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EDITORIAL
Year : 1996  |  Volume : 44  |  Issue : 3  |  Page : 129

Self sustainability in eye care


India

Correspondence Address:
Gullapalli N Rao
India

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Source of Support: None, Conflict of Interest: None


PMID: 9018989

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How to cite this article:
Rao GN. Self sustainability in eye care. Indian J Ophthalmol 1996;44:129

How to cite this URL:
Rao GN. Self sustainability in eye care. Indian J Ophthalmol [serial online] 1996 [cited 2019 Dec 14];44:129. Available from: http://www.ijo.in/text.asp?1996/44/3/129/24572

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 underprivileged 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.

Self sustinance of eye care projects has, therefore, become a much debated subject in the context of all developing countries. It is now almost universally accepted that eye care services to all people cannot be provided at no cost and that certain strategies of cost recovery have to be implemented. There are many examples in India demonstrating the value of multi-tier system of cost recovery that simultaneously covers free care to a very large percentage of people. Some state governments such as Andhra Pradesh are seriously contemplating to adapt similar strategies in their hospitals. This realisation on the part of the governments both at the central and state level is a welcome development that augurs well for the future of health care in India.

While cost recovery is an obvious method of resource generation, there is a great need for other innovative approaches to meet the substantial demand for non-paying services. The model of social welfare now practiced in Industrialised nations may not be applicable to developing countries. Although health insurance is gaining popularity, it is limited only to the employees of large corporations at the present time. Newer strategies may be tried with pilot projects in some parts of the country. One method that is being tried by the rural eye centres associated with L.V.Prasad Eye Institute is a low cost insurance programme. This programme envisages a charge of one rupee per month per person for eye care insurance, The study involves adoption of a 500,000 population for each rural eye centre. At the rate of one rupee per person, this will yield a revenue of Rs. 500,000 per month or Rs. 6.0 million per year. Since the approximate number of surgeries required for this size population is 2000 annually, this will translate to an income of about Rs. 3000 per procedure. In this model, the cost of running these centres performing about 2000 surgical procedures is around 2.0 million per year (all cataract surgeries performed with intraocular lens implantation), This clearly shows the potential to generate funds adequate to cover not only operational expenses but also capital requirements. The implementation of this programme is fraught with certain difficulties but can be accomplished with necessary planning. This is only one concept that is being experimented and many other models can perhaps be tried,

Another unexplored area is mobilisation of local support through philanthropy, Every part of the country has potential to raise resources provided a systematic approach is undertaken. While international support, both as grants and loans has made a major contribution in combating blindness in India, every effort should be made to slowly wean away from reliance on external sources.

Self-sustenance is also dependant on cost containment, This is another area of considerable weakness in our health care system. Lack of necessary managerial infrastructure is a major contributory factor for this problem. Streamlining of all procedures goes a long way in containing costs. The methodology for optimal utilisation of available resources need to be explored. Longer working days with multiple shifts may be needed to justify the high cost of infrastructure in some instances. This strategy is already being employed in the west with success.

Ultimately, the viability of any eye care facility revolves around giving high quality service combined with institution of appropriate cost recovery and cost containment strategies.




 

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