The World Health Organization describes six building blocks that make up the health system. All are interdependent but have overlaps with the three pillars of VISION 2020: Human Resource Development, Infrastructure Development (including equipment and supplies) and Service Delivery. The variability of these components in any community defines how services are delivered and how they affect the prevalence of blindness and visual impairment (VI). Though health system strengthening is considered a priority, there are very few organisations in the world which have successfully demonstrated it. There are exceptions, of course, and the following three organisations have successfully adopted some common principles to strengthen their health systems and ensure maximum efficiency and results.
Human resource has been a challenge to all these organisations but was overcome by having a concept of Eye Care Team and task sharing
The C L Gupta Eye Institute, India
The C L Gupta Eye Institute (CLGEI) is located in a hugely under-served and highly populated state of Uttar Pradesh, India. Founded in 2009, it is now a self-sustaining eye care delivery model. Begun as a philanthropic foundation, it was soon joined by Dr Ashi Khurana, a local practitioner who then partnered with the L V Prasad Eye Institute to create a world-class eye institute.
Figure 1: CL Gupta Eye Institute surgery chart
Visualiza Eye Care System, Guatemala
Visualiza Eye Care System (Visualiza) has been transformed from a small, private facility in 2002 to a regionally renown, three-hospital training and service delivery eye care organisation. The transformation was inspired when, in 2004, Dr Yees travelled to Aravind Eye Care System in India. This visit, and subsequent exposure and training sessions, were instrumental in Visualiza staff and leadership teams being able to implement decisive and rapid changes.
Figure 2: Visualiza Eye Care surgery chart
Distribution of Visualiza Eye Care centres in Central America
Lions SightFirst Eye Hospital, Kenya
Founded in 1997 thanks to the initiative and involvement of the local and international Lions Clubs fraternity, Lions SightFirst Eye Hospital in Nairobi owes its existence to the vision of this global leader in community service. Much of the credit for its success, though, goes to the governance of the board of trustees as well as the operational leadership of the Medical Officer and the Manager.
Human resource has been a challenge for all of these organisations, but was overcome by having a concept of Eye Care Team and task sharing, along with having an Ophthalmologist leading the team. In CLGEI and Visualiza, it was the initiative of the local Ophthalmologist whereas, in Lions SightFirst Eye Hospital, the Ophthalmologist issue was overcome by employing expatriates. Apart from that, other staff (Nurses, Technicians, Managers etc.) were selected locally and trained in reputable institutes across the globe. Over a period of time, they have built up their internal capacity for training, thus ensuring an adequate and stable work force with ongoing internal training, thereby sustaining and growing the services of their organisation. CLGEI had sub-speciality services since inception, and has even started sub-speciality training too. The Lions SightFirst Hospital is in the process of developing sub-speciality services as well. Furthermore, CLGEI has hosted more than 22 workshops and Continuing Medical Education (CME) programmes, including two national conferences.
In terms of service delivery, all these organisations have systems to provide comprehensive eye care, and have shown exponential growth in their patient load over a period of time, as shown in Figures 1, 2 and 3.
Figure 3: Lions SightFirst Hospital surgery chart
Procurement of consumables was an issue, especially in Africa, and the Lions SightFirst Eye Hospital closely monitors inventory levels on a weekly basis, ensuring it has a buffer of four to five months inventory.
Despite providing free services to 20-40% of the population, all these organisations are financially sustainable. This is achieved by having a multi-tier paying system. This price spectrum is structured in a way to make the services affordable for those in the middle- and higher-income groups and for some in the lower-income groups. The CLGEI achieved this financial sustainability just six months after its inception.
Despite providing free services to 20-40% of the population, all these organisations are financially sustainable
Funding through donation
The Lions SightFirst Eye Hospital is able to meet almost 80% of operating expenses, with the remaining 20% coming essentially from a broad-based pool of local donors cultivated over time by the hospital. For the capital expenses relating to building or high-cost equipment, all these organisations raise money through grants and large donors. Looking at their commitment to community eye care, they also have support from various International Non-Governmental Organisations (INGOs). Visualiza has also started supporting similar clinics to develop throughout Latin America and assists other under-performing eye care institutions in the region to undergo the same transformation. CLGEI has also initiated this process of supporting hospitals in its region too.
The secrets of their success
In summary, some of the common traits for these three organisations include commitment and value-driven leadership, well-trained human resources and their retention, high-volume and high-quality service delivery, multi-tier payment systems for achieving financial sustainability and openness to national and international collaboration. The comprehensive manner in which all these organisations have organised themselves over time, across all aspects of health systems has been the foundation for their stability and sustained growth.
Acknowledgement: The highlight on Visualiza was adapted from a case prepared and summarized by Scott Burg. We would also like to acknowledge Dr Ashi Khurana, Vice Chairman, C L Gupta Eye Institute, and Juan Francisco Yee of Visualiza for providing the information for this section.