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Aravind Eye Care systems: A Model with a Vision of gifting eye sight to the
Needy

Conference Paper · October 2014

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Aravind Eye Care systems: A Model with a Vision of
gifting eye sight to the Needy.

Submitted by:

Dr. A. Satya Nandini

Professor and Head
Department of Management Studies and Research Centre
BMS College of Engineering
Email: satyanandini@hotmail.com
Phone: +919844071921

And

Mrs. Leena Guruprasad

Asst. Professor
Department of Management Studies and Research Centre
BMS College of Engineering
Email: leena.guruprasad@gmail.com
Phone: +919845811005
Aravind Eye Care systems: A Model with a Vision of
gifting eye sight to the Needy.

Abstract

Improving efficiency while catering to the needy is an acute issue faced by the health care
Industry of developing countries, as their demand exceeds capacity. Better health care are
required to deal with ageing population, increased costs & unmet demands. One case that
provides solution to such issue is Aravind, the largest Eye Care system in the world, with
over 3.1 million outpatients being served & over 370,000 surgeries being performed till date.

Aravind is an exemplar in this regard. Even more interestingly, it is fuelled by a self-funding

model: roughly 40% of its patients, those “paying” for its services, provide the profit
margins to deliver a high-quality service for the rest of the 60%, “non-paying” poor patients.

Dr.G.Venkataswamy, the founder of Aravind Eye Care got his inspiration from McDonalds’
business model to increase the efficiency and effectiveness of operations. McDonalds’ is very
good at producing & delivering products at the same way all over the world. Its been able to
standardize food delivery using high volume methods. A similar idea is at the core of
Aravind’s management philosophy.

Aravind Eye Hospital inspired by the business model of McDonalds has been able to achieve
high rate of efficiency in health services. An average Aravind surgeon performs 2000
surgeries per year against the global average of 500. An average eye operation in the
western hospital takes 30 minutes but in Aravind it takes only 10. This remarkable efficiency
is achieved by differentiating services into smaller work units and then, integrating these
work units with high precision and efficiency.

This paper attempts to dissect Aravind’s success Model which converts every need into a
significant demand.

KEYWORDS : Health Care, Aravind Eye Care, Model, Self-funding, Quality Health Care,
Success Model, McDonald’s, Inspiration, Efficient Business Model.
Contents

1. Blindness in India .................................................................................................................. 4

2. Founding of Aravind Eye Hospital: ....................................................................................... 6

3. Growing from Aravind Hospitals into an Aravind Eye Care System .................................... 6

4. Services offered by Aravind: ................................................................................................. 7

4.1. Hospital Services: ............................................................................................................ 7

4.1.1. Vision centres: .......................................................................................................... 7

4.2. Community Outreach ...................................................................................................... 8

4.3. Education & Training Programme: ................................................................................. 8

4.4. Research : ........................................................................................................................ 8

4.5. LAICO:............................................................................................................................ 8

4.6. Aurolab :.......................................................................................................................... 9

4.7. Eye Banks :...................................................................................................................... 9

5. AEH Locations: ................................................................................................................... 10

6. Aravind : Present Scale ........................................................................................................ 10

7. Aravind : Business Model .................................................................................................... 10

8. Efficiency in the Eye Care -the way of McDonalds ............................................................ 13

9. Success strategies of Aravind Eye Care: ............................................................................. 14

10. Aravind: Future Plans ........................................................................................................ 16

11. Findings & Conclusion: ..................................................................................................... 18

12. References .......................................................................................................................... 18

1. Blindness in India

With 7.8 million blind people in India, the country accounts for 20 per cent of the 39 million
blind population across the globe, of which 62 per cent are on account of cataract, 19.7 per
cent refractive error, 5.8 per cent glaucoma and one per cent corneal blindness.

Blindness could be classified into different categories. Cataract has been documented to be
the most significant cause of bilateral blindness in India. In India cataract has been reported
to be responsible for 50-80% of the bilaterally blind in the country. Global agencies for the
elimination of avoidable blindness have pledged support to operationalizing strategies to
reduce the burden of cataract blindness by the "Vision 2020: The right to sight"
initiative. Coordinated national efforts were supplemented by a world bank-assisted cataract
blindness control project which was launched in seven states of India in 1994. From around
1.2 million cataract surgeries per year in the 1980s, the cataract surgical output increased to
3.9 million per year by 2003. Recent data from the World Health Organization (WHO) shows
that there is a 25% decrease in blindness prevalence in India. This could be due to the
increased cataract surgeries in the country. At the same time the proportion of the aged has
also increased significantly in the country. The 60+ population which stood at 56 million in
1991 will double by 2016. This increase in population means that the population 'at-risk' of
blinding cataract will also increase tremendously. India is committed to the goal of
elimination of avoidable blindness by 2020 in line with the Global Vision 2020: the right to
sight initiative.

Cataract is a condition in which the eye lens becomes opaque. The degeneration is
progressive and takes place over five to ten years. Earlier, the surgical procedure was to
remove the lens when it had become more or less fully opaque (the so called, maturity) and a
thick, positive power spectacle lens (known as aphakic glass) was prescribed to substitute for
the natural lens. About 40 percent of cataract surgeries carried out in India in 2003 were still
of this traditional type.The modern technique, however, was to insert a tiny artificial lens,
called the intra-ocular lens (IOL), inside the eye in place of the lens that was removed. The
IOL surgeries enabled less hospitalisation, quicker post-operative recovery, and quicker
restoration of sight (in a week to ten days). In a further improvement, IOL lenses were also
available in foldable material. These lenses were “folded” and inserted through a small
opening into the eye and it “opened out” inside the eye. These lenses required a smaller
incision and hence recovery period was shorter than that required for non-foldable lenses.
Multi-focal lenses to take care of both distant and near vision were also available. Another
major improvement in surgery was through a technique called phaco emulsification, in which
the opaque natural eye lens was pulverized using ultrasonic beams and then extracted through
suction. IOL was then inserted as usual. This technique enabled the patient to return home
two to three hours after the surgery. IOL insertion required advanced training of surgeons in
microsurgery and was always done under a microscope (in contrast, the traditional method
did not require a microscope). In trained hands, the time taken to conduct IOL and non IOL
surgeries were not very different as was seen by the case writers: about 12-15 minutes for the
operation itself (excluding preparation, post operative bandaging etc.) Phaco surgery required
both specialized doctors and specialized and expensive equipment (the cost of a good phaco
equipment started at Rs.600,000).

In 2006, India had nearly 7 million cataract-blind individuals, with roughly 3.8 million new
cases occurring annually.1 With a population of over a billion, and a per-capita income of
about $600/year (PPP $3,600), nearly 25% of Indians were considered to be below the
poverty line, but much larger numbers (approximately 50%) were at income levels that would
place treatment at private eye clinics beyond their reach. In theory, anyone who is unable to
afford payment is eligible for free surgery at government-run district hospitals but in practice,
a vast number of poor people prefer to pay a small fee to get better quality care at an NGO.
Some government eye hospitals have reputations for offering good service, but overall the
poor consumers prefer private or voluntary eye hospitals because the services are more
reliable and overall outcomes better.

There are many examples of excellent public health delivery models around the world, but
rarely do we see one that has been able to grow steadily over three decades, and yet
simultaneously maintain, even increase, the excellent quality of its service. Aravind is an
exemplar in this regard. Even more interestingly, it is fuelled by a self-funding model:
roughly 40% of its patients, those “paying” for its services, provide the profit margins to
deliver a high-quality service for the rest of the 60%, “non-paying” poor patients. This paper
attempts to dissect what we have learned from Aravind’s success for the benefit of healthcare
professionals managing other similar public health systems.
2. Founding of Aravind Eye Hospital:

In 1976, Dr. Govindappa Venkataswamy - known as Dr. V - retired from performing eye
surgery at the Government Medical College in Madurai, Tamil Nadu, India. He decided to
devote his remaining years to eliminating needless blindness among India's poor. Twelve
million people are blind in India, the vast majority of them from cataracts, which tend to
strike people in India before 60 - earlier than in the West.

Dr. V started by establishing an 11-bed hospital with six beds reserved for patients who
could not pay and five for those who would pay modest rates. He persuaded his siblings to
join him in mortgaging their houses, pooling their savings and pawning their jewels to build
it. Today, the Aravind Eye Care System is a network of hospitals, clinics, community
outreach efforts, factories, and research and training institutes in south India that has treated
more than 32 million patients and has performed 4 million surgeries. And it is still largely run
by Dr V's siblings and their spouses and children - he has at least 21 relatives who are eye
surgeons.

3. Growing from Aravind Hospitals into an Aravind Eye Care System

Though the initial focus of the Govel Trust was on building hospitals and reaching out to the
poor to do surgeries, it was soon clear to Dr. V. that, to reach their goal of eradicating
needless blindness, several other activities had to be put in place. Thus over the years, these
activities were added and Aravind Eye Hospitals evolved into the Aravind Eye Care System.
The Aravind Eye Care System had many divisions, described in detail later in the case. The
main divisions were: Aurolab, the manufacturing facility set up primarily for manufacturing
intraocular lenses; a training centre named Lions Aravind Institute of Community
Ophthalmology (LAICO); a centre for ophthalmic research named Aravind Medical Research
Foundation; a research centre for women and children named Aravind Centre for Women,
Children and Community Health; and an international eye bank named The Rotary Aravind
International Eye Bank. The details of these centres are given later on in the case. All the
activities of these centres were related to the core mission of eradicating needless blindness.
Figure 1: Services offered by Aravind

4. Services offered by Aravind:

4.1. Hospital Services:

Started in 1976 as an 11 bed hospital in Madurai, Aravind now has branches at Theni,
Tirunelveli, Coimbatore, Pondicherry, Dindigul and Tirupur. The hospitals provide high
quality and affordable services to the rich and poor alike, yet be financially self-supporting.
They have well equipped speciality clinics with comprehensive support facilities.
In the year ending March 2013, 3.1 million outpatients were treated and over 370,000
surgeries were performed.
To reach out to the rural Tamil Nadu Aravind has established its primary eye care facility
named, vision centres. The community eye clinics take care of the ophthalmic needs of a
semi urban population.

4.1.1. Vision centres:

The model of vision centre is envisaged by the Vision 2020. The Right to Sight, a global
initiative of International Agency of Prevention of Blindness (IAPB) a global machinery
working across the world for the prevention of avoidable blindness). IAPB has unveiled four
tier pyramid model to provide eye care for the needy population where vision centres are at
the primary level. Aligning with this initiative, Government of India is planning to set up at
least 20,000 vision centres across the country. For providing basic eye care services on a
permanent basis in villages Aravind has established more than 40 IT enabled Vision Centres
providing telemedicine facility in various districts of Tamil Nadu. Each vision centre will
cover a population of about 45,000 - 50,000.

4.2. Community Outreach

An integral part of AECS is its community outreach programmes which take eye care service
to the doorstep of the community. In the year ending March 2013, 2,841 camps were
conducted through which 554,413 patients were screened and 90,547 patients underwent
surgery.

4.3. Education & Training Programme:

Aravind Eye Care System is a collaborating centre for the World Health Organization 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 programmes.

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.

4.4. Research :

The research activities at Aravind reflect Aravind's commitment to finding new ways to
reduce the burden of blindness. 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.

4.5. LAICO:
Lions Aravind Institute of Community Opthalmology(LAICO), established in 1992 with the
support of the Lions Club International SightFirst Programme and Seva Sight Programme, is
Asia's first international training facility for blindness prevention workers from India and
other parts of the world. It contributes to improving the quality of eye care services through
teaching, training, research and consultancy.

4.6. Aurolab :

In the early 1990s, there was a great deal of debate about the relevance of Intra Ocular Lens
(IOL) to developing countries. Though widely accepted as a better procedure, it was argued
that developing countries should not go in for it as the IOLs were expensive. Taking on this
challenge, in 1992, Aurolab was established as a non � profit charitable trust for
manufacturing ophthalmic consumables.

Today Aurolab manufactures a wide range of ophthalmic consumables like intraocular lenses,
pharmaceutical products like eye drops, surgical adjuncts like sutures and blades and also
ophthalmic instruments and specialty products. Aurolab products are exported to 120
countries around the world and acoounts for a total of 7.8% of global share of intraocular
lenses.

4.7. Eye Banks :

Started in 1998 at Madurai with just a collection of 253 eyes, now the eye banks across the
Aravind Hospitals procure more than 4000 eyes and perform about 1400 corneal transplants
annually. Eye balls which cannot be used for transplants are effectively used for various
research and development programmes.
5. AEH Locations:

Figure 2 : Location presence of Aravind

6. Aravind : Present Scale

Aravind Eye Care System today encompasses a network of eight eye hospitals, 40 vision
centres in rural areas, seven community eye clinics, a PG Institute of Ophthalmology, a
manufacturing centre for ophthalmic products (Aurolab), an international eye research
institute (Dr G Venkataswamy Eye Research Institute), eye banks and a resource as well as a
training centre (LAICO) that is revolutionising hundreds of eye care programmes across the
developing world. In the year ending March 2013, Aravind’s eye care facilities handled 3.1
million outpatients over 370,000 surgeries were performed. During the same year its outreach
department conducted over 2,841 camps through which 554,413 patients were screened and
90,547 patients underwent surgery. Over 6,500 candidates from 94 countries have undergone
some form of training at Aravind. Aurolab’s cost-effective ophthalmic products are exported
to 120 countries and accounts for a total of 7.8 per cent of global share of intraocular lenses.
The research activities at Aravind reflect its commitment to finding new ways of reducing the
burden of blindness. Aravind Eye Banks procured a total of more than 4,300 eyes of which
more than 1,500 were utilised for corneal transplantations. LAICO works with over 280 eye
hospitals in India and other developing countries through a structured process of consultancy
and capacity building. It is conservatively estimated that this resulted in an additional
500,000 surgeries being done annually in these hospitals.

7. Aravind : Business Model

Aravind is not just a health success, it is a financial success. Many health non-profits in
developing countries rely on government help or donations, but Aravind's core services are
sustainable: patient care and the construction of new hospitals are funded by fees from paying
patients. And at Aravind, patients pay only if they want to. The majority of Aravind's patients
pay only a symbolic amount, or nothing at all.

Dr. V’s vision was ambitious: to eliminate preventable blindness in India by providing high-
quality, high-volume, compassionate eye care to all. The business model he established is
deceptively simple. Aravind provides care to those who can afford to pay market rates and
then uses the profits to fund care for those who cannot. Each fully paying patient cross
subsidizes the care of three or four others. Patients who cannot afford to pay are given
cataract surgery for free.However the government reimburses Aravind with $10 for each
procedure.

As we all know, about 80 percent of eye health care costs are fixed; the variable cost
component is only 20 percent. At Aravind, the realized that both types of costs
had to be addressed forcefully if they wanted to make our business model work and use the
profits from fully paying patients to cross-subsidize care of others.

To address fixed costs, they decided to maximise the use of infrastructure & producitivity of
staff, especially surgeons. To Improve their fixed costs, they looked at patient-centric care
and explored ways through which they can make their processes more efficient. Dr.V got his
inspiration from McDonald’s, the fast-food chain. Mc.Donald’s is very good at producing &
delivering products at the same way all over the world. Its been able to standardize food
delivery using high volume methods. A similar idea is at the core of Aravind’s management
philosophy.

At Aravind's hospitals, free patients lodge on a mat on the floor in a 30-person dormitory.
Paying patients can choose various levels of luxury, including private, air-conditioned rooms.
All patients get best-practice cataract surgeries, but paying patients can choose more
sophisticated surgeries with faster recoveries (but not higher success rates). The doctors are
identical, rotating between the free and paid wings.
Doctors are hard to find and expensive, so the surgical system is set up to get the most out of
them. Patients are prepared before surgery and bandaged afterwards by Aravind-trained
nurses. The operating room has two tables. The doctor performs a surgery - perhaps 5
minutes -- on Table 1, sterilizes her hands and turns to Table 2. Meanwhile, a new patient is
prepped on Table 1. Aravind doctors do more than 2,000 surgeries a year; the average at
other Indian hospitals is around 300. As for quality, Aravind's rate of surgical complications
is half that of eye hospitals in Britain.

Figure 3: Process flow at the Operation Theatre

They also aggressively pursued opportunities to lower variable costs. In early 1990s, there
was a great deal of debate about the relevance of Intra Ocular Lens (IOL) to developing
countries. Though widely accepted as a better procedure, it was argued that developing
countries should not go in for it as the IOLs were expensive costing them 70$, though a
normal Indian patient could only afford to $10 per IOL. Taking on this challenge, in 1992,
Aurolab was established as a non � profit charitable trust for manufacturing ophthalmic
consumables at affordable prices to developing countries. Though its primary focus is on
ophthalmic industry, Aurolab is also diversifying into related health care areas where its
existing capabilities can be leveraged, such as cardiovasular sutures, microsurgical hand
sutures, antiseptics and disinfectant solutions etc.

Today, Aurolab products are exported to 120 countries around the world and acoounts for a
total of 7.8% of global share of intraocular lenses.

Standard for all patients is the Aravind assembly line. Dr. V spent a few days at McDonalds'
Hamburger University in Oak Brook,, Ill., but that visit was a product of his longstanding
obsession with efficiency. Dr.V would go into an airport and walk around with the janitor
and see how he cleans the toilet. He would go to a five star hotel and follow the catering
people. This proves the obsession that Dr.V had to reach out efficiency.

8. Efficiency in the Eye Care -the way of McDonalds

Aravind can practice compassion successfully because it is run like a McDonald's, with
assembly-line efficiency, strict quality norms, brand recognition, standardization,
consistency, ruthless cost control and above all, volume.

Aravind Eye Hospital inspired by the business model of McDonalds has been able to achieve
high rate of efficiency in health services. An average Aravind surgeon performs 2000
surgeries per year against the global average of 500. An average eye operation in the western
hospital takes 30 minutes but in Aravind it takes only 10. This remarkable efficiency is
achieved by differentiating services into smaller work units and then, integrating these work
units with high precision and efficiency.

The underlying idea is to achieve cost effectiveness and efficiency through standardization
and ‘engineering’ surgeries for high volume production. The services of the hospital are
divided into smaller units and the patients are transferred from one unit to another in the form
of assembly lines. For example, in case of a cataract surgery, each surgeon works on two
operating tables alternately and is supported by a team of paramedics which carry out the
less-skill aspects of the surgery like washing the eye, giving anaesthetics, etc. Once the first
table patient has been operated, the surgeon directly moves to the next table where the other
patient is ready to be operated without wasting any time. The paramedics then make the first
table ready with a new patient to be operated again. This makes the process highly efficient
and effective.

The effectiveness of this model is undeniable from the fact that Aravind Eye hospital is able
to serve more than 250,000 patients every year.

The vast majority of people blind from cataracts in rural India have no idea why they are
blind, nor that a surgery exists that can restore their sight in a few minutes. Aravind attracts
these patients in two ways. First, it holds eye camps - 40 a week around the states of Tamil
Nadu and Kerala. The camps visit villages every few months, offering eye exams, basic
treatments, and fast, cheap glasses. Patients requiring surgery are invited with a family
member to come to the nearest of Aravind's nine hospitals; all transport and lodging, like the
surgery, is free.

When Aravind surveyed the impact of its camps, it found to its dismay that they only
attracted 7 percent of people in a village who needed care, mainly because they were
infrequent. To provide a permanent presence in rural areas, Aravind established 40 storefront
vision centers. They are staffed by rural women recruited and given two years' training by
Aravind. They have cameras, so that doctors at Aravind's hospitals can do examinations
remotely. These centers increased Aravind's market penetration to about 30 percent within
one year of operation.

9. Success strategies of Aravind Eye Care:

Intelligence and capability are not enough. There must also be the joy of doing something
beautiful.

- Dr.G.Venkataswamy

The success of Dr. V. and Aravind lay in their masterfully constructing—over many years—a
health care system in which many components were strategically designed and brought
together. Five key strategic choices are particularly notable.
1. The first strategic choice key to Aravind’s success has been the organization’s
unstinting focus on the elimination of cataract blindness. In founding Aravind, Dr.V.
could have gone in many directions to eliminate blindness. He chose cataract
blindness. That first singular choice was the most important in Aravind’s
development.

2. The organization’s second key strategic choice—to pursue a “hybrid” business

model—was initially driven by necessity.While Aravind’s mission from the outset
was to serve the under-served, particularly the rural poor, Dr. V.and his early core
management team (his brother, Mr. G. Srinivasan; his sister, Dr. Natchiar and her
husband, Dr. Namperumalsamy; and Dr. Nam’s sister, Dr. Vijayalaksmi and her
husband Dr. M. Srinivasan) recognized that in order to achieve this mission they
needed funding. Lacking other options, they decided to raise revenue by building a
clientele of paying customers seeking specialized services. They soon recognized that
their improvised, hybrid business model had many advantages over the alternative of
offering only one level of service to patients unable to pay; earning revenue
to cross-subsidize their core mission was only one of the many benefits.

The core motivation behind the hybrid operating model was the ambition to reach a
scale of operations that matched the scale of the challenge. Dr.V’s main obsessions
was to study the principles that enabled retail systems, such as McDonald’s , to attain
scale. That led Aravind to adopt and refine the channel of “screening camps” as a way
of reaching out to the rural poor.

3. Having put in place a strategy for gaining volume, the next big challenge lay in
building the capacity to take care of the massive volume of cataract surgery that was
being targeted. This led to Aravind’s third key strategic choice: to design an
operational system that would be low-cost, without compromising on the quality of
care. The design of an “assembly” line system was a direct outcome of this effort.

4. Clearly a low-cost assembly line system would produce quality outputs at affordable
cost only if the components going into the assembly were high quality at low cost.
This logic led Aravind to its fourth key strategic choice: vertical integration of key
production inputs.
 5. Ultimately none of these systems would have had staying power without the fifth key
choice: to have doctors and support staff work together as the human engine to design
and run such a system. The healthcare delivery model needed to be supportive of the
highly disciplined and motivated work force. This was the behind-the-scene crucial
fuel that provided the energy to sustain the other four key elements of strategy. Every
one of these strategic elements that we have briefly alluded to was critical to
Aravind’s success, as Figure 3 indicates. If even one element failed, the entire system
could unravel, but if they all clicked the synergy would be exponential.

Figure 4 : Virtuous Cycle of Performance at Aravind

10. Aravind: Future Plans

Aravind has set a target of performing one million surgeries annually by the year 2015
and is gearing up to achieve this target by establishing new hospitals. With the increase
in awareness about cataract, Aravind has begun to shift its focus to more comprehensive
outreach services, such as Diabetic Retinopathy camps, eye camps for children and refraction
camps.

Aravind plans to extend its outreach services to include all speciality areas of eye care. An
initiative has begun to set up permanent primary eye care facilities, so the community does
not have to wait for a camp. So far 40 such vision centres and seven community centres
(outpatient clinics) have been set up in rural communities. This will be scaled up further to
cover the entire service area as an alternate strategy to eye camps to reach the community.

Dr G Venkataswamy Eye Research Institute will give significant thrust in research of basic
sciences like genetics, biochemistry and immunology; drug development; clinical trials for
assessing efficiency of intervention options; population based studies and health systems
research for designing an effective delivery system.

Looking ahead, product development and manufacturing to address other conditions like
Glaucoma, Diabetic Retinopathy, etc., will take place. A low cost Green Laser to treat
Diabetic Retinopathy has just been launched at half the current prices. This will be refined
further to bring down the costs. Similarly, efforts are on to produce an affordable retinal
imaging system.

On the education front, Aravind is in the process of obtaining deemed university status.
Aravind is beginning to expand its capacity building process to include speciality areas such
as Paediatric Ophthalmology and Diabetic Retinopathy.

LAICO has also started helping other institutes to build their capacity in research. It has also
begun an initiative to help set up Centres for Community Ophthalmology across the
developing world which will cater to the training and capacity building needs in their
geographic areas.

LAICO is also looking at ways to partner with the public sector in order to increase the
resource utilisation of the government eye hospitals.
11. Findings & Conclusion:

Aravind’s Business Model is fundamentally built on a few core principles. The first one is in
terms of market development and through that demand generation. This is a process of
converting a need in to a demand and in the process they get a significant percentage of this
to their own facilities.

The second core principle is excellence in execution of ensuring a high level of efficiency in
providing the treatment, including outpatient services and surgeries.

The third core principle is one of quality. The aim is to ensure that the patient regardless of
whether he is a free or a private patient gets value for his investment in money or time.

The fourth principle is of sustainability wherein we set the prices not so much based on what
it costs us but on how much the various economic strata of the community can afford to pay.
They then work backwards to contain the costs within these estimates. This leads to not just
financial viability but a higher order of management, as well as inculcating a certain culture
in the organisation.

The combination of these four principles builds a sustainable Model as they have
demonstrated over the last three decades and replicated with similar results in over 200 other
eye hospitals.

12. References
1. Krisnan, Pavithra. Infinite Vision. Aravind Eye Care System; Br J Ophthalmol. 1990;
74 (6):341-3.
2. The Lancet • Vol 355 • January 15, 2000: 180-4
3. V.K. Rangan, “Lofty Missions, Down-to-Earth Plans.” Harvard Business Review 82,
no. 3 (March 2004).
4. “Making Sight Affordable” (Part I): Aurolab Pioneers Production of Low-Cost
Technology for Cataract Surgery,”Innovations 1:3 (Summer, 2006), pp. 25-41.
5. V. Kasturi Rangan and R.D. Thulasiraj, April 2012“Making Sight affordable(Part
II):Aravind Eye Care, Journal of IIM Ahmedabad
 6. Tina Rosenberg, January 16, 2013 “A Hospital Network with a vision”, Newyork
Times.
7. S. Saravanan (2003), “Organizational Capacity Building – A Model Developed by
Aravind Eye
Care System”, Illumination, III(1) (January-March), pp.20-21.
8. “The Aravind Eye Care System: Delivering the Most Precious Gift” in C.K. Prahalad
(2004), The Fortune at the Bottom of the Pyramid. N.J.: Wharton Publishing.
9. “National Survey on Blindness – 2001-2002, Summary”, published the Quarterly
Newsletter of
National Program for Control of Blindness & “Vision 2020: The Right to Sight
Initiative”, 1(2), July- September 2002.

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