1. Aravind Vision Centers
Primary Eye Care Facility of
Aravind Eye Care System
Tamilnadu, South India

2. Aravind’s Outreach practices;
Comprehensive eye screening camp
Diabetic Retinopathy screening camp
Eye screening for employees in industries
Eye screening for children
Aimed to
Create access and awareness
Reduce the backlog of blindness
Improve health seeking behaviour

3. Study on Uptake of Eye Care Services in AEH
Only 7% of people who need eye care utilized eye screening camps

4. Scenario without additional action
Global Blindness
Million
blind
x 2
Scenario without additional action

5. A journey to accomplish the Goal of VISION 2020
Outreach Services
Major barriers
Access ?
Attendant ?
Affordability ?
Awareness ?
Attitude ?
Uptake
of Eye care
is 7%
93%
???
Outreach
Surgery
Camps
Need an alternate strategy
- Primary Eye Care facility
Outreach
Screening
Camps
Available
Accessible
Affordable
Providers centered care
9/10/2018

6. Aravind’s experience in Primary Eye Care – Vision Centres
1st centre inaugurated at Ambasamudram -Theni in April aimed to:
provide permanent eye care facility in the rural area
Inculcate proactive health seeking behavior
increase the uptake of eye care services
Reduce the backlog of blindness in the given population
Specifications–
IT enabled eye care service delivery
Manned by trained mid-level ophthalmic personnel
Vision centre linked with nearest base hospital through IT
All Patients interact with Ophthalmologist thro video conference
Today
Latest opened at kadayam, TVL in March,2014.
Scaled up to 46 centers till date

7. Key Components - Planning to Execution
Village / Site selection:
50,000 population in a radius of 5 Kms.
Accessible by road transport
Standardization :
Infrastructure, Human Resources, Layout, …
Operational practices
Support system (base hospital)
Hierarchy of staff to establish
Secondary and Tertiary eye care
Demand Generation
Baseline information, outreach initiatives
Community involvement & ownership

8. Comprehensive Primary Eye Care
Services Offered
Preliminary Examination
Refraction
Urine/Blood Test
Blood Pressure
Consultation with Ophthalmologist thro teleconference
Eye health education through Counseling
Glasses & Medicines dispensing services
Infrastructure
Refraction Cubicle
Slit Lamp
Computer, Web cam
Satellite Connectivity with Base Hospital
Optical dispensing unit
Autoclave
Generator
Staffing
1 Technician
1 Coordinator
2 EHFWs
9/10/2018

9. Staff mix and Responsibilities
Vision centre Technician:
dispense eye glasses
capacity to diagnose common eye problems,
able to handle slit lamp and fundus photography
Facilitate video conf. with ophthalmologist using IT
Vision centre Coordinator:
patient registration , patient flow management, counseling
optical – medicine sales, accounts, statistics & inventory
Interpersonal coordination (community↔hospital)
Follow up on referrals
Eye Health Field Worker:
Community mobilization (survey, key informant methods…)
Identify and referring curable and incurable blind people
Outreach initiatives in association with Outreach department
Communication & Coordination (community ↔ centre ↔ hospital)

10. Innovation: Low cost technology for imaging
Investment Cost:
Digital Camera & Adapter: US$ 250
vs.
Digital Fundus Camera: US$ 25,000
helps in video conference with Ophthalmologist…
15% of Outpatients only needs to visit base hospital 10

11. Electronic Medical Records in VCs

12. Support from Base Hospital
Leadership team
Uninterrupted supply chain
Back up for human resources
Training and CME programme
Secondary and tertiary level eye care
IT enabled service delivery system
Support from outreach department for awareness
and promotion
9/10/2018

13. Factors influence uptake of eye care services
Interaction with Ophthalmologist
Counseling increases the rate of compliance
Leverage word of mouth (satisfied patient motivates the community)
Providing options for eye glasses / surgery (wide range of lenses, frames, type of IOLs)
Subsidy/Free service for poor (address economic barrier)
9/10/2018

14. Quality Assurance Electronic Medical Records & Tele Consultation
Performance review based qualitative and quantitative parameters once in 6 months
Data based monitoring to improve efficiency in service
Follow up on referrals
Cost control thro financial reviews
Monthly visit by a team with an ophthalmologist

15. Quality of care influences ‘uptake’
Paramasivam 65 years - A bilateral mature cataract patient, village chanter from Sevgampatti village.
… I was totally dependent on my grandson even for daily routine. I could not move without help. But fortunately as recommended by an operated patient, I went to Batlagundu Vision C and got operated at Aravind Theni.
I am now independent in taking care of myself and am back to taking care of the rituals in my village shrine as earlier…
Mrs. Omana 45 years – A Tailor by profession
Presbyopic patient has visited Batlagundu VC
…I had great difficulty in handling needle and thread. I felt very painful and stressed in tailoring.
I came to know about Batlagundu VC through my daughter and got my eyes examined. They diagnosed my condition and prescribed glasses. I feel relieved now, being comfortable in tailoring and handling mobile phone too…

16. Capital and Recurring Cost
Capital Cost
Rupees
USD
Ophthalmic Equipments
3,79,150
6216
Instruments (BP app., needle sterilizer…)
5585 92
Computer accessories& digital camera
1,37,600
2256
Eye glass dispensing unit (edging kit…)
23,000
377
Set up cost (promotion, furniture, Invertors…)
2,05,030
3361
Overhead / Incidental
75,036
1230
Total investment cost
8,25,401
13,531
Recurring Expenditure per month (HR, Rent etc)
30,000
492

17. Key Components
Site Selection Criteria: Service area population, considering our previous work, potential work load
Infrastructure: Standardized across all centres
Human Resources: Scheduled Training For Vision technician and Coordinator in clinical,IT & administration areas.
MIS: Electronic Medical Record, All indenting, stock maintenance through MIS
Monitoring cum Mentoring: Monthly visit by medical team
Demand generation: Information calendar, EHFW, Specialty Outreach around VC, avoid comprehensive camps in the Service Area
Participation by community: involve community through outreach
Ownership: Multiple ownership (Outreach, Clinical, administration, community)

18. Sustainability: Patient Care
Target 25 OP perday
Counseling to increase the uptake of services
(specs, surgeries and referrals)
Follow-up in the community for Cataract, Diabetics and Glaucoma
Periodical specialty outreach
Health Education in the community
Commitment & retention of HR
Local staff
A strong community support

19. Sustainability: Revenue Generation
Spectacles: 65%
Consulting fee: 20%
Medicine and lab investigation: 15 %
Aimed at 100% cost recovery on recurring cost by the end of 2 years

20. Vision centre Leadership Team
Consultant Medical Officer
Visiting Medical Officer
Ophthalmic Technician
and Coordinator
Outreach Organizer
Eye Health Field Workers
Base Hospital Coordinator
Base Hospital level
Vision centre level
Community level

21. Quality Assurance cum Mentoring - By Medical Team Visiting Every Month
Aravind Vision centres -Madurai
S.No
Vision centres
Day of Visit
Incharge Doctors 1
Alanganallur
1st Wednesday
Dr.Niraj Kumar 2
Thiruppuvanam
2nd Wednesday
Dr.Nishanth 3
Gandhigramam
3rd Wednesday
Dr.Sankaranathan 4
Rameswaram
4th Wednesday
Dr.Chandrasekar 5
Natham
3rd Tuesday
Dr. Indira Durai 6
Sholavandan
Dr.Niraj kumar 7
Usilampatti
2nd Tuesday
Dr. Rahul 8
Manamadurai 9
Sathur
4th Tuesday
Dr. Praveen subhudhi 10
Kariyapatti
1st Thursday
Dr. Preethika Gandhi 11
Singampunari
1st Tuesday
Dr .P.S.Vivek 12
Peraiyur 13
KalaiyarKoil
2nd Thursday
Dr. Raghuram 14
Srivilliputhur
3rd Thursday
Dr.Arunkumar 15
Vedasandur 16
Devakottai

22. Benefits to the community
Increased Awareness
Permanent Availability of Service
Personalized care at Hospital
Follow-up to the patients identified with eye defects
Ensures Universal Coverage of eye care to the Service population of 50,000

23. Alanganallur Vision Centre
(April 14, 2007)
Total Population covered
55,000
Unique outpatients‡
16,280
Eye Condition
Est. Need
Served
Coverage
Glaucoma (1%)
551
257
47%
Diabetic Retinopathy
Diabetics*
1,650
615
37%
Diabetic Retinopathy**
330 91
28%
Refractive Errors (15%)
8,250
3054
Cataract (annual)
550
181
(CSR: 3291)
33%
Referral to Tertiary Care Centre: 80% uptake
‡ As on Dec 2013 (7 year period)
*30% of total population is above 40 years of age; of these, approximately 10% are diabetic;
** 20% of diabetics may have DR

24. Benefits to organization at macro Level*
07/16/96
Benefits to organization at macro Level
Increased Presence
Change in health seeking behavior
Increased up take to services(cataract surgery & Spectacles)
Increased in specialty referrals from VCs
Save case finding cost (saves Rs.250/-) compare to camp
Increase in direct walk in patients
Globally looked upon as a model
Development of leadership capacity at different levels(Ophthalmologists, Refractionists, organizers)
Saves Rs. 250/- approximately for every cataract surgery otherwise spent in a camp to identify and transport *

25. Reflection by MO - In charge
“Decision making is the crucial part of professional carrier which can be developed by frequent visits to vision centres”
– Dr.A.Kowsalya , Incharge - Alanganallur
“Provides opportunity to look at non-clinical aspects of centre and improve managerial skills”
– Dr.N.Vidya , Incharge - Kalaiyarkoil

26. Aravind Vision Centres in 2013 (Jan to Dec)
Uptake
43,512
Eye Glasses
(Community level)
(Conversion 91%)
44 Vision Centres (2013)
3,06,170
Outpatients
Paying 2, %
10,497
Cataract Surgery
Subsidized and Free 7,205 – 72%
(Conversion 65%)
15,875
Specialty registered
(Conversion 73%)

27. Recognitions
e-Health INDIA 2009 Award in the category of ‘Innovative Grassroots Tele-centre of the Year' (August 2009)
Piramal Prize –Approach that Democratizing Healthcare(2008)
M.S.Swaminathan Research Foundation Award for Rural health Care and Telemedicine (2007)

28. Future Plan
Reaching the Potential in existing Vision centers – Ensuring follow-up for specialty , Corneal blindness free zone etc.
To reach 10 Million Population with 120 Vision Centers by 2020

29. Reaching 10 Million by 2020: Timeline for setting up new VCs
Year
New VCs
Base Hospitals
2013 3
MDU & TVL
2014 7
MDU, TVL, PONDY, CBE, Tiruppur
2015 10
MDU,TVL, PONDY &CBE
2016 15
Salem, Pondy, MDU & DGL
2017 20
Salem, Pondy & MDU
2018
Salem, Pondy & Chennai
2019
Salem & Chennai
2020 90

30. Much has been done and Much remains to be done…* *
07/16/96
07/16/96
Much has been done and Much remains to be done… * * ##