Madurai Aravind Hospital

Aravind Eye Care Hospital is an ophthalmological hospital with several locations in India. It was founded by Dr.Govindappa Venkataswamy[1].

The hospital is named after Sri Aurobindo, one of the 20th century’s most revered spiritual leaders Given the magnitude of blindness and the challenges faced in a developing country, the Government alone cannot meet the health needs of all. Realising this predicament, Dr.Govindappa Venkataswamy wanted to establish an alternate health care model that would supplement the efforts of the Government and also be self-supporting. Hence, upon his retirement in 1976, he established the GOVEL Trust to initiate eye care work. Under this Trust, the Aravind Eye Hospitals were founded. Today, Aravind is more than an eye hospital. It is a social organisation committed to the goal of elimination of needless blindness through comprehensive eye care services.It is also an international training centre for ophthalmic professionals and trainees who come from within India and around the world . It is an institute for research that contributes to the development of eye care and to train health-related and managerial personnel in the development and implementation of efficient and sustainable eye care programmes. Aravind also is a manufacturer of world class ophthalmic products available at affordable costs.

It is the only examination centre of the Royal College of Ophthalmology, United Kingdom, in India. It is headquartered in Madurai.

Over 30 years, Aravind has treated over 2.4 million poor Indians. Aravind is a financially-viable healthcare system in India. One of the hospital’s investors is the Acumen Fund, the non-profit venture fund that invests in companies delivering critical goods and services to developing countries.Spearheading the revolution of providing quality healthcare to the needy, Aravind Eye Hospital (AEH), Madurai, has won as many accolades from management gurus for its effective business model, as from its millions of patients. And why not? From a 11-bed Hospital in Madurai to the largest provider of eye care services in the world, Aravind has come a long way indeed.

Working with the mission of 'Eliminating Needless Blindness', the main hospital (paying section) has eight speciality clinics, seven operating theatres (OTs) and 268 patient beds. Every day, an average of 100 surgeries are performed and 1,200 outpatients are treated. While the free hospital, situated adjacent to the main hospital, has four OTs with a capacity for 320 inpatients. Every day, on an average, it handles about 800 outpatients and 200 surgeries are performed. The camp Hospital, situated close to the main Hospital, with two OTs with a capacity for 600 inpatients handles an average, handles about 100 camp surgeries.

It has full-fledged super-speciality clinics including retina and vitreous, cornea, glaucoma, IOL, paediatric ophthalmology, neuro-ophthalmology, uvea and orbit and oculoplasty, manned by highly-qualified specialists. The Hospital is the headquarter for the Madurai Eye Bank Association, which receives corneas from various institutions in India and the US.

"The Hospital was self-supporting for all the recurring expenditures from the beginning, and after five years it had accumulated surplus for its own development and the establishment of the new hospitals at Theni, Tirunelveli, Coimbatore, and Pondicherry," beams Dr Aravind Srinivasan, Administrator, Aravind Eye Care System. Around 70 per cent of its patients are provided free treatment.

Effective Model

The model of healthcare used at AEH is not only innovative, but absolutely the most effective model of healthcare. It operates under the notion of compassionate capitalism. With good management and a highly efficient fee system, the non-profit hospital is able to operate with a 40 per cent margin. This is despite the fact that 7 out of 10 patients pay nothing, or close to nothing, and the Hospital does not depend on donations. This economically self-sustaining model is based on generating enough revenue from 30 per cent of the patients to cover the costs of the providing free or low-cost eye care to the majority. Instead of relying on donations and funding, AEH developed the ability to manufacture all the materials it needed.

The Hospital reduces costs by using ophthalmic paramedical staff to do all the preparatory and post-operative work on each patient, allowing ophthalmologists to perform an increased number of surgeries. Each ophthalmic surgeon has two tables, which allows a surgeon to perform one 10 to 20 minute operation, and then swivel around to do the next. Post-op patients are wheeled out and new patients wheeled in. With its efficient strategies, AEH is known to reach the bottom of the pyramid.

The Hospital was also one of the early starters to integrate ICT in its healthcare services as early as in 1983. "Using Wi-fi, we created 'vision-centres' to generate awareness about eye camps, and VSAT-mobile vans to go into the interiors of the villages about 8-10 times a month," informs RD Thulasiraj, Director IT and Systems, AEH.

Its self-sustaining model is being copied in at least 30 countries around the world. "The staff is almost 10 times as efficient as the national average. And the engine of growth is not a hard-headed businessman, but a 86-year-old philanthropist called Dr Govindappa Venkataswamy," beams Dr Srinivasan.

Not a Smooth Ride

One of the main hurdles was getting patients to the hospital. The often elderly patients required escorts, or could not afford transportation and the rural-urban divide was more evident than ever. AEH started an outreach programme using community organisations to identify and assist potential patients with the help of tele-opthalomology. Today, the patient acceptance rate is between 95 to 98 per cent.

Another realisation was that the Hospital alone could not do it and that it would have to facilitate training for other surgeons and other staff members, such as nurses, technicians, administrators, and managers. "So we started the training programmes. The direct impact was huge, and the indirect impact is compounding," informs Dr Srinivasan.

Spreading Wings

AEH has indeed spread its wings faster and higher. In addition to hospitals, it has an ocular products manufacturing facility—Aurolab. Its tele-ophthalmology network has become a global online resource for AEH and for the entire field of ophthalmology. AEH partners with over a thousand community organisations and international NGOs such as the Lions Club International, Sight Savers International, Seva Foundation and Orbis International. The World Health Organisation has designated it as a 'Collaborating Centre for Prevention of Blindness'. "Our focus now is to expand throughout developing countries. The long-term plan is to grow in capacity to reach out to a larger population in need through a network of 100 managed eye hospitals and attain the mission of Eliminating Needless Blindness," visions Dr Srinivasan.

Looking Ahead

With 30 years of steady progress behind it, it is in no danger of fading into obscurity with the passing of its founder. Having succeeded in building the capacity of over 200 eye hospitals located all over India through a consultancy process, AEH is moving one step ahead to provide management services to eye hospitals in areas of need in India and other parts of the world. Since it opened, AEH has given sight to more than 2 million people. The operating model is open for other hospitals to learn from and help realise its vision of eliminating unnecessary blindness by 2020.

The Aravind Eye Hospital, a leading eye care player in the country, has decided to establish a university here to offer postgraduate, diploma and certificate courses in ophthalmology with world-class training facilities. A formal application will be submitted to the University Grants Commission (UGC) next week for permission to set up the Aravind University for Ophthalmic Sciences. P. Namperumalsamy, Chairman, Aravind Eye Care System, told The Hindu on Saturday that there was an expectation among general public and ophthalmic fraternity that "we should take a lead in churning out well-qualified and trained hands in the field of eye care."

"Since there are expectations, we thought of going in for an ophthalmic university for which the process will commence in two or three days time," he said on the sidelines of `Made in Madurai' seminar on design/innovation, organised by the Confederation of Indian Industry (CII), Madurai Zone.

Dr. Namperumalsamy said that the hospital would approach the Union Ministry for Human Resources Development for obtaining required clearances.

Already, 36 courses in the field of medical/paramedical ophthalmology were being offered now and if the university proposal took shape all the courses would come under a single banner.

Another initiative

Another major initiative taken up recently was to take the `Aravind model' to Bangladesh in association with the Grameen Bank.

He said that Aravind Eye Hospital would provide technical know how to set up five hospitals in Bangladesh based on how quality eye care was provided at reasonable cost in Madurai.

According to Dr. Namperumalsamy, the hospital has helped in recruiting doctors/staff for Bangladesh and the objective is to cater to the needs of `bottom of pyramid' segment people who require good eye care. The idea evolved when Grameen Bank founder and Nobel laureate, Mohammed Yunus, visited the Aravind Eye Hospital a few years ago, he said.