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"India might have the maximum number of problems but it also has the maximum number of solutions"

Jan 23, 2012

Group Chair of the Hyderabad-based LV Prasad Eye Institute, Dr Gullapalli N. Rao, introduces his equity-based model to promote eye care in India. In an interview to OneWorld South Asia, Dr Rao says that the institute is driven by the principles of equity, efficiency and excellence.

The Hyderabad-based LV Prasad Eye Institute may be a non-profit for its founders, but it’s all the time maximising gains for people who avail of its services. Driven by Three-E principles of Equity, Efficiency and Excellence, it works on a business model called the Eye-Health Pyramid. The model “emphasises the creation of sustainable permanent facilities within communities, staffed and managed by locally trained human resources, and linked effectively with successively higher levels of care”. Excerpts from an interview with the Group Chair, Dr Gullapalli N. Rao:

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OneWorld: You had established yourself as a successful ophthalmologist in the US. What prompted you to come back and start the LV Prasad Eye Institute?

Dr Gullapalli N Rao: When my wife and I came back from the US in 1986, I did not have any big idea initially. I came back with the simple intention of returning and giving back to the society whatever I had learned there. I wanted to do something different from the routine so the idea of a big centre originated.

I went around and revisited various famous institutions, tried to understand their functioning and various practices, made a note of what is good and what is bad, tried to incorporate the best of the west and the best of what we had and make it locally applicable, that’s how it all started. It was made easier as I was introduced to Mr LV Prasad, who was a big movie producer at that time, by family friends.

I explained to him the project and he was interested in funding it. He gave us five acres of land in Banjara Hills and Rs 1 crore. But we had to arrange for the equipment. Before asking anyone else for help, my wife and I committed our last four years’ salary from the US to the cause and then went ahead and asked for help from others. That’s how the institute was conceptualised.

OW: What was the total investment?

Dr Rao: Around $ 600,000. The building came from Mr LV Prasad’s money. We also took help by way of a small bank loan, but now our philosophy is that we should make do from what we earn: no bank loans or debts.

OW: How big is the hospital now? What is the average number of patients? 

Dr Rao: We now take care of about 700,000-750,000 outpatients and conduct about 70,000-80,000 surgeries a year. In addition to that we cater to around a million people for door to door screening at various areas. We train around 250-300 eye care professionals of different cadres every year from all around the world. Besides, about 2,000 professionals are exposed to the new trends through continuing education programmes every year. We also have around 100- 150 publications every year in the field of research. Thus it’s a big enterprise and at the tertiary and the advance tertiary levels we compete with the best in the world. Equal importance is given to all the aspects such as patient care, education
and clinical research. The unique feature of our institute is our commitment to the most marginalised sections in the remote areas. We don’t do this through eye camps but through primary eye centres, by being there for them. For example, there are 83 such centres in remote areas of Andhra Pradesh.

OW: How does the business model work? 

Dr Rao: We ensure that all our operating costs are met from the money that we get from our patients. And at any given time 50% of the patients are treated free of cost.

OW: Please elaborate? 

Dr Rao: At the primary level, the service component is 100% free. The screening is free and if some villagers need glasses, they are provided the same at a nominal cost ranging from Rs 100-1,000. The small profit made from this is used to pay the technicians and running costs. So in a smaller village the cost recovery is generally 30%, while in a bigger village with higher population, it could be around 150%. Thus at primary levels they cross-subsidise each other. Ten such primary centres connect to a rural eye hospital called secondary care centre that provides the secondary eye care health. An ophthalmologist, who is trained with a two-year MS from LVPEI, works there along with 20 other trained eye care personnel who are recruited from within the community. In such centres 65-70% of the surgeries are done free. No subsidies are taken from the government. The remaining 30- 35% surgeries are subsidised after the cost recovery as well. Then comes the tertiary level where half of the surgeries are done free of cost; the rest contribute to the cost recovery.

OW: What about your ventures outside Andhra Pradesh? 

Dr Rao: We have a centre in Bhubaneshwar to replicate whatever we did in Andhra Pradesh and reach rural areas there. We have also helped 200 hospitals in 18 states and done programmes on capacity building. We help them in situational analysis, redesigning facilities, training human resources, make recommendations on systems and processes, and basically restructure the whole institution along with periodic reviews, if needed. We have also given similar services in 16 countries outside India mainly in Asia, Sub-Saharan countries, Bangladesh etc. Trainees all over the world come over to LVPEI for enhancement of their eyecare skills.

OW: How have the things changed in the last couple of decades in the field of eyecare? 

Dr Rao: In India, both the quality and quantity of eyecare have improved significantly over the last couple of decades. For example, if you consider cataract surgeries, we used to do 1.5 million surgeries per year around 10-20 years ago, now we do 6 million. Similarly, the emphasis on the quality of eyecare has significantly improved. We did a survey/study on the outcomes of cataract surgery in Andhra Pradesh 15 years ago and found out that 35-40% of the people operated upon were blind. This was shocking! We shared the study with WHO, which led to many similar outcome of studies all around the world and the same statistics were found to be true at most of the places. Everybody woke up and thus started an improvement in the standards of cataract surgery, thus benefiting other aspects of eyecare as well.

OW: You have also served resident and CEO of the International Agency for the Prevention of Blindness. What’s you assessment of India’s efforts in preventing blindness? 

Dr Rao: The word should be avoidable and not preventable. Avoidable includes both preventable and treatable. It means those whose blindness can be eliminated with the use of present technology. For example, 15 % of the blindness cases are due to non-availability of glasses, which can be addressed just by providing those glasses. About 50% of the blindness cases are due to cataract, which can be safely and effectively operated upon with 95% success rate. Patients with Vitamin A deficiency contribute another 5% cases to blindness and can be taken care of by providing nutritional supplements in the form of vitamin A. Then if you train and educate postgraduate students properly, the percentage
suffering from glaucoma and diabetic retinopathy is taken care of and thus blindness can be avoided. India might have the maximum number of problems but it also has the maximum number of solutions. Our challenge is to apply those solutions to the maximum number of people.

OW: What about growing awareness about eye donation in India?

Dr Rao: India has still a long way to go in the field of eye donations. We require around 100,000 donors for corneas, but at present we have only about 20,000. The easiest way to bridge this gap is to put grief counselors in 500 major hospitals, to encourage and counsel bereaved families to donate corneas of the deceased. This step can fulfill the gap within five years if executed, in addition to voluntary donations and public information.

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