5.  Gap analysis:  Assess unmet need in the community  Assess current utilization of Infrastructure and Resources  Set Targets:  Based on community need  Lead to optimum utilization  Strategic approaches to achieve targets  Financial viability: what it takes to provide services/achieve targets and how to meet the expenditure

6.  Assumptions about the environment  Assumptions about the Mission  Assumptions about the core competence Applying it to the “Present” and “Future”

8.  Relevance  Standardisation of processes and protocols  Ensure service uptake levels  Quality of diagnosis & treatment  Patient comfort  Outcome

9. Helps in:  Instrumentation  Training  Patient flow  Quality improvements  Patient’s understanding & co-operation

10. 10

12.  Performance  Addressing challenges  Monitoring changes & variations  Review effectiveness of the strategies & introduce necessary changes to programme implementation

13. Cost Containment Improve Resource Utilization Implement Low-cost Technologies e.g. Surgeries/Surgeon Operations/bed/year e.g. Surgeries/Surgeon Operations/bed/year e.g. Sutures, Eye drops, IOL/Specs, Maintenance Fixed Cost Variable Cost Revenue Generation Self Generated Other Sources Subsidy/Donation Other Sources Subsidy/Donation e.g. Rich patients, Support services, Spectacles e.g. Govt, Local NGO, Community e.g. Govt, Local NGO, Community Patient Generated Revenue Subsidy Other countries e.g. Multilateral, Bilateral, INGO Subsidy National Self-reliance Ext. Dependence Continually refine pricing & management processes Diversify the portfolio Sustainability Process

14.  Maximize Revenue  Minimize costs Revenue > Cost of eye care services Tension: Social obligation Tension: Quality & Patient Satisfaction

15.  Scale: Investment in infrastructure, size of the facility and staffing are the major determinants  Efficiency  Optimum utilization of the infrastructure  Seasonal variations in patient load  Staffing & Staff utilization pattern  Productivity

16.  Logistics driven  good inventory management  group purchasing for better price  Good materials management (reduce wastage in storage & pilferage)  Cost engineer your clinical protocol  Eliminating unnecessary investigations, procedures & medications

17. Hospital’s perspective:  Hospital Charges  Medication ?? Patients’ perspective:  Cost of care  Transportation  Food  Lost wages  Cost of accompanying person  Family visits  Follow-up visits  Restrictions

18. Total Beds: 63 + 100 Paying: 40 (22 %)Paying: 40 (22 %) Free walk-in: 23Free walk-in: 23 Camp: 100Camp: 100 80 km, west of Madurai Location: 80 km, west of Madurai Service area population Theni District: 1 millionTheni District: 1 million City Population: 111,500City Population: 111,500 Kerala districts: 3.2 millionKerala districts: 3.2 million 55% of population in rural area Human Resources: Ophthalmologists: 2 Residents: 7 Clinical staff: 37 Administrative staff: 29 Services offered: Cataract; Refractive Errors; Glaucoma; Medical Retina & Lasers Patient Fee Strucutre (US$): OP Consultation: Paying: 1.00; Walk-in: Free Cataract: Camp: US$ 0 (- US$ 6)Camp: US$ 0 (- US$ 6) Subsidized: US$ 17Subsidized: US$ 17 Paying: US$ 30 - $ 380Paying: US$ 30 - $ 380

19. Paying Free Hospital Total Subsidised Camp Cataract Surgeries2,0081,8413,7077,556 Fixed Costs$ 150,630- Variable Costs$ 40,965$ 10,958$ 35,305$ 87,228 Total Cost$ 191,595$ 10,958$ 35,305$ 237,858 Unit Cost$ 95$ 6$ 10$ 32 Fee/Subsidy per case 1221214 Contribution per case $ 27$ 6$ 4 Total Surplus$ 54,216$ 11,046$ 14,828$ 80,090 32% All Financial figures are in US$

21.  Capital cost: Cost of Land, Building, major equipment, etc  Recurring cost: Ongoing cost of providing the services  Fixed Cost: Costs that have to be incurred regardless of the level of activity  Variable cost: Costs that vary directly with the level of activity  Unit cost: (Fixed cost + variable cost) per unit of service