'Private healthcare augmenting public health'

Keerti Bhusan Pradhan- keerti@righttosightindia.org

Overview

Setting the Context The Intervention Results Lessons Learned

Insights into Healthcare in Africa

Health care in sub-Saharan Africa centers primarily on government activity, but the private sector plays a surprisingly significant and growing role in meeting the region's health care needs.

International Research findings show that $20 billion of additional investment in the region's private-sector health care infrastructure is needed in the coming decade to improve the woefully poor health outcomes.

Challenges are many Inconsistent quality of care Health worker shortages Inadequate regulation to be addressed if the private sector is to most

effectively benefit the health of Africa's people

The Cost of Global Blindness

Research by Frick and Foster estimated the cost of global blindness and low vision at $42 billion in 2000.

Without a decrease in the prevalence of blindness and low vision, it was projected that the total annual costs would rise to $110 billion by 2020.

However, if avoidable blindness is eliminated, this will be reduced to only $57 billion in 2020.

This equates to overall global savings of US$223 billion over 20 years.

The Need

37 million blind worldwide

9 million in Africa with preventable blindness

50-75% due to cataract

5% due to glaucoma

6

Preventable Blindness: A Cataract Operation

The average cost of operation

is only £20

A cataract can be Removed in only

10 minutes

Over 50% of preventable

Blindness due to Cataract*

c60% of children in poor countries

die < 1 year of becoming

blind

Over 25 millionwith preventableBlindness in poor

countries

“Cataract surgery is one of the most cost-effective treatments that can be offered in developing countries. It can allow people to increase their economic productivity by up to

1500% of the cost of the surgery during the first post-operative year”. WHO

* Other causes include untreated refraction, alien bodies, trachoma

Right to Sight (RTS) mission is to eradicate the global crisis of preventable blindness through the use of proven, leading edge techniques in cost recovery, training and surgical practice.

RTS supports to facilitate capacity building through training and consultancy for development of the eye hospital through a Private-Private-Partnership Project.

Right to Sight works in partnership with Shalina Group to facilitate the planning of the clinic, focussing on training & capacity-building moving to sustainability.

•The Aravind Eye Care System is the largest eye care provider in the world with a renowned service delivery model, a facility for manufacturing high quality ophthalmic products at low cost – Aurolab and an institute for teaching and training – LAICO.

•AECS and LAICO (Lions Aravind Institute of Community Ophthalmology), work in partnership with Shalina Group to provide cutting-edge clinical / non-clinical training and comprehensive eye hospital planning.

Shalina Laboratories, a multi-million dollar pharmaceutical company in DRC with a good understanding of the local context and strong social responsibility.

Shalina Health Care and Shalina Foundation plan for an Eye Hospital in Lubumbashi. Project conceptualized in March 2007 when RTS & AECS representatives visited Lubumbashi to discuss eye care in the region.

With existing available space, it is decided the Eye Clinic can have approx. 3500 sq.ft. and 25 Beds initially

Tripartite Tripartite Partnership ModelPartnership Model

International NGOPrivate Not for Profit

NGO & Consulting Partner

Private Not for Profit Consultancy Firm

Private BusinessFirm

Private for Profit

Private Private Partnership

Process

Needs Assessment VisitMarch 2007

Training and Capacity Building

Project Implementation Hospital Inauguration Dec 8, 2007

Vision Building and Strategic Planning Nov 10-12, 2007

Affordable and Sustainable Eye Care Services in Katanga Province-DRC

Services Price Policy

Outpatient Services

Registration Fee $1 Valid for One Year

Examination Fee / Review $2 Valid for 30 Days / Any number of visits

Investigations $2

Laboratory Charges $10-30

Spectacle $20 to$100

Surgical Services

Phaco with Acrylic / Alcon Lens $550

Phaco with Aurofoldable Lens $300

SICS with Rigid Lens $200

SICS with Rigid Lens (Subsidized Fee) $30 Subsidized for Patients who cannot afford

Other Surgeries (DCT, DCR, I&C) $30-$50

Accommodation ( Room Rent)

Private Wards $25 Per Day (Not charged)

Free Wards $0 Room rent is included in the Surgical Charges

Achievements

More than 35,000 Outpatients seen in the first year of operations (Dec.07-Nov.’08)

Surgeries in the first year of operations-2000 Capacity building of local Congolese staff happening

simultaneously through osmosis/transfer of skills from expats to locals.

HR: 5 expats to 30 Congolese. (1:6) SEC operational expenses broke-even by the end of first

year

Steady stream of patients in Outpatient Department

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Lessons Learnt Clarity and Dissemination of vision, goals and objectives, sustainability initiatives for Eye Care

Institutions should be the criteria in Private-Private Partnership eye care model in Africa.

Operational ownership of Eye hospitals by the partners is vital to make a successful eye care venture in Africa.

Proof of Private-Private partnership model to be evaluated for learning in the African context and replicated in phases with a Vision to Eliminate Needless Blindness by 2020.

Future Plans Shalina has a vision and plan to expand this Private-Private partnership model of Eye care delivery to

18 African countries with six centers planned in DR Congo in phases.

Based on the success of this model Right to Sight in partnership with Shalina Group and with other Private partners will roll out more such eye care facilities in Africa to eliminate needless blindness by 2020.

This pilot would provide road map for many private partnerships to have eye care services in Africa leading towards the goal of eliminating avoidable blindness by 2020.