Aravind Eye Hospital Essay Example

and low agricultural productivity, which in turn traps farmers in debt. Since gaining independence, economic development has been uneven.

The increase in unemployment has led to a rise in poverty rates, which has been worsened by rapid population growth (Economy, 2009). Consequently, the job market is overcrowded and many people are stuck in poverty. India, like other developed countries, has a taxpayer-funded Universal Health Care System with the aim of providing medical services to the public, particularly those below the poverty line. Nevertheless, individuals often face challenges when attempting to access hospitals.

The inadequate healthcare system in India is influenced by several factors including the scarcity of medical practitioners, inefficiency in public hospitals, limited resources, and inferior equipment. The scarcity of medical practitioners affects their ability to serve the population effectively. Public hospitals suffer from inefficiency and provide substandard healthcare services due to a lack of resources and equipment. This imbalance between medical providers and the impoverished population they serve contributes to the overall inefficiency of the healthcare system. For instance, while there is a need for over 74,000 hospitals in India, there are currently only around 37,000 healthcare centers (Liberty, 2009).

Impoverished individuals are unable to undergo cataract surgeries due to the lack of funds to access private eye hospitals. Furthermore, limited resources and insufficient capacity for eye surgeries in government hospitals leave many people with no options, ultimately leading to blindness. This situation not only results in increased unemployment rates for visually impaired individuals but also pushes more people into poverty, affecting both the individual and their entire family.

If there was a place they could go to receive treatment, it would help stop the cycle of

poverty, and give them an equal opportunity to live.

Enter the Vision, Aravind Eye Hospital

Aravind Eye Hospital has emerged from its humble beginnings to advance eye health not just in India but globally. Doctor Govindappa Venkataswamy, together with his sister and brother-in-law, established Aravind in 1976 (Maurice, 2001). Initially, this eye hospital operated out of a rented house with only 10 beds. The three founders served as the sole doctors at Aravind during its inception. Throughout the years, it has experienced consistent growth annually.

The Aravind Eye Hospital in Madurai, Tamil Nadu, India has undergone significant growth. It now occupies a five-story building with 1,900 beds and has restored the sight of 1.5 million blind individuals as of 2001. Furthermore, Aravind Eye Hospital has expanded its presence to encompass a total of five hospitals throughout India (Maurice, 2001).

The Aravind franchise includes various components to assist with vision care. One component is a dedicated infirmary that focuses on restoring sight for children (Maurice, 2001). Additionally, there is the International Institute for Community Ophthalmology, which is part of Aravind Eye Hospital and provides training for eye care workers from low-income countries. The franchise also includes a medical research foundation and an eye bank that handles approximately 900 corneas per year in association with Aravind. Aurolab, another branch of Aravind, is a manufacturing facility that produces lenses, pharmaceuticals, and surgical supplies (Maurice, 2001). Opening Aurolab was a response to the high cost of imported intraocular lenses (IOLs) for low-income patients and faced opposition from the Indian government (Shah, 2004). Currently, Aurolab manufactures around 700,000 IOLs annually (Maurice, 2001).

Aravind purchases these IOLs, as do eye care facilities in more than 80

countries. The price of these IOLs is 10 times lower compared to similar quality ones used in western countries (Maurice, 2001). Aurolab not only produces the IOLs but also manufactures eyeglasses, sutures, and medications which are supplied to hospitals at discounted rates (Chang, 2004). In the year 2000, the Aravind group treated around 1.3 million patients, which is approximately 85-90% higher than most other hospitals in India.

Furthermore, Aravind conducts nomadic 'eye cantonments' all year round to promote awareness about eye care in India (Maurice, 2001). These cantonments visit villages on Sundays and transport the patients to Aravind in the evening (Chang, 2004). The surgeries are then carried out on Mondays, with the number of cases usually ranging from 300 to 400, and a record of 500 cases (Chang, 2004). It is worth noting that most eye surgeons worldwide perform fewer than 350 surgeries annually.

The average number of surgeries performed per physician at Aravind is 2000 per year. Aravind's goal is to improve its advantages by hiring and educating local physicians and surgeons. However, despite offering slightly higher salaries than government hospitals, seven to ten physicians leave each year. This happens because, as a non-profit organization, Aravind cannot financially compete with private practice establishments (Maurice, 2001).

The Journey to Aravind

As mentioned earlier, Dr. Govindappa Venkataswamy founded Aravind.

V (Maurice, 2001) possesses a deep love for his work and does not perceive it simply as employment. His dedication inspires him to pursue greatness, a sentiment confirmed by Dr.

V, if there is something you can create, you should create it. Dr. V was born in 1918 and passed away at the age of 87 on July 7, 2006 ('Govindappa', 2009).

He obtained a Bachelor's of Arts in chemistry from American College in Madurai in 1938 and later on, in 1944, he earned a Doctor of Medicine degree from Stanley Medical College in Madras.

In 1951, Dr. V received instruction from a physician of ophthalmology at the Government Ophthalmic Hospital in Madras. From 1976 until his decease in 2006, he served as the president of Aravind Eye Hospital. Additionally, in 1956, he became the head of the Department of Ophthalmology at the Government Madurai Medical College and also worked as an oculus sawbones at the Government Erksine Hospital.

Dr. V served in both of these positions for 20 years until his compulsory resignation from the government hospital in 1976 ('Govindappa', 2009). He was partially inspired by his mentor, the enigmatic philosopher Sri Aurobindo, whom he followed for 50 years (Maurice, 2001). When Dr.

V was asked about the influence of his wise man on Aravind, and he responded by saying, "You do your best in your occupation and higher thoughts come to you, and so you try to recognize those thoughts excessively (Maurice, 2001)." Additionally, Dr. V was motivated by his work at the government hospital (Shah, 2004). The government requested him to hold four camps a year while he continued to work with the government hospital in 1961. This opportunity also played a role in his chance identification.

He observed patients attending the camp lift each time it was held ( Shah, 2004 ). Another aspect of Dr. V's chance identification is the fact that 18 million people worldwide are blind due to curable cataracts ( Chang, 2004 ). This number is increasing at an alarming rate, almost like

an epidemic. Blindness leads to reduced life expectancy and loss of productivity for both the blind individuals and their caregivers ( Chang, 2004 ).

Dr. Govindappa Venkataswamy: A True Social Entrepreneur

Dr. V possessed entrepreneurial characteristics, which is one of the four categories used to evaluate Ashoka campaigners ( Bornstein, 2004 ). Individuals with entrepreneurial qualities aspire to bring about change in an entire field, not just accomplish local tasks. They not only want to express their ideas but also actively participate in solving problems by implementing their ideas ( Bornstein, 2004 ). Dr. V demonstrated entrepreneurial characteristics through his efforts to standardize cataract surgery procedures, enabling the spread of change throughout the field, beyond just his hospitals in India.

Another way in which he has demonstrated entrepreneurial qualities is through the training that Aravind provides for physicians in other states. Additionally, Dr. V's successful completion of over 100,000 eye surgeries himself shows his commitment to executing his idea ("Govindappa", 2009).

The Six Qualities of Social Entrepreneurship

Dr. V has also exhibited the six qualities of a successful social entrepreneur as outlined by David Bornstein (2004). These six qualities include a willingness to self-correct, share credit, break free from established structures, cross disciplinary boundaries, work quietly, and possess a strong ethical drive (Bornstein, 2004).

In order to prevent physicians at their own hospitals from falling back into complacency after completing training with Aravind, Dr. V sought assistance from concerned schools. His public request for help demonstrates his willingness to share credit and his desire for collaboration. Additionally, he acknowledges the need for self-correction by taking proactive measures to address the issue of complacent physicians, despite having received training from Aravind.

In addition,

Dr. V acknowledged the contributions of his fellow physicians at Aravind, recognizing that the success of the organization would not have been possible without the dedicated efforts of everyone involved. It is worth noting that the government initially opposed the establishment of Aurolab (Shah, 2004). However, Dr. V's decision to proceed with the project despite these obstacles demonstrates his determination to break away from conventional structures.

Dr. V showcased his interdisciplinary skills by venturing into various fields, including medicine and fabrication, when he established Aurolab. Additionally, by independently developing Aurolab and ensuring its affordability, Dr. V exemplified his ability to work seamlessly (Shah, 2004). Furthermore, Dr. V consistently demonstrated a strong adherence to ethical principles.

During an interview, Dr. V emphasized that Aravind's main focus was on integrity and respecting the patients (Shah, 2004). Additionally, he emphasized the prioritization of compassion over cost, as demonstrated by their willingness to exceed the fixed charge for a patient without passing on the extra cost to the patient.

R.D. Thularsiraj, the executive manager of Aravind, states that Dr. V established a set of values in the infirmary that leads their work towards a desire to help others and away from excessive focus on money (Maurice, 2001). In addition, Dr. V has implemented capacity building programs that aim to incorporate integrity and quality into new hospitals (Shah, 2004).

Structuring Sustainability, the Core of Aravind

Dr.

V had a vision to reach those who had not been reached before and to help impoverished individuals who would not be able to receive medical care without his assistance. He worked to overcome obstacles, promote community involvement, and developed a successful healthcare model. Despite his passing, his dream lives

on. Aravind Hospital in Tamil Nadu, the first hospital opened in Madurai, continues to explore new approaches in primary eye care and strives to innovate for the benefit of the population. V's sister and her husband, who are ophthalmic surgeons, joined Dr. V during the establishment of the hospital.

To cut costs and obtain financial backing from bankers, Dr. V and his colleagues implemented substantial salary reductions. Their objective was to offer eye care services to people of all socioeconomic statuses, regardless of their ability to afford it. Dr. V went even further by putting a mortgage on his house to secure the required funds for establishing the hospital.

In a year, the infirmary expanded and grew four times its original size, thanks to all the successful efforts made. Currently, there are five Aravind Eye Hospitals, all of which are financially independent. This is possible due to a system that allows for easier transfer of knowledge throughout the entire hospital chain. Dr. V implemented a unique approach by asking even the financially disadvantaged patients to pay if they could, with the belief that the revenue generated from paying patients (about 30% of clients) would support the rest. Two-thirds of patients receive free outpatient services, while paying patients receive additional amenities such as private recovery rooms and hot meals. The profit earned from each paying customer covers the expenses of two patients who are unable to pay.

Aravind is well-known for its fee structure. For the less fortunate patients, there are no charges, while others are required to pay 50 R's (their currency, equivalent to approximately $1 US). Impoverished patients may have to pay as little as nothing or

up to 250 R's, depending on their capacity to save. There is a subsidized rate of 750 R's (around $15 US). The regular patient fee, designed for middle-income patients, ranges from 3,500 to 6,000 R's.

For a Phaco surgery, the cost ranges from 6,500-12,000 R's (Saravana,2002). Aravind Eye Hospital has built trust and a reputation for exceptional care, which attracts paying patients. These patients are also drawn to the lower than market cost, which is at least 25% lower.

The Unique Business Model of Aravind

Aravind Eye Hospital operates with a business model that sets it apart from other healthcare businesses. It shares similarities with the fast food industry. Dr.

According to Health (2007), V. was amazed by the ability of a concatenation like McDonalds to consistently provide high-quality merchandise regardless of location and deliver it quickly. This revelation led him to believe that a hospital could operate under the same principle. As a result, he trained his employees to effectively handle large numbers of patients without compromising on quality. Presently, Aravind's network of hospitals is renowned for being the world's most effective oculus attention organization in terms of surgical volume and patient count.

The success of Aravind's business model relies on numbers – high-volume, low-cost procedures that offset the expenses associated with delivering a high-quality service. To attract more patients, Aravind Eye Hospital heavily advertises its services and benefits from positive word-of-mouth. Additionally, they have implemented technology to serve people unable to personally visit the hospital. This includes video conferencing, instant messaging, online patient questionnaires, and webcams. An example of their use of technology is evident in the internet kiosks they have set up in remote villages. Trained

women at these kiosks capture images of patients' eyes with webcams and send them, along with completed patient questionnaires, to the doctor.

The physician receives the file quickly via email and can communicate with the patient through an online chat system. This is possible through collaboration with the University of Berkeley Information Technology center and a low cost Wi-Fi connection. This allows access for the patient and reduces costs. It also enables the staff to provide consultations with individuals who would not otherwise be able to come to the hospital and facilitates information transfer among the team (Aravind, 2007).

What Sets Aravind Apart

A fundamental aspect of Aravind's model is the commitment to never turn away a patient due to financial reasons. In fact, it has been documented that Dr.

V once accepted a chicken as payment for surgery. Aravind's goal is to help as many people as possible, not to make a profit. Their business model is designed to be self-sustainable, allowing them to use all income to expand their operations, improve their work, and provide free services to those in need. Dr.

We established this theoretical account with the belief that individuals will pay when they are able to, even if it is several months after their surgery. Aravind's original concern in the theoretical account was solely focused on oculus surgery and care. However, over time, it expanded to include lens production in order to create affordable lenses. This change in the model was necessary due to the high costs of importing lenses from the West. To fulfill their vision of providing oculus attention to those in need, they had to find a way to reduce

expenses. Additionally, they implemented a two-tiered pricing structure as another strategy to attract more customers.

Affluent individuals are expected to contribute more, and Aravind can afford to perform numerous free surgeries for every paid surgery. Due to being the most reputable eye hospital in the region, affluent individuals choose to travel there. To maximize efficiency and resource utilization, the hospital staff only focuses on their specific specialization, and the surgical procedures themselves follow standardized protocols. In order to ensure access for all those interested in seeking treatment at Aravind, the clinic provides transportation services that pick up patients in the morning and return them to their communities after the day is over (Shah, 2009). Prior to being admitted to the hospital, patients must undergo an eye screening at their local community using one of the internet booths mentioned earlier. Based on their evaluation, they are then transported to the hospital if surgery or a live consultation is deemed necessary.

This procedure is supported by local concern leaders who also organize and provide financial backing. Aravind recruits locally in order to keep staffing costs low, primarily hiring staff members from small towns in the same community where they will work. These individuals have been trained and raised in the same community as the hospital, sharing its vision. Additionally, because local salaries and living expenses are lower, the hospital is able to pay these employees less than those from outside the state.

The medical staff at the Aravind Eye Hospital are not just trained for a job, but for a respected lifelong career. In addition to the doctors, the hospital has four highly trained paramedics to provide support. The

eye doctors at Aravind Eye Hospital are connected through video conferencing with technicians at their Vision Center for each patient. Aravind Eye Hospital has expanded their business model by venturing into lens production, and now operate a factory that can produce parts at affordable prices.

Dan (2008) states that the company produces lenses for approximately $5 at their mill, in contrast to the $200 for imported lenses. With outside support, they now export their products to over 80 countries. Their production method for lenses has expanded to include other products such as blades, instruments, sutures, and pharmaceuticals. They are able to produce these goods at a fraction of the cost compared to the Western world, resulting in a substantial profit and savings on purchasing from elsewhere. The revenue generated from paying patients accounts for approximately 20% of their budget.

The additional income is generated from the production of manufactured merchandise and the provision of training and consultations. Aravind constantly strives to improve in order to maintain a sustainable operation. Being an early adopter of numerous technologies, they have remained at the forefront of innovative advancements. They utilize their technology for easier communication with colleagues, patients, partners, and other hospitals worldwide. Aravind conducts regular evaluations of their system and ensures adherence to their intended model by following up on executive decisions. However, they consistently seek new avenues for self-improvement and growth.

Scalability of the Aravind Model

The Aravind Model effectively overcomes obstacles in the cataract surgery industry. Its main advantage is providing affordable quality care. It operates in a self-sustaining manner and serves both the poor and the wealthy. The business model emphasizes optimal utilization

of all resources.

This is accomplished through their high-volume quality and a well-organized system. The Aravind model can be reproduced in countries with low-cost labor, such as Asia or disadvantaged African countries. The model will be successful if there is a large population with a social need and if there are doctors who are willing to work multiple times daily.

Furthermore, in order to achieve financial stability, it is essential to generate sufficient revenue to support the provision of free services alongside the paid ones. It is crucial that the cost of services remains reasonable. To ensure the effectiveness of need-based services, incentives for paying customers are necessary. Individuals at Aravind opt for paid services because they desire amenities such as a private room with air conditioning and other comforts that are available.

Aravind Medical Center streamlines its operations by eliminating unnecessary tasks and reducing delays. They achieve this by implementing standardized protocols for clinical procedures, activities, and administrative steps, resulting in reduced errors and increased efficiency. Trained assistants take care of tasks such as preparing patients, taking measurements, and conducting diagnostic tests, allowing the surgeons to concentrate solely on performing surgical procedures.

By implementing state-of-the-art technology, Aravind allows surgeons to operate more efficiently and perform a higher number of surgeries. This not only reduces the time between surgeries but also enables surgeons to work more frequently. As a result, Aravind surgeons perform 1700 more surgeries on average compared to national standards. Becoming an Aravind surgeon offers numerous advantages, as it not only allows them to make a difference in people's lives but also pushes their own boundaries by conducting a greater number of surgeries than they normally would.

Additionally, Aravind has provided consulting services to over 200 hospitals and aims to extend this reach further in the near future.

The Aravind model has the potential for limitless scalability in developing countries due to its fee system, management techniques, high aspirations, and quality of care. Aravind aims to be an example for others to follow, just like how they have successfully replicated their hospitals across India. Similar to how the concept of Micro-credit from Grameen Bank has been adopted by numerous lending programs, Aravind's basic model of a 250-bed hospital has been implemented in hospitals in Mumbai, Kolkata, and Nepal. Furthermore, the Indian government is using Aravind's medical protocol philosophy for their training centers nationwide. Aravind's goal is to demonstrate efficient management and affordable care to patients because while any eye doctor can provide eye care, it can only be sustainable for the masses if managed properly.

This is their new focal point called Managed Eye Hospitals. In the long term, according to their website, they want to impact a larger population, by expanding to over 100 eye care hospitals in different parts of the world. They aim to serve as a model for other healthcare facilities to become more efficient and successful. Aravind's ultimate goal is to collaborate with others in order to completely eliminate treatable blindness by the year 2020 (Aravind, 2009).

A Bittersweet Critique

It is challenging to criticize a social issue, as we try to challenge or justify the flaws in the system by comparing it with the benefits it brings to the public. However, a company, no matter how well-intentioned, cannot reach its full potential without receiving constructive criticism necessary for improving their

system.

In this section, we will first discuss the defect we discovered within Aravind and how we believe it could have negative consequences for the company in the future. Then, we will explain some of the great benefits or advantages of Aravind and how we believe they will continue to excel in the future.

The Bad

The business model of Aravind, although scalable, heavily relies on having a strong customer base. Specifically, it requires a constant influx of paying customers to offset the costs incurred by providing their services for free or at greatly reduced prices. Additionally, the success of the model depends on the location of new ventures, as it involves hiring local residents to work in the hospitals.

If the quality of workers in the country attempted is diminished, the efficiency and effectiveness of the Aravind system will be compromised. Additionally, it would be more expensive to hire employees from outside the country, resulting in higher overall costs and limiting their ability to provide services to the needy population. Another issue is the high turnover rate in the Aravind system. Doctors from all over the world come to train in these hospitals because they can perform more surgeries in a day compared to months in other places. However, since Aravind aims to operate on a minimal budget, they cannot afford to pay competitive salaries that would attract doctors away from private practice.

One defect we observed during our analysis of Aravind is that they require staff members to work even when they are sick. This is done to ensure that production is maintained, but it also increases the likelihood of mistakes and

the spread of contagious diseases. While the dedication shown by employees is commendable, it is not appropriate for someone in the medical field to provide service while ill.

The Positive Aspect

Aravind has significantly expanded its societal impact by not only meeting healthcare needs but also creating jobs and hiring locally.

This mindset can be observed in both Aravind Eye Hospitals and their subsidiary, Aurolab. Rather than simply outsourcing to acquire employees and resources, Aravind is determined to continue supporting the social sector in their respective regions. Despite already treating more patients than any other eye care facility worldwide, Aravind Eye Hospitals are still actively promoting their services nationwide to reach and serve even more individuals. They are proactively seeking their target market instead of waiting for them to seek them out.

The Aravind system has established eye cantonments, booths, and coach tallies to bring them closer to their market and physically transport their clients. Their utilization of technology enables them to consult and share their practices with hospitals globally, increasing productivity among staff and reaching out to the population unable to access hospitals. Aravind Eye Hospitals offer an efficient and effective service that primarily serves the social sector, providing essential assistance to economically disadvantaged and visually impaired individuals. Additionally, Aravind's reputation for innovation, technical prowess, and operational efficiency attracts new eye doctors to the system.

Once these new doctors are trained in the Aravind manner, it benefits the doctors themselves due to the large number of surgeries they will complete, and it also expands the Aravind model to more hospitals worldwide. We believe that Aravind is doing an excellent job so far and has a very sustainable model.

They have been decisive in their decision-making thus far, and we are confident that they will only become stronger over time. However, there will be a limit to this growth as Aravind gets closer to achieving its vision of curing all the world's treatable blindness, and their market will begin to decline.

Once demand decreases significantly, Aravind's current model will become ineffective, requiring major changes. However, overall, it is an excellent business model and has greatly benefited the people of India.

Work Citations

1. Azad India Foundation: http://www.azadindia.org/social-issues/poverty-in-india.html
2. Economy Watch: http://www.economywatch.com/indianeconomy/poverty-in-india.html
3. Reason For Liberty: http://www.reasonforliberty.com/current-affairs/indian-health-care-an-overview.html
4. Bornstein, David. How to Change the World: Social Entrepreneurs and the Power of New Ideas. New York, NY: Oxford University Press, Inc., 2004. Print.
5. Chang, David F. 'Three plans offer hope. (Cover narrative).' Ophthalmology Times 34.9 (2009): 1-43. Health Source: Nursing/Academic Edition.

EBSCO. Web. 27 Oct. 2009.

'ASCRS: The American Society of Cataract and Refractive Surgery. 2009. ASCRS. Web.'

17 Nov. 2009. ;a href="http://www.ascrs.org/awards/Govindappa-V";hyyp://www.ascrs.org/awards/Govindappa-V;/a;