An approach to Universal eye health ARAVIND EYE CARE SYSTEM 5 - PowerPoint PPT Presentation

Vision Centres • An approach to Universal eye health ARAVIND EYE CARE SYSTEM

5 Specialty Care Research Aravind in Training Tertiary 1976: Care Centers 1000 - 2000 patients 6 Secondary Cataract Services A Day at Aravind Specialty Diagnosis  12,000 Patient Examinations Care Centers  1,500 Surgeries 150 - 400 patients  5-6 Outreach camps Comprehensive Eye 6 Examination • 1,500 examined Treatment of Minor + ailments • 300 transported to base Outpatient for surgery Centers 100 -150 patients  Classes for 100 Residents & 59 300 technicians and + Comprehensive Eye Examination administrators Primary Care 15 -25 patients Centers

Aravind Eye Care System  Patient care  Community Outreach  Manufacturing  Research  Training  Consultancy

Aravind in 2015-16 3,727,387 Outpatient Examinations 408,220 Surgical Procedures 50% for free / steeply subsidized

DOING GOOD & DOING WELL (in Rs. millions) 2,000 2014-15 (in Rs. millions) Free 1,800 27% Paying Income : Rs. 2645 1,600 50% Expenses : Rs. 1481 1,400 Subsidized 23% 1,200 1,000 800 600 Toal Expenses 400 Total Income 200 - 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

LAICO : Creating Competition

Create Competition “to eliminate needless blindness” 310 Eye Hospitals worldwide

Impact of Capacity Building Process: Cataract Surgeries (40 Hospitals) 100,000 Capacity Building 91,445 80,000 76,995 Cost Recovery 60,000 90% 52,506 40,000 Cost Recovery 20,000 60% 0 1 yr Before 1 yr After 2 yrs After

Community Outreach In 2016: 16% 2,590 camps Outpatients 570,921 33% outpatients 88,774 Cataract Surgeries cataract surgeries

Outreach Camps

Camps – Patient Segments

Annual Performance: Outreach Camps Workplace Pediatric School Comprhnsv. DR Camps Camp Screening Camp Camps • 46 camps • 302 schools • 213 camps • 276 camps • 1,531 camps • 8,420 • 288,219 • 50,602 • 16,621 • 347,053 children children workers diabetics patients (screened by • 94 specs • 13,806 • 2,269 DR • 63,401 teachers) spectacles patients spectacles • 428 children • 91,893 seen identified with other • 92,816 by eye defects cataract doctor identified surgeries • 19,365 children found to have defects

From Outreach … …to Universal Coverage Aravind Eye Care System

Considerations for Universal Coverage… • Accessible & affordable: – to everyone in the service area • Coverage for all eye diseases • Quality of care – right diagnosis & treatment • Completion of full treatment cycle – locally or through referral network – ensuring high levels of compliance – Easy access to medicines & glasses

Uptake of eye care at outreach camps Study of uptake in eye camps No of villages covered 47 Population studied 22,047 No of people with eye problem 749 % of people with eye problem 3.4% Of the above, attended the eye camp 51 % attending camp 6.8%

Effectiveness of screening camps? • We reached only 7% of those in need of eye care 1 • Those with rarer eye conditions were not addressed 1 “Low uptake of eye services in rural India”; Astrid E. Fletcher et al; Archives of Ophthalmology Vol 117, Oct 1999

Aravind Vision Centers

Electronic Medical Records in VCs

Coverage in Service population (inception till 31 st March 2015) No. of Unique Population Estimated VC Age Centres Population Patients covered coverage <1 year 5 308,390 6,000 2% 10% 1-2 years 5 258,247 15,402 6% 30% 2-3 years 3 232,621 24,698 11% 53% 3-4 years 3 226,184 42,648 19% 94% 4-5 years 5 313,939 67,331 21% 107% >5 years 30 2,021,752 764,049 38% 189% Total 51 3,361,133 920,128 27.4% 137% From outside the service area 373,751 Grand Total 1,293,879 Estimated coverage calculation: assuming that 20% of the population in need of eye care

Uptake Comparison Eye camps vs. Vision Centres Camp 51 Vision “Study” Centres* No of villages covered 47 1,909 Population studied/covered 22,047 3,361,133 840,000 No of people with eye problem 749 % of people with eye problem 3.4% 25% 920,128 Attended eye camp/V. Centre 51 % of those in need 6.8% >100% 27.4% % of the population 0.23% * Inception till 31 st March 2015 * From inception till end Mar 2015

Primary Eye Care Centers  58 centers ~4 million population  40% reach within the first year  rising to 75% by year 2  91% of problems resolved locally

Vision Centre: Services • Comprehensive eye Examination • Refraction • Blood sugar test • Blood pressure • Consultation with ophthalmologist through tele-consultations • Eye health education through counseling • Glasses & medicines dispensing services 11/3/2016

Key Components Planning to Execution Village/Town & Site selection: • 50,000 population in a radius of 5 Kms. • Accessible by road transport Standardization: • Infrastructure, Human Resources, Layout, … • Operational practices Support system: • Management Structure for Support & Control • Tele-Consultation and eye care for the referred Demand Generation: • Baseline information, outreach initiatives • Community involvement & ownership

Vision Centre: Infrastructure Ophthalmic Equipment • – Slit Lamp, Tonometer – Trial set, Torch light – Ophthalmoscope – BP Apparatus, Ht./Wt. scale – Glucometer Computers - 2 (one with • webcam, speakers & printer) Internet Connectivity • Optical & Medicines • Space of about 300 to 600 sq. ft. dispensing unit With furniture for clinical work Sterilizer • and patient waiting UPS - Invertor • 11/3/2016

Vision Centres – Infrastructure & Equipment 11/3/2016

Local HR – Value Fit Over Clinical Competency Vision centre Technician : 3+ years Experience at Hospital  Do refraction and dispense eye glasses  Capacity to diagnose common eye problems,  Able to handle slit lamp and fundus photography  Facilitate video conf. with ophthalmologist using IT  Giving care and Support to the patients Vision centre Coordinator : 3+ years Experience at Hospital  Patient registration , patient flow management, counseling  Optical – medicine sales, accounts, statistics & inventory  Interpersonal coordination (community -hospital)  Follow up on referrals Eye Health Field Worker (shared) :  Community mobilization (survey, key informant methods…)  Identify and referring curable and incurable blind people  Outreach initiatives in association with Outreach department  Community based follow-up

Clinical support • Tele consultation with each patient • Continually upgrading the skills of OA • Clinical quality monitoring • Surgery, advanced investigations or other care for the referred patients

Investments per Vision Centre Capital Cost USD INR Ophthalmic Equipments 6,100 400,000 Instruments (BP app., needle sterilizer…) 75 5000 Computer accessories 2,000 1,32,000 Eye glass dispensing unit (edging kit…) 350 23,100 Set up cost (promotion, furniture, 3,300 217,800 invertor…) Overhead / Incidental 600 40,000 Total investment cost 12,425 820,050 Recurring Expenditure per month 600 40,000 (HR, rent and maintainance etc.)

Management support • Supervision • Ensuring supplies • Maintenance – of equipment & computers • Monthly visits • Centralized patient experience assessment • Quarterly review meetings

Vision Centres: Performance April 2015 - March16 Uptake 59 Vision Centres 60,763 Bought - 91% Eye Glasses (3.7 (86%) Million) Paying 3,829- 27% 14,326 Outpatient Acceptance 65% Cataract Visits Surgeries Subsidized & Free 440,625 (68%) 10,497 (73%) 22,504 Specialty referred Attended Hpl - 70% (73%)

Aravind Vision Centre Locations Map

What makes it possible?

Generating demand Access: Generating demand: Awareness Permanent set up - Door to door - Health education providing screening & follow up - Involving volunteers services six days - School screening to promote eye care of a week in a - Screening for low - Promoting eye location easily vision donation accessed by - Diabetic retinopathy community screening camps - Screening eye Referral and camps for children follow up at secondary & tertiary eye care centres

Ensuring quality of care • Electronic Medical Records & Tele Consultation • Evaluation based on qualitative and quantitative parameters once in 6 months • Data based monitoring to improve efficiency in service • Follow up on referrals • Monthly visit by a team with an ophthalmologist

Studying patient distribution % Population covered <=10% 11-20% 21-25% >25%

Technology Patient Registration- Unique ID

Technology Registry for cataract