Aravind Eye Care- CSR Initiative

The presentation explores the CSR initiatives of Aravind Eye Hospitals. The efforts to create a holistic approach to providing eye care to the underprivileged section of the society and end to end integration of product and services to generate a low cost, strategic competitive model.

1. TABLE OF CONTENT INTRODUCTION STRUCTURE OPERATIONAL EFFICIENCY REVENUE MODEL REFERENCES

2. INTRODUCTION

3. Aravind Eye Hospital is internationally recognized as an institution best suited to make not just a dent, but a grand canyon in the world of blindness. There are nearly 39 million blind in the world. And nearly one-third of them are unnecessarily blind, which means that they don’t have to stay blind; a medical intervention can treat them. But the intervention in many cases requires surgery. And there just aren’t enough doctors to go around. In a world that is being increasingly commercialized, ARAVIND is breaking down the dichotomy between making money and doing good.

4. Dr. Govindappa Venkataswamy or “Dr. V” as he was fondly called, wanted to eradicate needless blindness in India. In order to do this, Dr. V emulated the service efficiency of McDonald's fast food and sought to adapt it to the eye care system to cope with increasing the numbers of patients treated. Aravind eye hospitals today, are acting as an ethical symbol for the society by giving sight to millions of blind people in India. The problem of cataract related blindness was major in India with at least 4.8 million cases every year. Cataract related blindness can be avoided by timely intervention and surgery. A small non profit hospital with eleven beds was started but due to the ethical practices followed by this hospital it became the number one hospital to perform the highest number of eye surgeries in the world. Dr. Govindappa Venkataswamy (1918- 2006)

5. With 7.8 million blind people, India account for 20 per cent of the 39 million blind population across the globe. Eye error % of Total Cataract 62% Refractive error 19.7% Glaucoma 5.8% Corneal Blindness 1%

6. ARAVIND BUSINESS MODEL There are 3 key elements that define the Aravind Business Model  Economies of scale With excellent management and high patient volume, Aravind keeps productivity high, with surgeons performing 25–40 procedures daily; unit costs are maintained at the very low level of about $10 per cataract operation Cross-subsidies Aravind provides free or very low-priced care to two thirds of its patients with the revenue derived from the one third of patients who are able to pay moderate prices. The only difference in the treatment of those who do and don’t pay is in the amenities, such as the air conditioning in the recovery room.

7. Vertical integration Recognizing that the imported intraocular lenses constituted a major component of the total surgical costs, Aravind obtained a transfer of technology through the US-based Seva Foundation, and additional support from the Combat Blindness Foundation, to permit it to manufacture these lenses at a fraction of the cost. The manufacturing activity scaled up quickly, from 35,000 in 1992–1993 to nearly 600,000 lenses today. Now, at the Aurolab subsidiary established for this purpose, a workforce of about 200 young women from rural backgrounds produces lenses to a global standard of quality that are used at Aravind , as well as at facilities throughout India The system of eye hospitals also is considered one of India’s premier ophthalmic training institutions, providing a steady flow of well-prepared professionals and support staff. 

8. MILESTONES YEAR MILESTONE 1976 ARVIND EYE HOSPITAL- MADURAI 1985 ARVIND EYE HOSPITAL- THENI 1988 ARVIND EYE HOSPITAL- TIRUNELVELI 1992 AUROLAB 1996 LAICO 1997 ARVIND EYE HOSPITAL- COIMBATORE 1998 ROTARY ARVIND EYE BANK- MADURAI 2001 FIRST AMECS HOSPITAL 2003 ROTARY ARVIND EYE BANK- PONDICHERRY YEAR MILESTONE 2004 FIRST PRIMARY EYE EXAMINATION CENTRE- AMBASAMUDRUM FIRST COMMUNITY EYE CLINIC- MELLUR 2007 AUROLAB'S NEW FACILITY CHAMPALIMAUD AWARD 2008 DR. G. VENKATASWAMY EYE RESEARCH INSTITUTE GATES AWARD 2010 HILTON HUMANITARIAN PRIZE ARVIND EYE HOSPITAL- DINDIGUL, TIRUPUR COMMUNITY EYE CLINIC- SANKARANKOVIL 2011 ARVIND EYE HOSPITAL- SALEM COMMUNITY EYE CLINIC- PONDICHERRY 2012 ARAVIND EYE HOSPITAL- TURTICORIN, UDUMALPET 2014 ARAVIND EYE HOSPITAL- COIMBATORE (SECONDARY EYE CARE FACILITY) 2017 ARAVIND EYE HOSPITAL- CHENNAI

9. STRUCTURE

10. HOSPITALS AUROLAB EYE BANK OUTREACH IT TRAINING RESEARCH ARAVIND EYE CARE SYSTEMS

11. HOSPITALS Following his retirement at age 58 in 1976, Dr. V established the GOVEL Trust under which Aravind Eye Hospitals were founded. The GOVEL Trust was created as a non-profit trust, with Dr V as Chairman and his two brother, two sisters and their spouses and an ex officio member, the Madurai Main Rotary President as trust members. Dr V started with a modest 11-bed hospital, in Dr V brother's home at Madurai, after most banks refused to lend him money because of his age and eccentric model. In this hospital six beds were reserved for people who could not afford to pay while the remaining five were for paying patients. He had to mortgage all the jewellery of his family members to raise funds to start the first hospital. The hospitals were named after Sri Aurobindo , one of the 20th century's most revered spiritual leaders. Dr. V wanted to emulate the service efficiency of McDonald's fast food and sought to adapt it to the eye care system to cope with increasing the numbers of patients treated. 40 years later, this resulted in a further 12 hospitals and a complete eco system for Eye Care in India Sri Aurobindo Ghosh (1872-1950)

12. AUROLAB The cost of surgery was always a central concern at AEH. As noted earlier, AEH had decided on the IOL technique as the standard technique to be adopted in all cases (except in those where this could not be done).  But in the eighties, the cost of IOL lenses (all of which were imported) was very high, about $80-100, and this made the cost of surgery quite high. Hence in 1991, AEH set up a facility to manufacture lenses Named Aurolab , This was set up as a separate no-profit trust with the mission of achieving “local production at an appropriate cost”. The technology was obtained from “IOL International”, Florida, USA., with a one-time fee paid to the company for technology transfer along with a buy back arrangement. This helped in maintaining quality using the feed back given.  This venture was also supported by Seva Foundation, Sight Savers International, the Combat Blindness Foundation USA, Canadian International Development Agency (CIDA) through Seva Service Society Raw material for the lenses was imported from US/UK. The rigid IOL were sold for less than US $5 at Aurolab . In 2002, Aurolab produced about one sixth of the total number of low end lenses produced in the world. However, it also produced rigid and foldable lenses as well as superior categories such as acrylic lenses. Aurolab had been able to get the CE Mark (a mark of quality) and ISO 9002 certification. As on 2003, Aurolab produced about 600,000 lenses per year (with single shift working).  Large nongovernmental organizations such as CBM, Lions and Rotary also bought IOL lenses from Aurolab and supplied it to various eye hospitals all over the world. This increased sales worldwide and 33 percent of the IOL’s produced were exported. Of the remaining 67 percent of the lenses produced, 20-25 per cent was consumed by AEH and the rest were sold in open markets in India. Since inception Aurolab had supplied more than 2 million lenses to non-profit organizations in India and 160 countries.

13. Lions Aravind Institute of Community Ophthalmology (LAICO) was established in 1992 with the support of the Lions Club International Sight First Programme and Seva Sight Programme . It is Asia's first international training facility for blindness prevention. It contributes to improving the quality of eye care services through teaching, training, research and consultancy. The objective of LAICO is to improve the planning, efficiency, and effectiveness of eye hospital LAICO also offers long term courses in hospital management as well as short duration skill development courses in the area of community outreach and social marketing and instruments maintenance. These courses are offered at very reasonable prices. LAICO has already worked with 149 eye hospitals in India, Africa, and South East Asia. LAICO has made interventions in UP, West Bengal, Orissa, Delhi, and a few other states in India. It has also made interventions abroad in different countries among which are Malawi, Kenya, Zimbabwe and Zambia. LAICO in collaboration with International Agency for Prevention of Blindness (IAPB) had committed to achieving the “Vision 2020” LAICO

14. ARAVIND MEDICAL RESEARCH FOUNDATAION A number of clinical, population based studies and social and health systems research are conducted using the data readily available in the hospitals and the community outreach programs. The Aravind Medical Research Foundation(AMRF) coordinates the research needs. Many of these research projects are supported by different agencies and some by AEH itself. The combination of high clinical load, extensive community participation, and access to a large network of eye hospitals provides ideal opportunities for conducting clinical, laboratory, population-based studies and social and health systems research. Dr. P. Namperumalsamy , provides leadership to the research efforts of Aravind Medical Research Foundation Major Research Areas for the Institute are: Molecular Genetics Stem Cell Biology Proteomics Ocular Pharmacology Bioinformatics Ocular Microbiology

15. EyesTalk Leveraging Technology: Information Technology offers a great opportunity to reach the population, rich and poor, rural & urban, with facilities for good eye care at appropriate cost Recent advancements in tele -medicine break through barriers of distance and time and in the field of eye care they present a whole new array of exciting possibilities! Riding the wave of this new revolution is eyesTalk , free software that enables ophthalmologists anywhere in India and the rest of the world to receive second opinions/expert diagnoses from medical professionals of the Aravind Eye Care System. EyesTalk is a dynamic software that makes it safe and simple to send complete patient consultation records along with images from ophthalmic diagnostic equipment like slit lamps, fundus imaging, ultrasound etc. to specialists at Aravind for diagnosis/second opinion. The software allows you to maintain complete confidentiality of patient information and creates a database for these consultations that automatically updates itself in your system. To use eyesTalk all you need is a regular telephone line and a computer with a dial up modem: Uses conventional Internet Protocol (IP) for data transmission Ensures privacy and security of patient data through appropriate encrytion Allows comprehensive patient data entry through specialty-specific templates (separate entry sheets for retina, uvea , glaucoma, cornea etc) Does not require system to be constantly online Provides automated uploading and downloading of data when connected to the Internet

16. EYE BANK In India, the need for corneas for sight restoring surgeries is one lakh per year. Started in 1998 at Madurai with just a collection of 253 eyes, now the eye banks across the Aravind Hospitals procure more than 5000 eyes and perform about 1700 corneal transplants annually. Eye balls which cannot be used for transplants are effectively used for various research and development programmes Centre Eyes Collected Eyes Utilized Madurai 2,469 1,148 Coimbatore 1,570 701 Pondicherry 1,136 403 Tirunelveli 711 260 Total 5,886 2,512

17. EDUCATATION & TRAINING Aravind Eye Care System is a collaborating centre for the World Health Organization (WHO) with a mandate to design and offer training programmes to eye care personnel at different professional levels, from around the world, in the development and implementation of efficient and sustainable eye care programs Aravind’s training programmes cater to all levels of ophthalmic personnel – these are intended not only for ophthalmologists but also for ophthalmic technicians, opticians, clinical assistants, outreach coordinators and health care managers. Aravind offers several structured training programmes 

18. CANDIDATES TRAINING(2017-18) POSTGRADUATE COURSES Course Duration Intake Diploma in Ophthalmology 2 years 8 Master of Surgery in Ophthalmology 3 years 11 Diplomate of the National Board 3 years 19 Post DO DNB 2 years 13 LONG-TERM OPHTHALMOLOGY FELLOWSHIP Ant. Segment / Intraocular Lens Microsurgery 2 years 14 Orbit & Oculoplasty 18 months 7 Paediatric Ophthalmology & Strabismus 18 months 17 Glaucoma 2 years 14 Retina Vitreous 2 years 22 Cornea 18 months 18 Comprehensive Ophthalmology 2 years 1 Fellowship in General Ophthalmology   27 SHORT-TERM FELLOWSHIP (FOR INTERNATIONAL CANDIDATES) Orbit & Oculoplasty 6 months 1 Orbit & Oculoplasty 1 year 1 Cornea 1 year 2 Glaucoma 1 year 2 Paediatric Ophthalmology 1 year 2 Retina 1 year 3 SHORT-TERM CLINICAL COURSES FOR OPHTHALMOLOGISTS Small Incision Cataract Surgery 1 month 31 Clinical Observership Programme in Diagnosis and Management of Glaucoma 1 month 21 Lasers in Diabetic Retinopathy Management 2 months 47 Vitrectomy (Virtual) 2 weeks 1 Management of Retinopathy of Prematurity & Paedia. Retinal Disorders 1 month 14 Neuro-Ophthalmology 3 months 4 Phacoemulsification 1 month 35 SHORT-TERM PARAMEDICAL COURSES Optical Dispensing 3 months 4 OT Techniques 2 months 4 Refraction Techniques 2 months 8 Orthoptist 6 months 3 Ocularist 3 weeks 7 Fundus Fluorescein Angiography and Ultrasonography 2 months 7 Vision technicians 2 months 2 MANAGEMENT COURSES Management Priorities in Eye Care Delivery 1 week 21 Management Training and Systems Development for Hospital Administrators / Managers 4 weeks 28 Project Management training for Eye Care 4 weeks 10 Eyexcel - Expanding Global Eye Care Workforce through Excellence in Training 4 days 32 Research Methodology 5 days 50 Medical Records Management 2 weeks 10 Management Training for Eye Care Programme Managers 2 weeks 22 Community Outreach and Social Marketing of Eye Care Services 3 weeks 15 Instrument Maintenance - for Technicians 4 weeks 31 Instrument Maintenance - for Ophthalmologists 5 days 3 Training in Eye Bank Techniques 1 month 5

19. OPERATIONS

20. OPERATION FLOWCHART Registration Vision test, Preliminary Examination & Refraction by Vision Technician Dilation, Tension, Duct, BP & Urine Sugar (Mandatory for all ≥ 40 Cataract Tele Consultation with Ophthalmologist Advice for Cataract surgery by Ophthalmologist Counciling for cataract surgery by coordinator Referred to base hospital Admission for Surgery (paying or free): patient will be charged accordingly Surgery Post operative medication Discharge Councilling for follow up Patients with speciality eye problems & other complications Final consultation with medical officer through tele conference Medicines/Glasses Final consultation with medical officer through tele conference Referred to speciality clinics at base hospital Registration at the base hospital Diagnosis of the specialty problem at the base hospital Necessary treatment Exit Yes No No Yes

21. Aravind began performing surgeries on a large scale with treatment being free or heavily subsidized for the poor cross subsidized by the paying patients. Aravind established an outreach program wherein doctors reach out to remote villages to conduct eye camps, some times, in association with various organizations. The organizations take care of the costs of the camp, transporting the patients to surgery and their rehabilitation while Aravind does the surgery free of cost. Aravind started performing 5 times the number of cataract surgeries that were performed in the entire country and 16 times more than that of the entire U.S. Aravind focused on rotating doctors between free and paid wards, concentrating on efficiency and hygiene thus eliminating differences between the surgeries done for paid and non-paid patients. The rate of infection in Aravind was about four per thousand surgeries which was significantly lower than the international norm of six per thousand surgeries.

22. OUTPATIENT PROCEDURES Eye Examination Procedures There are many different eye conditions; you will need to have a detailed eye examination which could take upto hours, depending on the complexity of tests required. The durations indicated below are an average. Registration (5 minutes): On arrival you will be asked to fill in a registration card. Please give your complete permanent address with telephone number. You will be asked to take a seat until our receptionist accompanies you to your vision test. If the patient is below 15 years, you will be taken directly to the Paediatric ophthalmology. Vision test (10 minutes): Every patient has a simple test to check your level of vision from an eye chart. Refraction (10 minutes): A refractionist will place a series of lens in front of your eyes and will ask which looks clearer. This test determines your exact eye power and determines your level of sight.  Preliminary examination (20 minutes) : An eye doctor will carry out an initial examination of your eyes, please advise the doctor of any previous medical history. Blood pressure / Eye tension / Sugar test ( 30 minutes) This is only for patients aged 40+, we will check your blood pressure, intraocular pressure and a urine test for diabetes. Stages 3 – 5 may happen in any order depending on the patient load. Dilation (30 minutes) : The doctor in some cases may ask the refractionist to instil eye drops in the eye. This is to make the pupils bigger in order to get a better view of the inside of the eye. It may take 30 minutes for dilation, you will be asked to wait in the waiting room during this time. You will experience blurred vision for 2 – 3 hours following dilation. Final examination and diagnosis (5 minutes): After all the tests have been carried out the doctor will carry out a final examination and depending on the results you will be guided to the speciality clinics 

23. INPATIENT PROCEDURES Patients who require surgery or monitoring will be asked to get admitted in the hospital. Patients can choose from the different types of rooms based on the availability. At the time of counseling, the counselors assist in selecting the room, surgical techniques and implants available. Based on convenience, one can choose the package of choice. Cashless facilities and reimbursement certificates can be availed as applicable. Many of the surgeries are being done as day care procedures. Patients undergoing day care procedures need not stay in the hospital after the surgery. The package charges vary based on the type of accommodation selected for procedures other than the day care. Following are the different types of accommodation facilities available: Suite A Special A/C A Class(Non A/C) B Class C Class General Ward

24. PAYMENT On admission, a deposit equivalent to or approximate to the treatment or surgery charges will be collected. The balance if any, will be collected / refunded at the time of discharge based on the surgery / treatment and the type of accommodation chosen. Billsare payable by cash, with insurance claims, if any. Credit cards are accepted, a 2.3% service charge will be collected. Discharge Procedure Patients are requested to vacate the room before 10.00 am on the day of discharge. Instructions regarding post operative care, medication, discharge summary will be explained by the ophthalmic assistants at the time of discharge. Room Reservation Facility Aravind offers a facility for advance room reservation following the doctor's advice to get admitted for surgery or treatment at a later date. Support Services Catering services Restaurant is located on the ground floor and is open from 6.30 am – 9.00 pm. Breakfast, lunch and dinner are available there. Medical shop and Optical shop The medical shop is located on the ground floor, which functions from 7.30 am – 8.00 pm on all working days (Monday to Saturday) and on Sundays from 9.00 am – 1.00 pm and 3-30 – 5.00pm. 

25. EFFICIENCY INDICATOR Performance 2017 - 2018 Total Madurai Theni Tirunelveli Coimbatore Pondicherry Tirupur Dindigul Salem Tuticorin Udumalpet CBE CC Chennai OUT-PATIENT VISITS   HOSPITALS   Paying (New+Review) 2,225,418 664,199 100,239 327,815 397,033 303,440 51,023 75,951 135,421 58,636 39,554 36,144 35,963 Free (New+Review) 612,099 202,015 25,148 83,436 125,816 104,092 11,365 - 21,981 9,611 16,766 - 11,869 VISION CENTRES 586,418 245,310 66,704 128,958 50,085 68,502 12,493 - - - 14,366 - - COMMUNITY EYE CLINICS/CITY CENTRES 196,446 109,169 23,177 32,046 - 32,054 - - - - - - - OUTREACH   Comprehensive camps 349,620 103,408 17,053 47,250 89,933 75,360 - - 11,242 4,272 802 - 300 Diabetic Retinopathy screening camps 85,349 12,256 3,308 3,214 60,548 5,146     627 - - - 250 Workplace refraction camps 62,349 15,083 4,071 11,515 12,606 12,412 4,447 - - - 2,215 -   School children examined by Aravind staff* 50,160 13,326 1,840 6,193 5,110 21,198 25 - 1,919 - 435 - 114 Paediatric eye screening 7,060 - 1,644 1,469 1,627 2,320 - - - - - - - Mobile van refraction camps 8,315 - - - 7,484 - 831 - 831 - - - - Total Out-patients through Outreach* 562,853 144,073 27,916 69,641 177,308 116,436 4,472 - 14,619 4,272 3,452 - 664 TOTAL OUT-PATIENT VISITS 4,183,234 1,364,766 243,184 641,896 750,242 624,524 79,353 75,951 172,021 72,519 74,138 36,144 48,496 SURGERIES   Paying 244,629 86,108 8,654 35,004 48,749 35,120 2,806 4,580 13,041 2,712 2,752 1,986 3,117 Free walk-ins 138,446 52,555 4,400 16,214 29,473 22,064 2,163 1,192 4,132 1,442 3,596 - 1,215 Outreach 94,953 33,009 2,731 11,011 22,830 20,611 679 - 2,839 485 736 - 22 TOTAL SURGERIES 478,028 171,672 15,785 62,229 101,052 77,795 5,648 5,772 20,012 4,639 7,084 1,986 4,354

26. HOSPITAL WISE- SURGERY DETAILS

27. PATIENT VOLUMES Large patient volumes are critical to spreading fixed costs and gaining bargaining leverage with equipment suppliers. Beyond its hospitals, Aravind uses a three-pronged approach: community clinics tele -medicine centers eye camps This is to increase access to: preventive eye-care, to increase awareness about surgical eye-care to direct willing patients to Aravind hospitals. The community benefits by gaining access to basic eye-care at their doorstep and the hospital is able to increase its volume of patients.

28. REVENUE MODEL

29. As indicated previously, differential pricing is an important feature of Aravind’s model. The full price paid by one well-off patient funds the treatment for several poor patients. The quality of treatment however remains the same across patients ensuring that complication rates match global standards. The only difference is in the type of lens used and the quality of post-surgery amenities provided. While a subsidised patient is provided a basic hard lens and room on a sharing basis, patients paying the full price can choose from an array of options. Cross subsidisation is only sustainable if the costs of the hospital are low.

30. LOWERING FIXED COST The main driver of costs for any health care system are: Infrastructure Equipment Salaries It has perfected an assembly-line technique of surgery that increases this productivity by a factor of ten. Revenues are generated from a small percentage of paying patients. Aravind is focused on maximizing the utilization of its infrastructure and equipment and increasing the productivity of its workforce. Instead of increasing the number of surgeons to cope with the problem of unnecessary blindness, Aravind decided to find ways to increase a surgeon’s productivity. It ensures that doctors are focused only on the critical tasks of diagnosis and surgery. It provides high-quality training and standardizing procedures to equips nurses to take care of several non-surgical tasks. An of-cited example is the use of the just-in-time approach to increase the utilization of its operating rooms. A typical room at Aravind has two operating tables and several other equipment to perform non-surgical tasks. When a doctor is operating on one patient, the nurse performs non-surgical tasks on the other patient. As soon as the doctor finishes with the first patient he/she can move the surgical set up to the other patient and start the next procedure.

31. Main Hospital Free Hospital Independent functioning Completely free ICCE surgery cost – Rs 500 to Rs 1000 Mostly ICCE surgeries ECCE surgery cost – Rs 1500 to Rs 2500 ECCE if medically recommended Expenses include surgery, stay, medicines etc Dealt with more patients Patients guided at each step by several support staff Doctors and staff experienced and compassionate Experienced doctors and support staff Complications, if any, monitored carefully Hassle free check ups diagnosis and surgery People from same communities placed together

32. Fee for service: 35% of patient care Free/Subsidized service: 65% of patient care Separate facilities for the paying and free patients High Volume – High Quality eye care The patient chooses where to get his/her care. The care provided is of the same quality but the facilities provided are different based on the pricing. 

33. Consulting fee Poor Patients : Rs 0 Paying Patients : Rs 50 Cataract Surgery with IOL Poor Patients : 0 (*250 Rs) Subsidized rate : RS 750 Regular rate : Rs 3,500 - 6,000 Phaco surgery : Rs 6,500 - 12,000 Includes cost for 3 days stay and medicine. 

34. PAYING PATIENT- RATE CARD Room/Surgery Type (Rs.) Surgery Two Day Room Rent Medicines Total Cost Cataract with IOL Suite AC 5,500 2,000 700 8,200 Deluxe AC 4,500 1,200 700 6,400 A Special 4,500 600 700 5,800 A 4,000 300 700 5,000 B 3,250 200 700 4,150 C 2,750 60 700 3,510 Phaco with IOL Suite AC 6,500 ,500 700 8,700 Deluxe AC 6,000 800 700 7,500 A Special 6,000 400 700 7,100 A 5,500 240 700 6,440 B 5,000 160 700 5,860 C 4,750 60 700 5,510 Phaco with Foldable IOL Suite AC 9,500 ,500 700 11,700 Deluxe AC 8,500 800 700 10,000 A Special 8,500 400 700 9,600 Room/Surgery Type (Rs.) Surgery Two Day Room Rent Medicines Total Cost Phaco with Foldable IOL A 8,500 240 700 9,440 B 8,500 160 700 9,360 C 8,500 60 700 9,260 Phaco with Acrylic 3 Piece IOL Suite AC 12,500 1,500 700 4,700 Deluxe AC 11,500 800 700 13,000 A Special 11,500 400 700 12,600 A 11,500 240 700 12,440 B 11,500 160 700 12,360 C 11,500 60 700 12,260 Cataract without IOL Suite AC 3,500 1,500 700 5,700 Deluxe AC 2,000 800 700 3,500 A Special 2,000 400 700 3,100 A 1,500 240 700 2,440 B 1,250 160 700 2,110 C 1,100 60 700 1,860

35. WHY TRANSPORT? Economic Impact for each patient to the hospital (In Rs) No Transport Other Expenses Lost Wages Total Patient 1 25 50 100 175 Patient Attendant 1 25 50 100 175 Total to the vision centre   50 100 200 350 Patient 1 20 20 50 90 Patient Attendant 0.5 5 10 25 40 Total to the vision centre   25 30 75 130 Rupees Saved (Rs) 220 Roughly 50 lakhs for 25,000 patients       Impact in service delivery in the first 12 months of existence No. Per 50,000 % Acceptance Ratio No of Vision Centres 6 1     Population Covered 399,924 50,000     20% may have eye care needs 79,985 10,000     New patients seen 23,213 2,902 29%   Patients referred for surgery 1,686 211 7% 59% Other Patients referred to the Hospital 2,080 260 9% 84% Refractive Error prescriptions 4,931 616 21% 92%

36. THANK YOU!