• 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.

• STRENGTHENING EYE CARE SUSTAINABILITY IN DEVELOPING COUNTRIES

Here we are introduced to the various dimensions of organisational sustainability like leadership, core services, human resource management, leveraging technology etc.


• STRENGTHENING EYE CARE SUSTAINABILITY IN DEVELOPING COUNTRIES: CASE STUDY FROM GHANA

This presentation shares the active steps taken in Ridge Hospital, Ghana both at the infrastructural and clinical levels to deliver eye care services in a more sustainable manner.


• STRENGTHENING SUSTAINABILITY AND INFRASTRUCTURE:A CASE FROM GUATEMALA

Here we discuss the various steps taken at Visualiza Eye Care System, Guatemala as part of improving teh organizational sustainability

• 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.

• 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.

• 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.

• 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.

• 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.

• 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.

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.

• 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