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Dear Readers,
The concept of "Sustainability" is increasingly getting a lot of attention and it has become somewhat of a buzzword in the last few years; and rightly so! Sustainability is very important, and highly relevant especially in the healthcare setting.

Sustainability is looked upon as a desired state of an eye care programme. With changing paradigms, it is important to look at sustainability as one of the key strategies while designing a programme or and while managing an eye hospital to deliver the services. Current approaches to sustainability mainly address financial viability though in reality, it is important to look at it more comprehensively for sustained growth and development. This is possible if every organization addresses sustainability in the following domains:
  • Leadership: fostering leadership at all levels
  • Core services and management: Growing the services, people, dynamic processes and systems
  • Financial viability: both for the organisation and the clients (patients)
  • Community: Being relevant to the community and forging partnerships

This Sitenews uses a general approach to the understanding of Sustainability in eye care including Strengthening sustainability in eye care, Financial, and Hospital sustainability. This issue also introduces you to the Sustainability in General and public health and Sustainability concept in eye care programmes.

The personality featured in this issue is Jacqueline Novogratz for her organisation's drive to support and promote sustainable social ventures. This edition of Sitenews also features an Organization named Community Health Center (CHC) that works closely with its community, constantly adapting its programmes to address the real issues of the society.

Your feedback will help us improve the newsletter.Please send in your feedback at eyesite@aravind.org

Regards,
Library Team
The Issue Features...
SUSTAINABILITY IN
EYE CARE

Vol. 10, Issue 10,
October 2011
•   Sustainability in eye care
•   Strengthening sustainability in eye care
•   Financial sustainability
•   Hospital Sustainability
•   Sustainability in General and Public health
•   Sustainability concept in Eye Care Programes
•   Featured Personality
•   Featured Organization
•   Talk to Us
•   Past Issues

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  • ARAVIND EYE CARE SYSTEM: DEVELOPING SUSTAINABLE EYE CARE

  • The Aravind Eye Hospital model has proven to be one of the most effective programs for addressing the enormous backlog of blindness in India. Founded in Madurai by the charismatic GovindappaVenkataswamy, MD, who had a vision of providing quality cataract and eye care to the masses of his country, the Aravind Hospital system has evolved into a world leader in eye care, ophthalmic education, and the development of appropriate technology for cost-effective surgery. In this piece, Dr. Ravindran and Mr. Thulasiraj share how the organization is now mentoring hospitals throughout the developing world.

  • THE IMPORTANCE OF SUSTAINABLE DEVELOPMENT IN EYE CARE

  • Sustainability has become somewhat of a buzzword in the last few years, but dont let the fact that it has been overused detract from the value of the idea it represents. Sustainability is very important, especially in the healthcare setting. In many of the places in the world, where Unite for Sight partners with local eye clinics, those clinics are the only providers of eye care for a very large geographical area. The population of the area may rely on that one clinic to help them meet all of their eye care needs. Therefore, it is of vital importance that eye clinics retain their ability to operate autonomously through a sustainable business model.

  • SELF-SUSTAINABILITY IN EYE CARE

  • One of the factors central to the success of any health care programme is financial sustainability and eye care is no exception to this rule. In countries like India, this assumes even greater relevance since health care is expected to be delivered at very low or no cost to the consumer, a phenomenon borne out of the presumption that most health care consumers cannot afford to pay for services. Given the overall socio-economic conditions of the country, almost two thirds of population of India may require subsidized or free eye care. All eye care facilities in governmental and voluntary sectors have assumed the responsibility to provide eye care to these economically under-privileged classes. Resource constraint is a major problem faced by these organisations both from lack of funding and more importantly due to suboptimal utilisation of available resources. The obvious result of such services is poor quality eye care and consequent high ocular morbidity.



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IOL
  • INTRAOCULAR LENS REPLACEMENT TO CORRECT CATARACTS: A CASE STUDY OF MEDICAL TECHNOLOGY TRANSFER FOR SUSTAINABLE DEVELOPMENT

  • Cataracts account for almost 50% of blindness in the world (17 million people). The magnitude of this problem is stunning, and affects the sustainable economic progress of developing nations where 90% of the blind are located (and likewise 90% of the $19billion dollars in lost global productivity each year). The Vision 2020 program has called for eliminating cataract as a cause of avoidable blindness through Intraocular Lens Replacement surgery (IOL surgery), a relatively cheap solution with good outcomes.

    This paper will (1) give background on the scope and problems surrounding international technology transfer of IOL surgery (2) develop the international medical technology transfer framework adapted from work by Lall and Wei (3) compare programs in the countries of Nepal and Nigeria, (4) evaluate the success of their technology transfer of intraocular lens replacement and (5) provide recommendations for sustainable international transfer of IOL surgery.

Refractive Error
  • MAKING REFRACTIVE ERROR SERVICES SUSTAINABLE: THE INTERNATIONAL EYE FOUNDATION MODEL

  • The International Eye Foundation (IEF)believes that the most effective strategy for making spectacles affordable and accessible is to integrate refractive error services into ophthalmic services and to run the refractive error service as a business there by making it sustainable. An optical service should be able to deal with high volumes of patients and generate enough revenue not just to cover its own costs, but also to contribute to ophthalmic clinical services.



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  • FINANCIAL SUSTAINABILITY FOR HIGH QUALITY, LARGE VOLUME, SUSTAINABLE CATARACT SURGERY PROGRAMMES

  • Eye care with an emphasis on cataract surgery is probably one of the few health care services that can become financially self-sustaining from user fees while maintaining an orientation to serving the poor. Why is this? In large scale public health programmes that are prevention-oriented, it has been learned through many failures in cost of recovery that people are unwilling to pay for prevention. In contrast, people are indeed willing to pay for a cure. Further-more, in curative health care services, chronic and acute diseases can vary greatly in treatment and cost from patient to patient. There is not enough replicable volume to lower the unit cost and create economies of scale.

  • FINANCIAL SUSTAINABILITY

  • In developing countries it is most important that eye care programmes provide quality eye care services to communities in the long term. However, they must be financially sustainable within a reasonable period of time. Methods of sustainability have to be introduced from the very beginning of any eye care programme for these to benefit the community in the long term.

  • COST CONTAINMENT IN EYE CARE

  • Voluntary eye hospitals committed to serving the community must understand the reality of increasing costs due to inflation, advancements in medical technology and changing expectations of staff and patients. However, these costs are often not matched by the patients paying capacity. While increasing income, through increased user fees or donations are financial options which will be considered, this article will focus on cost containment.

  • CASE STUDY: IMPROVING THE MANAGEMENT OF EYE CARE PROGRAMMES

  • This article describes what we have learnt from our experience in managing HR, Infrastructure and technology, Financial Sustainability and etc., and hopefully will provide you with suggestions to improve management.



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  • TRANSFORMING EYE CLINICS AND HOSPITALS TO SUSTAINABILITY THE INTERNATIONAL EYE FOUNDATIONS SOCIAL ENTERPRISE MODEL

  • A stable but inherently unjust equilibrium exists in eye care in developing countries, causing exclusion, marginalization and suffering for both patient with eye disease and eye care providers who lack the authority, autonomy, resources or political power to change the situation. Patient choices include an unaffordable private sector or inherently inefficient public system. The medical profession controls the private sector, government bureaucracy controls the public sector and donors control the charity sector, and each has different priorities within the government sector. Ophthalmologists can choose to remain in an inefficient, unproductive and non-autonomous system. The alternative is to leave government service for private practice because they lack the authority and investment to undertake a social enterprise. Those in private practice lack the investment power and vision to expand and include a social side. The worst-case scenario is when ophthalmologists feel that they have no choice but to leave their country of residence altogether.



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  • IMPROVING THE LONG-TERM SUSTAINABILITY OF HEALTH AID: ARE GLOBAL HEALTH PARTNERSHIPS LEADING THE WAY?

  • Over the last decade development assistance for health has more than doubled.This increase provides an unprecedented opportunity to scale up health services,and in doing so, achieve the health Millennium Development Goals. However, sustaining scaling up will in turn require sustainable donor support until domestic health financing can substitute for it. The provision of long-term predictable finance is of particular concern in health because the bulk of costs are recurrent and many interventions require sustained, multi-year support to be successful. This is also true for health systems strengthening efforts. As the bulk of new aid resources flow through Global Health Partnerships (GHPs),their ability to make long-term commitments is critical to health systems development.

  • CHALLENGING HEALTH CARE SYSTEM SUSTAINABILITY IN OMAN

  • The healthcare system in Oman is being reformed. During last three decades, the system has demonstrated and reported great achievements in health care services, preventive and curative medicine. In 2001, WHO ranked Oman first because of what was described as aspectacular performance in reducing infant mortality rate over the past three decades. The healthcare system in Oman is facing a challenge of sustainability of achievement. In this paper, current health status indicators are presented along with effort to maintain health outcomes. Threats of sustainability are identified and international financing approaches are reviewed to develop a model for sustaining reform in Oman.



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  • THE SUSTAINABILITY NETWORK PROJECT CENTER FOR INNOVATION IN EYE CARE SEVA FOUNDATION

  • The first phase of the Sustainability Network Project includes activities proposed for the Global Philanthropy Forum Social Entrepreneur Marketplace award. BACKGROUND: The Center for Innovation in Eye Care is a global action network of eye health organizations and affiliated professionals who seek to reduce avoidable blindness through sustainable programs. The Center is positioned to target strategic issues vital to the success of the World Health Organization campaign: Vision 2020 The Right to Sight. Collaborations among a wide range of international service providers, research and training institutions, and donors will create breakthroughs required to rapidly expand and sustain service programs.

  • INTEGRATING THE SUSTAINABILITY CONCEPT WITHIN ORBIS INDIA EYE CARE PROGRAMMES

  • Sustainability is perhaps the most vital and yet elusive dimension for planners and implementers of development programmes to achieve. We at ORBIS understand sustainability as the ability to maintain the benefits achieved by our blindness prevention programmes indefinitely, i.e., after the conclusion of the initial partnership period where both technical and financial assistance are provided. To be sustainable, a service or an institution must become integrated into the local environment, and be able to support itself financially. In this article, we will share the framework and steps used by ORBIS for integrating the concept of sustainability into actual programme planning and implementation. The approach is based on our work and experience in establishing paediatric eye care centres in India from 2002 onwards.

  • SUSTAINABILITY KEY TO LONG-TERM OUTREACH PROJECTS

  • Surgeons making volunteer visits to a developing country always do some good, but the amount of good depends not just on the work they perform during their visit but on what knowledge, skills and supplies they leave behind. As we learn in this article about Dr. Jonathan Walkers project in Nicaragua, the most effective volunteer surgical missions concentrate just as much at building capacity in the developing country as on performing surgery during the visit.



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Jacqueline Novogratz

Jacqueline Novogratz is the founder and CEO of Acumen Fund, a non-profit global venture fund that uses entrepreneurial approaches to solve the problems of global poverty. Acumen Fund invests long term capital to identify, strengthen and scale business models that effectively serve the poor and champions this approach as an effective complement to traditional aid. Acumen Fund currently manages more than $60 million in investments in South Asia and East Africa, all focused on delivering affordable healthcare, water, housing and energy to the poor in Pakistan, India and Kenya. Prior to Acumen Fund, Jacqueline founded and directed The Philanthropy Workshop and The Next Generation Leadership programs at the Rockefeller Foundation.

Acumen Fund has approved investments of more than $72 million in 65 companies. Its investees have touched more than 86 million lives and created more than 55,000 jobs. Nearly 50 global Acumen Fund Fellows are emerging as architects of the social sector. In contrast to the traditional funding model, this form of investment emphasizes sustainability and strengthening of the venture.



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Community Health Center

The Community Health Center is committed to transforming the way health care is delivered. When it began providing care in 1972, the focus was simply on making sure everyone who needed it had access, regardless of ability to pay. As the Health Center has grown since 1972, the mission has become to not just provide health care, but to make sure that the care we provide is the best it can be, and is what best meets the needs of the communities and patients. That definition has changed over the years as the communities have changed, and as the health care system has evolved. To be a world class primary care organization, the Health Center is constantly transforming itself to reflect these changing needs and a changing environment. The Health Center indentifies at least 3 critical paths in this transformational work:
  • always striving for clinical excellence
  • constantly innovating and researching, seeking new ways to improve the health of the communities
  • committed to training health care professionals of the future


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