Optical Services as a Critical Component of Eye Care and Sustainability R Rahmathullah, J Barrows, W Shields, V Sheffield THE INTERNATIONAL EYE FOUNDATION

AIM ► Importance of opticals to sustainable ophthalmic services ► Options to establish optical services ► Planning process ► Results to be expected ► Critical considerations

► RE services not serving all populations ► Patients inconvenienced by going to another location to get glasses made ► Ophthalmology not taking advantage of optometry services ► Lost revenues to ophthalmology BACKGROUND.

► IEF SightReach® Management experience developing comprehensive and financially sustainable eye care services SETTING. ► Transitioning private sector to include social service and government sector to be business like ► NGO role: invest in services serving all populations and create capacity for financial sustainability ► Optical services integral to model

► Address large population with uncorrected refractive error ► Make services accessible, affordable, and convenient ► Ensure high quality – new spectacles, not used spectacles ► Ensure financial sustainability ► Provide percent of profit to “Sustainability Fund” GOALS.

Critical Questions - before you start! ► Integrate optometry into ophthalmology? ► Private business to raise funds? ► For what purpose(s)?  Support ophthalmology?  Subsidize services?  Expand/replicate services?  Provide training opportunities?  Support outreach services? ► Short or long term involvement? ► What is the exit strategy?

PHASES – for setting up optical service ► Planning – 2-3 months  Assessment of capacity, commitment, leadership, market potential ► Procurement – 3-4 months  Equipment, furniture, personnel ► Implementation – 6-18 months  Open the doors for business ► NGO Exit  Monitoring for quality, management, revenue

PLANNING PHASE ► Establish agreements  Roles of stakeholders  Who “owns” the business?  Inputs required ► Evaluate commitment  Commit time required to achieve defined result ► Pre-assessment  Determine capacity, willingness, leadership, policies, market feasibility

BUSINESS PLAN ► Define services  Market - patient population  Pricing strategy – cost vs. price; how much mark up to achieve purpose ► Emphasize quality  Durable/ attractive inventory; convenience; range of offerings; customer service; pricing ► Evaluate environment  Who/ what is the “competition”  Policies – optometry, taxes, customs ► Model financial return/break even point ► Identify inputs needed and budget

PROCUREMENT PHASE ► Personnel needed  Optometrist, who does refraction?  Sales, workshop, accounting, security staff ► Facility set up  Location, accessibility, visibility  Refraction, sales, workshop? ► Procure equipment, inventory  Appropriate equipment  How much inventory to have on hand? 1 Optometrist 2 Opticians 2 Sales People-also fit spectacles

COORDINATED IMPLEMENTATION ► Management structure  Establish clear lines of authority, accountability, transparency  Staff policies  Accounting procedures and policies  Procurement procedures and policies

EXIT PHASE ► Monitor management ► Monitor quality ► Monitor procurement ► Monitor growth in patient services ► Monitor revenue generation

IEF OPTICAL SERVICES MODEL ► 7 Opticals in 12 hospitals in Africa, India, Latin America - different approaches: ► Improve existing services: Guatemala, India (1), Honduras  Eye unit takes ownership vs. consignment  Increase equipment, inventory and staff ► Start from scratch: Malawi (2), India (1)  Identify space  Follow phases of planning, procurement, implementation

COST IEF Model ► Optical shop with workshop: equipment, stock, supplies, furniture only - $40,00-$50,000 US ► 1-2 year period of IEF planning, site visits, technical assistance, monitoring, etc. – average $20,000 US

Blantyre Penya Optical ► 20,240 examined, 8,109 refracted ► 52% female, 7% children ► 40 average refractions per day ► 25 average pair glasses per day ► Contribute 15% of monthly gross sales revenue to hospital sustainability fund

Percent contribution optical revenue of all revenue US $

Percent contribution optical revenue of all revenue Blantyre – LSFEU/ Penya Optical Optical - 88%$127,176 Patients12%$17,968 India – Gomabai N&RC Optical - 12%$51,422 Patients88%$373,440 India – Vision Centers Optical - 86%$10,515 Patients14%$1,669 Guatemala – Visualiza (2 units) Optical - 30%$255,355 Patients70%$599,507 El Salvador - ClaraVision Optical - 18%$48,534 Patients82%$220,412

CHALLENGES ► Procurement process  Supplier relationships; burdensome foreign exchange process  Burdensome customs policies and procedures  Devaluation ► Transfer of profits  Robbing Peter to pay Paul ► Affordable pricing in crowded market  Affordable vs. free

WHY THIS MODEL? ► Why hire an optometrist?  Capture patients not coming through eye clinic  Ophthalmic staff dedicated to treatment and surgery ► Why 2 sales and 2 technicians?  Optical Service should be large enough to handle an increasing volume, be financially sustainable, and earn profit for eye unit’s sustainability fund ► Why have a workshop on site?  For patient convenience and rapid fulfillment of prescriptions

CONCLUSIONS ► Clear purpose is critical ► Run as a business ► Commitment essential ► Need to manage agreements ► Attention to quality is critical ► Continuous management required

ACKNOWLEDGEMENTS ► MALAWI (Lilongwe): Drs. Moses Chirambo, Joseph Msosa, and optometrist Kiran Kumar. ► MALAWI (Blantyre): Drs. Gerald Msukwa, Khumba Kalua, Nkume Batumba, and optometrist Navin Kumar. ► INDIA (GNRC): Mr. S. Parawal ► INDIA (Theni Vision Centers): Dr. P. Namperumalsamy, Mrs. Preethi Pradhan, and Mr. R.D. Thulasiraj ► GUATEMALA: Drs. Mariano Yee, Nicolas Yee, Mr. Juan Francisco Yee, and optometrist Dr. Kim Yee ► EL SALVADOR: Drs. Juan Miguel Posada Fratti, Julio Caballero, and Mrs. Ena de Posada ► HONDURAS: Dr. Juan Odeh-Nasrala, Mr. Rene Arturo Lopez Torres, and Mrs. Odeh-Nasrala