The Community Eye Hospital Model
Each Community Eye Hospital is based on a 3-4 floor building plan (1000 sq meters) and treats between 30,000-40,000 patients per year, at site. Hospitals use effective and robust medical equipment, which has been tried and tested for use in low-resource settings.
A CEH is, typically, staffed by 20-25 persons, including two to three ophthalmologists. Core services on offer are as follows:
- Cataract surgery, using SICS and phacoemulsification techniques
- Glaucoma treatment
- Diabetic retinapathy treatment
- Refractive error treatment
- Minor surgeries (pterygium, etc.)
- Non-invasive treatment (conjunctivitis, other minor eye ailments)
Hospitals also provide Outreach Microsurgical Eye Clinics (OMECs), delivering the above services to rural communities, and treating an additional 5,000-10,000 patients a year. OMECs are followed up by site visits a month later to ensure a high-level of post-operative/treatment care. OMECs are conducted according to guided standard operating procedures for screening, diagnosis, surgery, and post-operative care.
Affordable, Sustainable, Effective and Replicable/Scalable
The CEH business model has been customized to provide affordable services at a high volume. In particular, Dr Ruit and his team at Tilganga have refined the delivery of eye care in low-resource settings.
In most developed countries, cataracts are removed using phacoemulsification techniques. These involve the use of a high-frequency ultrasound device to breaks up the cataract, before its removal, and replace it with a new, clear intraocular lens.
SICS, by contrast, is less complicated and, consequently, it is considerably cheaper than phacoemulsification. A small incision is made in the eye and the lens removed manually. The technique requires less complex equipment and surgeons can be trained more quickly in it. It is also very well suited to high volume, and is much quicker to execute than phacoemulsification techniques. The ability of Community Eye Hospitals to provide high volume services is crucial as there are large backlogs of cases in each proposed location.
CEH utilize the profits gained by paying patients to subsidize/pay for the treatment of poor patients and ensures hospitals’ financial independence. In established hospitals, the income generated by premium patients (approximately 15 per cent of total), is used to subsidize economy patients (39 per cent) and cover the costs of non-fee paying patients (47 per cent).
SICS is virtually as effective as phacoemulsification techniques. A 2013 review (Cochrane) of 108 randomized trials found both comparable in terms of visual acuity outcomes and complications.
Replicable and Scalable
The CEH model has already been successfully replicated and exported. Dr Ruit and his team have established hospitals in Kalimpong (India), Lhasa (China) and Hetauda (Nepal). Each new hospital has been established with minimal cost, has been highly effective and gained financial independence.
As part of The Ruit Foundation’s commitment to sustainability and capacity building, Community Eye Hospitals also serve as centres for training local ophthalmologists. Hospitals train ophthalmologists in the operational procedures required to perform all treatments (SICS, phacoemulsification, pterygium graft, glaucoma, retina, ocuplasty, keratoplasty). Hospitals also serve as models of best practice, and provide training to other local eye care professionals. The model of best practice offered extends beyond the provision of services. The CEH business model is a beacon for other national and regional eye-care services, exemplifying an affordable and sustainable approach, with the potential for replication.