Health innovations

How inclusive business models are making health accessible for all

Eye care for all: Providing eye care for all levels of the economic pyramid in India

Eye care for all: Providing eye care for all levels of the economic pyramid in India

Interview with Kiran Anandampillai, CEO and Founder, iDrishti

iDrishti eye hospitals is a social impact enterprise that provides high quality affordable eye care across several districts of Karnataka, India. iDrishti's mission is to ensure every person across a district can get access to high quality eye care.

Can you tell us how your healthcare model works? You have different elements: hospitals, mobile clinics and telemedicine.

When we started, the idea was to go to populations that still had a lack of eyecare. The state we operate in, Karnataka, has more than 30 districts. Usually, one district is between a million to 1.5 million people in India. The district capital usually has 100,000 to 300,000 people, and most of the population is spread out across the districts. So the question became, how can we actually reach these people and ensure that there is that pathway for eyecare? The way we do it is we establish a secondary care center in the district capital, the eye hospital, which has surgical facilities and ophthalmologists. In smaller towns, we have a real time tele-ophthalmology setup at fixed vision centres to provide access to an ophthalmologist. And then we have designed a special vehicle called a mobile clinic that we are able to send to the villages for care.

With the mobile clinic, we can treat and even dispense glasses right to the village, but for people who require surgical interventions, we try to get them to come to the district hospital. Either they come back on the same vehicle or they use their own transport. That's really how the model works.

I would like to show you a few photographs of our hospitals. We really build very high class infrastructure in the district capital. 

eye hospital facilities
© iDrishti

This is our tele consultation or the telemedicine.

teleconsultation of an eye doctor
© iDrishti

For towns where you can't find a doctor, we have a whole technology based approach where we can make sure that a remote doctor is able to actually see what's going on in your eye and then make a prescription.

And this is our mobile clinic. 

mobile eye clinic: an open bus
© iDrishti

You can see when it pulls into the village, little benches can pull out of the side. People can wait with a little canopy, we have a solar panel on the top, so we can get power for all of our equipment. And then you have two refraction stations inside, and a little optical store also inside where you can choose your glasses. And then we have a counseling area where people who request surgery are counseled, and then it's also a transport vehicle to bring people back if they need to come to the hospital.

So these mobile eye clinics are quite large, and you sell eyeglasses as well.

We have slightly different models depending on the part of the economic pyramid that we are targeting. If we have a sponsor we give the glasses away for free. For example, Essilor Vision Foundation used to sponsor us to give away glasses in certain regions. If there is no sponsor, then we price the glasses. Reading glasses are priced at about 200 Indian rupees, or about two and a half dollars. 

And then for prescription glasses, it's now at about 500 rupees, which is about 7 to 8 dollars. We collect the prescription during the visit to the village and we deliver it seven days later.

How do you make your prescription services and your eye care affordable for your low income patients while still making a profit?

We have a philosophy of allowing patients to have choice. The intent is to make sure that we have products that can service any layer of the economic pyramid. The products I spoke to you about are our lowest cost products and they have the lowest margins also, but it's very important to us to have a mix. Even within a village, you have a small economic pyramid. There are people who are slightly better off. And so, we allow consumers to pick and we make sure that there's a choice. So there is a choice at about $20, which has a higher margin for us. And there is a choice at $10 and there's a choice at $8 and so on. It’s like you going and buying a bottle of wine. You will decide what bottle you want. You will make the choice based on your economic level.

You mentioned that you make products at a variety of prices for different incomes. Which kind of populations and income segments mostly use your services?

We are a social impact company. Our belief is that there is an economic pyramid there in the district, so there are several people in the population who can afford to pay for quality service. So our infrastructure and our outreach is actually targeted to make sure that the affluent and the middle class chooses us as the primary provider of care. Our services are not very different from what they would get if they went to a bigger city. This allows us to then reuse the same infrastructure to essentially target the bottom of the pyramid at a very different price point, because now I have to focus only on what we call the marginal cost of care. So, for example, for a surgery, if the cost of my doctors are covered, if the cost of my rent is covered, then all I need to worry about is the cost of the surgical consumables that are used; what's the cost of the implant that went into the eye? Therefore I'm able to bring the price of a surgery down for the bottom of the pyramid. The average price that the affluent class pays for an eye surgery is in the range of about 25,000 Indian rupees. But for the bottom of the pyramid, we price it at 3,000 to 5,000 Indian rupees, but then we don't provide this to everyone. We make sure that we are selecting through our outreach programs who's eligible for these low cost products, because we also want a certain level of confidence that we are really targeting our efforts towards the bottom.

How does technology help you with providing these services?  If there are people in villages who don't necessarily have access to internet, how much of a challenge is that for you?

Our care is very physical. We use technology in what we call an assisted fashion. When you think of a vision center, it's a physical center, which is in a location that does not have an eye doctor or an ophthalmologist. It is operated by paramedical staff. So when you walk into the center, we have a protocol that requires a lot of technology as part of the protocol, to make sure that we are able to correctly capture and relay your problem. Technology helps us capture that and relay that to the remote doctor, and then get a prescription back.

You have teamed up with Essilor on vision screening programs in schools. What are the benefits of partnerships for your business?

Yes. Our objective as an organization is to bring high quality eye care to almost everyone. In spite of our pricing approach, we find that we are not able to cover everyone, because there are still people who can't afford our affordable products. This is where we think philanthropy should step in, and this is one of the reasons why we partner with organizations like Essilor Vision Foundation. In fact, with Essilor Vision Foundation, we recently completed a very large activity where we decided to screen everybody who lives in one subdistrict, almost 300,000 people. We visited door to door and we screened at home to identify people who had vision issues. And then those who had vision issues, we would invite them to come to a nearby event that we were organizing with our mobile eye clinic. If they required further intervention, we would then direct them to our hospital. We did the whole thing for free to the patient, but with support from the Vision Foundation. So we really value some of these philanthropic partnerships that we do to help us reach that portion that cannot be served through a financial based model.

When you actually screened an entire district, what did you find in terms of the percentages of people with vision problems?

Almost 24 per cent required some form of eyecare. Eighteen per cent required just glasses. But then others required either surgical interventions or care. India, as you might know, is also the diabetes capital of the world, and we are starting to find that the back portion of the eye, which is called the retina, is starting to be affected by a lot of people who also have uncontrolled diabetes. We are also seeing an increased problem in children. I think largely because of use of devices now, myopia is going up. We have seen an increase over the years, it used to be about four to five per cent when we started our school screening programs, and now it's up to about seven or eight per cent in many areas where there is an increased device use. So, a fairly large percentage of the population does require eye care.

Are you planning to expand?

We are. We are a growing organization. Currently we cover about 10 districts in the state of Karnataka and we are hopeful that in the next few years we can cover all the districts of Karnataka. That is our first objective, before we decide whether we want to move to other states in Karnataka or other states of India.

Kiran Anandampillai

Kiran Anandampillai dedicates his time to driving impact in healthcare. He is the founder and CEO of iDrishti, which delivers high quality eyecare from a district capital to the village level. iDrishti currently manages 12 eye hospitals across Karnataka, India.

Also, he is currently the Advisor - Technology at the National Health Authority (NHA). He supports NHA to create digital public goods under India’s two large digital health initiatives – The Ayushman Bharath Digital Mission (ABDM) and Ayushman Bharath (PMJAY). He is a telecom engineer by training and was a founding member of OnMobile, where he helped build it to become a public company. He was a volunteer with UIDAI for the Aadhaar program and is currently a volunteer with the iSPIRT foundation where he works on the Health Stack.


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