Case Analysis

The Aravind Eye Hospital, Madurai, India

In service of sight

Submitted by:
Achintya Goel
Roll No - 150101006
Section - C

CASE STUDY ANALYSIS

THE ARAVIND EYE HOSPITAL IN SERVICE FOR SIGHT
Scenario:
In 1992, there were around 30 million blind people in the world. The
maximum in Asia with around 20 million people, 6 million in Africa, 2
million in Latin America and the rest in Europe, Oceania, former
Soviet Union and North America

6.67

6.67

20
Africa
Asia

66.67

Latin America
Others

Fig: Division of Blind Population in the world in 1992

Cataract was the major reason for blindness in developing countries
and they accounted to over 75% cases.
More than 80% of them were age related and generally occurred in
people over 45 years of age.
Blindness in India
In 1991, Indias Population was around 850 million, of which about
20 million were blind and with 2 million increasing every year.
Cataract was the main cause for 75% to 80% of the cases. 8000
ophthalmologists performed 1.2 million operations a year in India.
India had around 42,200 eye hospital beds and 2/3 rd of the Medical
resources and infrastructure were in urban areas where only 1/3 rd
population lived.
30% cataract surgeries were performed in government sector for
free, 40% in private sector for a fee, 30% performed free of cost by
NGOs and volunteer groups.
Cataract Operation

95% chance of improved vision

Two techniques (i) ICCE(without intraocular lens) (ii) ECCE(with
intraocular lens)
ICCE most widely used, completed in 20 minutes
After 3-5 weeks fitted with aphakic spectacles
ECCE took around 30 minutes
Better results than ICCE patients
Instant improvement in ECCE, gradual improvement in ICCE
(3-5 weeks)

Aravind Eye Hospital

Founded by Dr. Govindappa Venkataswamy in 1976.

His sister Dr. C Natchiar and her husband Dr. Nam were
amongst the first doctors
First hospital in Madurai then later in Tirunelveli in 1988 and in
Theni in 1985

Timeline of Aravind Eye Hospital:

20 bed eye hospital in Madurai

Goal of providing quality eye care at reasonable

1976
cost

30 bed Annexure

1977

Goal to accomodate patients after surgery

70 bed free hospital

1978

Goal to provide the poor with free eye care

250 beds

1981

80,0001981
sq feet space

4 major operation theatres

1985

1985
New facility
in Theni
1988

1988
New facility
in Tirunelveli
1991

1991 intraocular lenses(IOLs)

Set up a facility for manufacturing

AURO Labs - Intraocular Lenses (IOLs)

IOLs an integral part of ECCE Surgery

About Rs. 800 per lens when imported from the United
States
Auro Lab produced 60,000 IOLs a year
50% defect free lenses
Manufacturing cost of Rs. 200 per lens, to be improved to
approx. Rs 100 per lens

Mr. Balkrishnan, a family member, managed Aurolabs. He

had an extensive engineering experience and doctoral
education in US

Aravind Eye Hospitals Model for delivering Eye Care

Registrati
on

Vision
recording

Preliminar
y
examinati
on

Testing of
tension
and tear
duct
function

Refraction

Final
examinati
on by
senior
medical
officer

Optical
shop

Quality of Service at the main hospital:

Reliability: Highly reliable service, cataract removal technique used
gave more than 95% chance of improved vision. There were several
highly experienced doctors on duty hence providing efficiency and
trust. Even the nurses were recruited and trained from scratch by
the Aravind clinic hence assuring uniform levels of efficiency in
them.
Responsiveness: Highly responsive, patients were seated and
readied for surgery in fixed numbers as per the number of beds and
surgeons available. It took approximately 15 minutes per ECCE
Surgery thus maintaining time efficiency.
Assurance: The doctors were highly trained and most of them were
from foreign universities and assured the best medical treatment.
Empathy: Highly Empathetic, doctors often indulged in talks with
patients and empathized with them prior to treatment. Cost of
cataract surgery was Rs.500 to Rs.1000, hence providing value for
money. Patients were awakened early, light breakfast before surgery
that displayed courteousness.
Tangibles: Both ICCE as well as ECCE treatments were provided. The
operating tables were equipped with operating microscopes. There

were 3 class rooms i.e. A, B and C with different privacy and

facilities for the patients hence adding further value. Multiple testing
facilities (Ocular tension, tear duct function, refraction test) were
provided. Retina specialty section with knowledgeable employees

Quality of Service at the free hospital:

Reliability: Highly reliable Cataract removal technique used that
gave more than 95% chance of improved vision.
Responsiveness: Highly responsive. At camps, Arrvinds team screen
patient. Those require surgery were transported to Madurai. They
were returned after 3 days after surgery and recuperation.
Assurance: Specialist use to sit at separate floor and senior medical
official use to analyze final operation report.
Empathy: Doctor gets into personalize talk with patient to make
them comfortable
Tangibles: Almost all surgeries ICCE ECCE only because of medical
reason
Only one of the operating table equipped with operating
microscope

Role of Aravinds clinic and support staff:

i.
ii.

iii.

External Marketing: Offer quality eye care at reasonable cost

and cure blindness caused by cataract. Provide excellent
service to both the rivh and the poor.
Internal Marketing: Recruiting and completely training the
nurses and other staff to serve the patients and perform the
tasks more efficiently. The doctors were highly educated from
foreign institutions and provided extremely time efficient and
trustworthy services.
Interactive Marketing: Organizing Camps, providing
communication services to the poor and food during the entire
duration of their treatment. The local businessmen sponsored
the camps, they turned local colleges into campsites to enable
more people from adjacent areas to get treatment and cure
their blindness.

Weaknesses in Aravinds Model

i.

ii.

iii.

iv.

Transport issues: Camps and promotional activities spread the

news of the eye care facilities, where people came to get their
eyes checked, however it still required the selected patients to
come down to the hospital for surgery and many could not
afford the transportation costs, could not stay away family for
that longer a duration or were afraid of the treatment. Hence,
a high frequency of transport facilities as well as higher level
of interaction with the poor could be a suggestion totally
considering the amount of efforts that were already being
taken.
Occupancy issues: Monday to Wednesday the occupancy was
very high in the hospital and staff had to work at 100%
efficiency while Thursday and Friday were relatively relaxed.
This could have been managed by implementing a token
system or a pre appointment system so as to spread out the
traffic through the whole week. Operations management
techniques could be used to spread out the traffic to the whole
day rather than through the morning only which is generally
the scenario in which the hospital is highly crowded in the
mornings.
Salary Structure: The salaries (around 80,000 for senior staff
and 12,000 for nurses) were comparatively low in comparison
to the private hospitals (salaries for senior staff could go up to
3,00,000 ) which could lead to less dedication and higher
attrition rates.
Bed occupancy rate was much higher in the free hospitals as
compared to the paid hospitals. So Aravind eye care could
lower the capacity at the free hospitals to increase the
utilization of the paid hospitals and hence make certain profits
and save some costs.

Analysis of Exhibit 6
The revenue generated from main hospital could bear the costs of
the free hospital as well as the eye camps, as 65.77 % of revenue
came from the operations from main hospital.
Also, there was a net surplus of 51.59% which indicates that there is
a huge profit margin thus making the hospital highly self-sufficient.
Analysis of Exhibit 7

Madurai
Bed
Capacity

324

Paying
Tirunelv The
eli
ni
200

40

Total
564

Madur
ai
400

Free
Tirunelv
eli
Theni
200

60

Total
660

Grand
Total
1224

Beds
occupie
d per
day (sixmonth
average
)
Occupan
cy rate

265

51

10

326

396

154

28

578

903

81.8

25.5

25

57.8

99

77

46.7

87.6

73.7

Madurai Plant is operating at maximum capacity.

Free Hospital is utilized more efficiently as compared to the
Paying Hospital
Theni Plant is under-utilized with both Paying and Free Hospital
being less utilized: 46% and 25% respectively
Tirunelveli Plant has higher utilization for Free hospital but
Paying Hospital is under-utilized at just 25.5%
Madurai buys equipment for Tirunelveli which increases
expense for Madurai hospital and doesnt show independent
sustainability of Tirunelveli hospital.
Also, one of the reasons of underutilization could be lack of
initial market survey and instead hospital in Theni was opened
because it is the hometown of Dr. Nam

Analysis of Exhibit 8
Only 12.7% (14951) turned up for surgery in Madurai out of the total
117,175 screened patients in the 331 camps.
Similarly, 8.49% (4922) turned up for surgery in Tirunelveli out of
the total 57924 patients screened in the 293 camps and 5.94%
(945) turned up for surgery in Theni out of the total 15901 patients
screened from 83 camps.