One Mission, Multiple Roads: Aravind Eye Care System in 2009

Situation Analysis
This case study is regarding the Aravind Eye Care System(AECS) in 2009 and the challenges
it faced to grow at par with the best eye hospitals in the world yet keeping their mission
intact. Aravind Eye Care System had started its operations in 1976 with the mission statement
- “Elimination of needless blindness”. AECS, through its network of eye hospitals, vision
camps and eye research centres provided paid and free eye surgeries and consulting services
primarily in the state of Tamil Nadu. From its inception AECS had grown leaps and bound
over the years and even by providing 162,809 free surgeries among the 309,015 total
surgeries, it was able to maintain a respectable surplus in 2009. But as they move forward
they are facing some challenges.
Their first challenge was their over reliance on cataract surgeries. As cataract was one of the
main causes of blindness in India, from its inception AECS was more focused towards it. But
over the years, the absolute number of cataract surgeries had been increasing but their
percentage had come down to 66%. The cataract surgery was standard in nature and so AECS
had developed two bed system which had helped them decrease cost and increase efficiency.
Also the IPO developed in-house also lowered cost. That helped them in providing free
services. Just as the percentage of cataract surgeries were decreasing, other areas of eye care
like diabetic retinopathy (DR) were emerging. The DR patients needing treatment were going
to increase form 1.5 million to 2003 to 4.7 million in 2020. The DR treatments was not
standardized and varied from patient to patient and so would not be cost effective. Also
various training and research had to be carried out in this field. For this AECS had started to
focus on the new areas and spread awareness regarding DR as it was preventable. They had
also created Dr. G. Venkataswamy Eye Research Institute to have a comprehensive research
programme in eye care.
The second challenge was maintaining the standards of the services. As the living condition
of people improved, people seeking free services decreased and people’s expectations
increased. AEHs had to hence improve the facilities provided. Also now many people had
private and state sponsored policies but the hospital policies to provide free care in free care
units had not changes. Also the expectations of the doctors had increased. Many doctors
wanted to pursue research and write papers and the market was becoming competitive. Some
doctors were leaving AECS for private hospital due to higher pay. For this AECS had started
supporting the doctors and scholars in attending and presenting papers in international
conferences.
The third challenge was the continued incidence of blindness in India. There was a disparity
in the services provided in the rural and in the urban areas. There was 1 surgeon for 20,000
people in urban areas while 1 surgeon for 2,50,000 people in rural areas. Also there was a
disparity in services among states as well. For this AECS had stared an initiative in a limited
way, called Aravind Managed Eye Care Services (AMECS) to manage other hospitals
without owning them. AECS was reluctant to offer them the brand name but they offered the
hospitals with training. It was managing four such hospitals: one at Amreli, Gujarat in
collaboration with Sun Pharmaceuticals Group; one at Kolkata in collaboration with MP Birla
Group; and one each at Amethi and Lucknow, U.P. in collaboration with Rajiv Gandhi
Charitable Trust. AECS faced issues here as they went outside their state they found it was
difficult to monitor from a far and also it was difficult to find people who shared their culture
and values. For the rural areas AECS had established Vision Centres (VC) and Community
Eye Clinics (CEC). VCs were small units staffed with an ophthalmic technician and had
telemedicine support from the base hospital. The CECs were larger than VCs, but smaller
than the hospitals. Every day a doctor from the nearest base hospital would visit the CEC. All
CECs had an optician, a field organizer, an optical shop person and a nurse. In 2008-09,
100,249 patients had visited the CECs , and 123,198 the VCs.

The fourth challenge was to spread awareness regarding the eye health issues. Various camps
like refractive error camps, screening camps at schools were organized but the percentage of
people coming forward in this camps were decreasing and due to this AECS had decided to
decrease the frequency of some camps.

AECS was also facing competition from private hospitals and government hospitals. The
private hospitals were able to give better services while government gave free services as
well.

While talking to important stake holders, most of them had an opinion that the surplus was
not an issue rather it was important to find the way in which AECS wanted to grow. Most of
them wanted that the vision and goal should not get diluted while growing and diversifying.
For that partners were required that shared the same culture and vision that could help them
grow in India as well as abroad. The stake holders also wanted to concentrate their efforts on
the upcoming challenge like diabetes, refraction and related illness. The concentration should
be on increased the VCs from the current 31 to nearly 50. Also a lot of opportunities were
possible at LAICO as they now worked with the private as well as government bodies.