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Aravind Eye Care System

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The content below is not actively maintained and may be out of date. We last updated the content below in July 2009.

Aravind Eye Care System does not currently qualify for our highest ratings.

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Table of Contents

What do they do?

The Aravind Eye Care System's primary focus is directly providing eye care by (a) running a network of five eye hospitals in India1 and (b) holding "eye camps" to screen and identify patients in need of services.2 In addition, Aravind:

  • Advises, supports and oversees other hospitals attempting to implement the "Aravind model."3
  • Trains clinicians to perform eye care and administrators to manage eye hospitals.4
  • The Aravind Eye Care System also includes a medical research institute (the Aravind Medical Research Foundation)5 and AuroLab, a company that produces eye care materials.6

Aravind's model

The Aravind Eye Care System primarily focuses on surgery to correct cataracts.7 Aravind supports its operations by charging patients who have the ability to pay for their medical care. Aravind aims to charge 1/3 of clients and provide free care to 2/3 of clients.8 Aravind's website states that in 2006, 2/3 of outpatient visits and 3/4 of surgeries were provided for free.9 In 2008, however, it appears that only 23% of outpatient visits10 and 57% of surgeries11 were provided for free.

The fees Aravind receives from paying patients fully fund the hospitals' operations, and provide Aravind with some additional revenue they use to expand.12 Therefore, Aravind does not require charitable donations to provide (or increase access to) its core activity: providing cataract surgeries to those in need.

Does it work?

Based on (a) the data on complications in surgeries that Aravind has sent us and (b) the improvement in vision that normally results from cataract surgeries, we would guess that Aravind's activities are significantly improving the vision of the individuals they serve.

Monitoring adverse events during and following surgery

Aravind's Clinical Quality Assessment provides data on complications in surgery, showing the total number of surgeries and complications during those surgeries for one of Aravind's hospitals during 2008.13 The Clinical Quality Assessment also provides a comparison of adverse events among Aravind patients (both during surgery and in the 48 hours following surgery) to patients in the United Kingdom, showing that complication rates among Aravind patients are slightly lower than those among U.K. patients.14 While we see no reason to believe that the populations served by Aravind and the U.K. hospitals are strictly comparable, these data do give us confidence that Aravind is competently performing cataract surgeries.

Monitoring vision improvement

Aravind could not provide us with information on patients' pre- and post-operative visual acuity. However, we do believe that they maintain these records. The researcher who completed the Harvard Business School Case Study reports pulling "out six patient records at random to get a sense of the improvement in sight after surgery."15 In these extremely limited cases, patients' vision improved from near blindness to reasonable levels.16

What do you get for your dollar?

Aravind's primary activity of performing cataract surgeries appears to cost very little per significant life change. This activity also brings in revenue from paying patients (see above).

The cost-effectiveness of the activities supported by donations is unclear.

Cost per surgery performed

In 2007-08, Aravind performed a total of 285,745 surgeries, 200,123 of which were for cataracts.17 At a total cost of $10.1m, this yields $35 per surgery performed.18

In addition to surgeries, Aravind also trains eye doctors. In 2007-08, Aravind trained more than 500 individuals.19 Among graduates, we do not know what portion ultimately work in eye care and perform eye surgeries.

Role of donations

Aravind raises funds through a United States tax-exempt charitable entity, Friends of Aravind.20 According to the Aravind representative with whom we spoke, Aravind uses donations to provide additional eye care services to patients aside from cataract surgery.21

We have no information about the costs of these activities, or about their relative weights in the budget, but we would guess that they are likely substantially more expensive than the surgeries discussed immediately above.

Room for more funds?

As discussed immediately above, the role of donations in Aravind's activities is largely unclear; information is available only at a very general level, and it is clear that these activities are quite different from Aravind's primary activity of performing cataract surgeries.

Unanswered questions

  • Pre- and post-operative visual acuity. We have relatively little information about the improvement in vision among Aravind's patients. We have based our view that their vision improves on (a) "normal" results for cataract surgeries, (b) comparable rates of adverse events between Aravind patients and patients in the U.K., and (c) an extremely small (though likely random) selection of records of individual patients whose vision significantly improved. More data on Aravind patients' pre- and post-operative vision could offer a more compelling answer to this question.
  • What are Aravind's plans for the future? Donors may support Aravind even though it does not need donations to support its operations because they believe that Aravind will use their money wisely to improve eye care in India. We are especially interested in Aravind's plans for testing new methods of providing care.

Sources

  • 1.

    "Founded in 1976 by Dr. G. Venkataswamy, Aravind Eye Care System today is the largest and most productive eye care facility in the world. From April 2007 to March 2008, about 2.4 million persons have received outpatient eye care and over 285,000 have undergone eye surgeries at the Aravind Eye Hospitals at Madurai, Theni, Tirunelveli, Coimbatore and Puducherry." Aravind Eye Care System, "About Us."

  • 2.

    "Through free eye camps, medical teams from each hospital reach patients in rural areas. The teams work closely with local community leaders and service groups to organise the camps. Eye camps are conducted every day of the week. During the year 2006, a total of 1,793 camps were conducted, at which 2,313,398 patients were examined and 270,444 site restoration surgeries have been performed." Aravind Eye Care System, "Community Outreach."

  • 3.

    Chitra Prasad, phone call with GiveWell, May 7, 2009.

  • 4.

    Chitra Prasad, phone call with GiveWell, May 7, 2009.

  • 5.

    "The Aravind Eye Research Institute is run by the Aravind Medical Research Foundation (AMRF). AMRF was formed to investigate issues concerned with causes and treatment of various eye diseases and problems related to delivery of eye care." Aravind Eye Care System, "Aravind Medical Research Foundation."

  • 6.

    "Aurolab, the manufacturing division of Aravind Eye Hospital, supplies high quality ophthalmic consumables at affordable prices to developing countries." Aravind Eye Care System, "Aurolab."

  • 7.

    In the year ending in March 2008, cataract surgeries accounted for 200,123 of a total of 285,745 surgeries performed at Aravind hospitals (both direct and managed). Aravind Eye Care System, "Aravind Eye Hospitals: Performance (2007-2008)."

  • 8.

    Chitra Prasad, phone call with GiveWell, May 7, 2009.

  • 9.

    "2,313,398 outpatient visits were handled and 270,444 surgeries were performed at the Aravind Eye Hospitals in 2006. Two-third of the outpatient visits and three-fourth of the surgeries were serviced to the poor, free of cost." Aravind Eye Care System, "Our Hospitals."

  • 10.

    1,239,978 for-pay and 372,940 free. Aravind Eye Care System, "Aravind Eye Hospitals: Performance (2007-2008)."

  • 11.

    122,900 for-pay and 162,845 free. Aravind Eye Care System, "Aravind Eye Hospitals: Performance (2007-2008)."

  • 12.

    In 2007-08, Aravind had total revenues of $17.0 million and expenses of $10.1m. Revenues came primarily from sureries ($10.9m); donations and other awards added up to $1.6m. These figures are from Aravind Eye Care System, "Consolidated Income and Expenditure Account."

  • 13.

    Aravind Eye Care System, "Clinical Quality Assessment," Pg 1, Table 1.

  • 14.

    Aravind Eye Care System, "Clinical Quality Assessment," Pg 2, Table 3. Data for U.K. patients comes from Desaia, Minassianb, and Reidya 1999, Pg 1339, Tables 6 and 7.

  • 15.

    Rangan 1993, Pg 13.

  • 16.

    Rangan 1993, Pg 13. For more information on the visual acuity scales below, see John Morgan Eye Center, University of Utah, "Visual Acuity."

    • 5 of the 6 patients had no vision pre-surgery. Of these 5, 1 patient's vision improved to 20/20 vision (6/6 on the metric scale), 2 patients improved to 20/40 (6/12), 1 patient to 20/60 (6/18), and 1 patient to 20/120 (6/36).
    • 1 patient had 20/400 vision. That individual improved to 20/40 (6/12).
  • 17.

    Aravind Eye Care System, "Aravind Eye Hospitals: Performance (2007-2008)."

  • 18.

    The hospitals for which Aravind reports costs are Madurai, Coimbatore, Tirunelveli, Theni, Pondy, Laico, and Govel, according to Aravind Eye Care System, "Consolidated Income and Expenditure Account." The hospitals for which Aravind reports completed surgeries are Madurai Theni, Tirunelveli, Coimbatore, Puducherry as well as Aravind Managed Eye hospitals. Madurai, Coimbatore, Tirunelveli, and Theni account for 226,022 surgeries at a cost of $8.2m, or $36 per surgery. We therefore believe that $35 is a reasonable estimate of Aravind's cost per surgery performed.

  • 19.

    Aravind Eye Care Systems, "Education and Training Programmes." It's unclear to us whether this figure represents the number of individuals who completed training or were enrolled in training.

  • 20.

    "Friends of Aravind (FOA) is a 501(3)(C) registered non-profit organization in the US, formed specifically to support the Aravind Eye Care System in its mission to eliminate needless blindness, by funding some of its extraordinary projects." Friends of Aravind, "Homepage."

  • 21.

    These activities include:

    • "Providing free specialty eye care to a lot of patients suffering from Diabetic Retinopathy, Retinoblastoma (eye cancer), Glacoma and any other eye diseases. Majority of the donations received for patient care are used for this purpose.
    • Providing food and travel for the free rural patients.
    • Providing free spectacles to school children.
    • Supporting fixed expenses of the training institute which provides capacity building, hospital management and other training to numerous eye care program managers across the globe mainly in Asia, Africa and South America."

    Chitra Prasad, email to GiveWell, June 29, 2009.

    A full list of the activities supported by Friends of Aravind is available on its website. Friends of Aravind, "Projects."

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