1. 'Private healthcare augmenting public health' Keerti Bhusan Pradhan- keerti@righttosightindia.orgkeerti@righttosightindia.org

2. Overview Setting the Context The Intervention Results Lessons Learned

3. Insights into Healthcare in Africa Health care in sub-Saharan Africa centers primarily on government activity, but the private sector plays a surprisingly significant and growing role in meeting the region's health care needs. International Research findings show that $20 billion of additional investment in the region's private-sector health care infrastructure is needed in the coming decade to improve the woefully poor health outcomes. Challenges are many  Inconsistent quality of care  Health worker shortages  Inadequate regulation to be addressed if the private sector is to most effectively benefit the health of Africa's people

4. The Cost of Global Blindness Research by Frick and Foster estimated the cost of global blindness and low vision at $42 billion in 2000. Without a decrease in the prevalence of blindness and low vision, it was projected that the total annual costs would rise to $110 billion by 2020. However, if avoidable blindness is eliminated, this will be reduced to only $57 billion in 2020. This equates to overall global savings of US$223 billion over 20 years.

5. The Need 37 million blind worldwide 9 million in Africa with preventable blindness 50-75% due to cataract 5% due to glaucoma

6. 6 Preventable Blindness: A Cataract Operation “Cataract surgery is one of the most cost-effective treatments that can be offered in developing countries. It can allow people to increase their economic productivity by up to 1500% of the cost of the surgery during the first post-operative year”. WHO * Other causes include untreated refraction, alien bodies, trachoma

7. Right to Sight (RTS) mission is to eradicate the global crisis of preventable blindness through the use of proven, leading edge techniques in cost recovery, training and surgical practice. RTS supports to facilitate capacity building through training and consultancy for development of the eye hospital through a Private-Private-Partnership Project. Right to Sight works in partnership with Shalina Group to facilitate the planning of the clinic, focussing on training & capacity-building moving to sustainability. The Aravind Eye Care System is the largest eye care provider in the world with a renowned service delivery model, a facility for manufacturing high quality ophthalmic products at low cost – Aurolab and an institute for teaching and training – LAICO. AECS and LAICO (Lions Aravind Institute of Community Ophthalmology), work in partnership with Shalina Group to provide cutting-edge clinical / non-clinical training and comprehensive eye hospital planning. Shalina Laboratories, a multi-million dollar pharmaceutical company in DRC with a good understanding of the local context and strong social responsibility. Shalina Health Care and Shalina Foundation plan for an Eye Hospital in Lubumbashi. Project conceptualized in March 2007 when RTS & AECS representatives visited Lubumbashi to discuss eye care in the region. With existing available space, it is decided the Eye Clinic can have approx. 3500 sq.ft. and 25 Beds initially

8. Tripartite Partnership Model International NGO Private Not for Profit NGO & Consulting Partner Private Not for Profit Consultancy Firm Private Business Firm Private for Profit Private Private Partnership

9. Process Needs Assessment Visit March 2007 Training and Capacity Building Project Implementation Hospital Inauguration Dec 8, 2007 Vision Building and Strategic Planning Nov 10-12, 2007

10. Affordable and Sustainable Eye Care Services in Katanga Province-DRC ServicesPrice Policy Outpatient Services Registration Fee$1Valid for One Year Examination Fee / Review$2Valid for 30 Days / Any number of visits Investigations$2 Laboratory Charges$10-30 Spectacle $20 to $100 Surgical Services Phaco with Acrylic / Alcon Lens$550 Phaco with Aurofoldable Lens$300 SICS with Rigid Lens$200 SICS with Rigid Lens (Subsidized Fee)$30Subsidized for Patients who cannot afford Other Surgeries (DCT, DCR, I&C)$30-$50 Accommodation ( Room Rent) Private Wards$25Per Day (Not charged) Free Wards$0 Room rent is included in the Surgical Charges

11. Achievements More than 35,000 Outpatients seen in the first year of operations (Dec.07-Nov.’08) Surgeries in the first year of operations-2000 Capacity building of local Congolese staff happening simultaneously through osmosis/transfer of skills from expats to locals. HR: 5 expats to 30 Congolese. (1:6) SEC operational expenses broke-even by the end of first year

12. Steady stream of patients in Outpatient Department

13. 13 Lessons Learnt Clarity and Dissemination of vision, goals and objectives, sustainability initiatives for Eye Care Institutions should be the criteria in Private-Private Partnership eye care model in Africa. Operational ownership of Eye hospitals by the partners is vital to make a successful eye care venture in Africa. Proof of Private-Private partnership model to be evaluated for learning in the African context and replicated in phases with a Vision to Eliminate Needless Blindness by 2020. Future Plans Shalina has a vision and plan to expand this Private-Private partnership model of Eye care delivery to 18 African countries with six centers planned in DR Congo in phases. Based on the success of this model Right to Sight in partnership with Shalina Group and with other Private partners will roll out more such eye care facilities in Africa to eliminate needless blindness by 2020. This pilot would provide road map for many private partnerships to have eye care services in Africa leading towards the goal of eliminating avoidable blindness by 2020.