and cultivate community ophthalmic systems are clearly evident. Prior to LAICO’s involvement, a hospital in Chitrakoot, a city in Northern India, averaged 20,000 to 25,000 surgeries per year. Since LAICO’s input, the hospital averages 48,000 surgeries per year, all with IOLs. This 92 percent increase in total surgical volume was achieved without any additional major investment. Another hospital in Blantyre, Malawi, showed an even more remarkable impact: a 142 percent increase in its surgical volume only a year after the capacity-building process was initiated. At the global level, LAICO participates in task force steering committees as invited by WHO, IAPB, ICO, etc. At the national level, LAICO is involved in Indian National Programmes for Control of Blindness in various capacities and as a member of Vision 2020 India. It also plays major role as an advisory partner for many INGOs as Seva, Sight Savers, etc.
Academics
Be it setting up similar hospitals in other districts, the introduction of ophthalmic training and teaching institutes, the creation of LAICO, Aurolab or a research department, the expansion of AECS has been steady from 1980 onwards. Hospital expansion went side by side with the initiation of academic programs, starting with accredited residency training in 1981 (DNB). Aravind now offers DO, MS, PhD degrees, fellowships and courses in hospital management, among other things. At any given time more than 100 fellows and residents from various countries undergo training, a very competitive program. The tremendous volumes unleashed by the outreach programs created surgical training opportunities unparalled in the world. Twelve to 15 percent of all Indian ophthalmologists get either long term or short term training here, as do residents from other countries.
Paramedical Training
The success and the productivity of Aravind Eye Care System are largely attributed to the training of paramedical personnel. They are high school educated girls from rural areas. They help the ophthalmologists by doing all work which need not be done by ophthalmologists whose time is spared for doing surgery. The value-added training and the Aravind culture of discipline, hard work, ethics, sincerity, honesty, modesty, compassion, and righteousness extended to paramedical staff definitely add to the successful model of eye care delivery.
On any work day, 6,000 outpatients are attended to and 850 surgeries are performed in Aravind Eye Hospitals. Four to five eye screening camps examine 1,500 people and transport 300 patients to the hospitals for surgery each day. Classes for 100 residents and fellows, and 300 technicians and administrators are held per day, thus making Aravind the largest provider of eye care services and trainer of ophthalmic personnel in the world.
Aravind Medical Research Foundation
The Aravind Medical Research Foundation (AMREF) has been doing field studies, epidemiological surveys, operational research and clinical trials. For many years, the spectrum of research activities at AMRF has diversified from epidemiology, clinical research and clinical genetics to basic research and translational research. The importance of basic research on genetics, immunology, microbiology, cell biology, biochemistry and molecular biology of eye diseases with special reference to the Indian context is well recognized.
Aravind is currently under construction for building a new major center for research. The Dr. G.Venkataswamy Eye Research Institute will strengthen and integrate various research activities including proteomics of plasma, vitreous and tear proteins, and stem cell research.
For many years, research has taken a back seat because of Aravind's intense focus on high volume and cost-cutting sight restoring surgeries. Research is non-revenue generating but has to be done. Research activities at Aravind reflect its commitment to finding new ways to reduce needless blindness. Aravind’s combination of high clinical load, extensive community participation, and access to a large network of eye hospitals, provides ideal opportunities for conducting clinical, laboratory, population-based studies, and social and health systems research. As all of us are aware, collaborations with like-minded institutions and scientists for rapid outcomes and results is the need of the hour. This effort will definitely need technical and intellectual support from funding facilities at a global level.
Aravind has positioned itself in the forefront in eye research of India. We invite all international research scientists and funding organizations to join hands and collaborate with us in our research activities for preventing and eliminating needless blindness in the world.
Aravind Managed Care Hospitals
In 2006, not satisfied with its reach and expansion, Aravind set a goal of performing 1 million surgeries a year by the year 2015. The senior leadership group has put together a strategy to achieve this through the concept of "managed hospitals," which involves staffing and managing the day to day operations of an eye hospital that is not owned by Aravind. In this partnership model, the partner manages the investments and creates an enabling interface for the hospital’s effective functioning. A CORE team from Aravind Eye Hospital would manage the staffing through local recruitment, selection and training at Aravind Eye Hospital.
The hospital would be run as if it were an integral part of Aravind’s own network of hospitals. In the pilot phase, three hospitals in India (at Kolkata in West Bengal, Amethi in Uttar Pradesh, and Amreli in Gujarat) are functioning in this model. The next great ‘learning by doing’ experiment has thus been launched. If successful, an exemplar system will achieve another level of scale, with millions more cured of blindness.
Future
Keeping the mission of reducing needless blindness, Aravind would like to venture into other specialities with all its available expertise, skill, management capabilities and community involvement in ophthalmology in addition to continuing our work in cataract blindness. Just like we have established a model for cataract intervention, which is recognized by all, we would like to put into action all programs under Vision 2020 of the WHO. Research to prevent blindness will form an integral part of the system in the future.
The new goals of Aravind include increasing the total number of surgeries from quarter million to 1 million, establishing more Aravind Hospitals and developing more Aravind managed hospitals and bringing into existence a national and global university of ophthalmic sciences. Presently, Aravind is working with Grameen Bank, run by Nobel Laurette Mohammed Yunus, to develop five eye hospitals at Bangladesh and has initiated collaborative moves with Chinese eye institutes including Peking University Eye Centre.
Spirituality
Aravind Eye Care System is named after a philosopher Sri Aurobindo with whose teachings we are all very much associated with. Spirituality allows the divine force to work through each of us for a greater good. If work is approached from a spiritual perspective, then it becomes a divine work. If in your actions, you allow the divine force to flow through you, you will accomplish things for greater than you might have imagined - Sri Aurobindo. We should develop Faith and determination to do.
Faith, more Faith
Faith in your possibilities
Faith in the Power that is at work behind the veil
Faith in the work that is to be done and
The offered Guidance
- SRI AUROBINDO
Finally, I conclude by saying:
Much has been done and
Much remains to be done
With support like this forthcoming
We can do it and we will do it.
Once again I take this opportunity to thank every one of you for recognizing Aravind Eye Care System.
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