While growth is imperative for Aravind Eye Care Hospitals, it has never lost sight on reaching eye care to a greater number of people in need, especially in rural India

S. MEERA

Growth is critical to the health of any business. But Aravind Eye Care Hospitals (Aravind) desires a path to grow that does not alter its vision, which includes reaching quality eye care to the needy either free or at nominal costs. The way to achieve this growth is through high volumes in addition to which the company has put in place systems and processes for the optimal use of medical and paramedical staff to reduce a patient’s wait time.

Aravind had also looked at the possibility of growth through partners and chose to work with MP Birla group, setting up an eye care annexe in Bellevue Hospital in Kolkata, where local staff was recruited and trained. “But as our involvement decreased, our interaction also decreased and the relationship suffered,” points out R. D. Thulasiraj, executive director at Aravind. Despite this, Aravind did not want to retain control as that is against its principle. And in 2010, it decided to grow on its own and has already implemented its plans.

On its own feet

One of the key lessons for Aravind has been that eye care is a product, a commodity that is predictable and can be operated on high volumes. It also wanted to cut the travel for its patients while consolidating its base of private, paying customers so that its social goals could be met too.

With this in mind, Aravind has opened four smaller hospitals with in-house training facility in Dindigul, Tirupur, Tuticorin and Udumalpet. Salem is a promising location and through eye camps, the hospital has established a name here. Following this, it bought an existing building and converted it into a tertiary hospital. Eventually, it will start a teaching facility here too. It has also acquired land in Chennai for a large format hospital, which is expected to be functional from 2014. Tirupathi and Tanjore are on the radar and Aravind will consider stepping outside of Tamil Nadu to reach the rest of India, as a consultant. In fact, it has also received enquiries from developed countries like Singapore, Finland and San Francisco (U.S.) where it would like to replicate its social model.

Deeper reach

While eye camps are a great way to take eye treatment to the rural areas, there is much more that is required. Therefore, Aravind started following the primary care model by setting up smaller centres in rural towns that cater to the nearby villages as well. This way, about 65,000 to 70,000 people are covered. The centres are linked online to a doctor at the nearest base hospital, and each hospital has 41 such centres attached to it. A doctor is assigned to each centre to examine, diagnose and prescribe treatment remotely. The patients are charged Rs. 20 for consultation and the focus is more on coverage than on generating revenues here.

In 2011-12, Aravind Eye Care performed about 350,000 surgeries and laser procedures. Of these, around 170,000 were paid for and the remaining free or subsidised.

In three years, Aravind has achieved 90 per cent penetration in Tamil Nadu. These centres see at least 1,000 patients a day and have around 80 technicians working in them. The target is to establish 100 such centres.

Product route

Across the board, eye care is more cataract-centric. “Our plan is to become more proactive in other areas,” says Thulsiraj. Paediatric eye care is one of the main focus areas and schools have been targeted for this. Currently, around 60,000 to 1,00,000 students have been covered, and the plan is to improve the reach and target at least a million children each year, per hospital.

Diabetic retinopathy is another area that needs attention. By virtue of the impact of diabetes on the nerves, this problem is not diagnosed early enough amongst diabetics. Aravind has partnered with the healthcare vertical of Mumbai based IL&FS (Infrastructure Leasing and Finance Services) to develop a diagnostic tool that will be placed at the physician’s office, which will recommend an eye check for diabetics as part of the screening. The eye test parameters will be sent online to the Madurai centre of Aravind Eye Care, which will return the result the same way. In case of any problems, the doctor will recommend further treatment, or prescribe the test at the next check up.

Here, the model is that of revenue sharing from the fee collected between IL&FS and Aravind. Post the proof of concept, the tool has been installed in a few clinics with 300 people already having been tested on this machine.

Looking for people

Aravind is raring to go, but one challenge that stands in its way is the need for trained and experienced staff. “Today, our greatest crunch is in the paramedical area,” admits Thulsiraj. As of now, young women studying in standard 12 are being trained internally and certified. The intake has been around 400 – 450 each year, but now the demand at Aravind has risen to 2,000 paramedical staff due to growth. With a 15 per cent attrition rate and a forecasted growth in requirement of 5 per cent – 10 per cent, Aravind has been forced to go in search of potential candidates in schools. Earlier, there was a push situation and candidates used to come through references, but now there is a pull situation. “We are casting our net wide, but are also selective,” he adds.

The other challenge, albeit a transient phenomenon, is a result of the corporatisation of the eye care sector. As chains in eye care are established, attrition has increased as such hospitals only look for trained staff so that they can become operational quickly. “But the good thing is that these chains have increased awareness about eye health,” he points out. And though patients go to such hospitals first, they also seek a second opinion, evaluate their options, compare costs and then go with what sounds optimum, thus benefiting the other eye care players. “Also, being bottom line oriented, their pressures are different from ours,” says Thulsiraj.

Another bottleneck to growth, he admits, is the emphasis on maintaining the work ethos of Aravind across the hospitals. As a result, when any new hospital or health centre is established, the initial staff comes from within the system, and the locals comprise only 10 per cent. As it grows, there is an expectation that Aravind will employ around 3.5 lakh – 4 lakh.

The growth story

By 2009 -10, Aravind had performed 2,85,000 surgeries and laser procedures. In 2011-12, it has grown by about 25 – 30 per cent to 3,50,000. Of these, around 1,70,000 were paid for, the remaining being free or subsidised. This is as per the organisation’s policy, where volumes have been stressed on to fund its social goals. By establishing more large format and small format hospitals and centres, and entering the products field, Aravind hopes to spread itself across the spectrum to be able to continue to cater to the local population and provide high quality healthcare.

GROWTH DRIVERS

• Large format hospitals in major towns of Tamil Nadu
• Small primary health centres in villages connected to the large hospitals
• Eye camps for creating awareness and reaching out to villages
• Reaching out to children through eye tests in schools
• Recruiting in schools and internal training for paramedical staff

DID YOU KNOW?

• Of the 3,50,000 internal procedures done at Aravind Eye Hospital, only 1,70,000 are paying patients
• Aravind runs 41 primary centres in small towns to cover the rural areas of Tamil Nadu
• Aravind has four large formats covering all major cities of Tamil Nadu, with more coming up in Salem and Chennai
• Aravind has tied up with IL&FS to develop and market products for the eye care market

THEN AND NOW