Optical Services as a Critical Component of Eye Care and Sustainability

IEF

R Rahmathullah, J Barrows, W Shields, V Sheffield THE INTERNATIONAL EYE FOUNDATION

www.iefusa.org

AIM

► Importance of opticals to sustainable ophthalmic services ► Options to establish optical services ► ► IEF ► Planning process Results to be expected Critical considerations www.iefusa.org

BACKGROUND

► RE services not serving all populations ► Patients inconvenienced by going to another location to get glasses made ► IEF ► Ophthalmology not taking advantage of optometry services Lost revenues to ophthalmology www.iefusa.org

SETTING

► IEF SightReach® Management experience developing comprehensive and financially sustainable eye care services ► ► IEF ► Transitioning private sector to include social service and government sector to be business like NGO role: invest in services serving all populations and create capacity for financial sustainability Optical services integral to model www.iefusa.org

GOALS

► ► Address large population with uncorrected refractive error Make services accessible, affordable, and convenient ► ► IEF ► Ensure high quality – new spectacles, not used spectacles Ensure financial sustainability Provide percent of profit to “Sustainability Fund” www.iefusa.org

Critical Questions - before you start!

IEF ► ► ► ► ► Integrate optometry into ophthalmology?

Private business to raise funds?

For what purpose(s)?

 Support ophthalmology?

 Subsidize services?

  Expand/replicate services?

Provide training opportunities?

 Support outreach services?

Short or long term involvement?

What is the exit strategy?

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PHASES – for setting up optical service

► Planning – 2-3 months  Assessment of capacity, commitment, leadership, market potential ► Procurement – 3-4 months  Equipment, furniture, personnel ► Implementation – 6-18 months IEF ►  NGO Exit  Open the doors for business Monitoring for quality, management, revenue www.iefusa.org

PLANNING PHASE

► Pre-assessment  Determine capacity, willingness, leadership, policies, market feasibility ► Establish agreements  Roles of stakeholders IEF ►    Who “owns” the business?

Inputs required Evaluate commitment Commit time required to achieve defined result www.iefusa.org

BUSINESS PLAN

► Define services  Market - patient population  Pricing strategy – cost vs. price; how much mark up to achieve purpose ► ► ► IEF ► Emphasize quality  Durable/ attractive inventory; convenience; range of offerings; customer service; pricing Evaluate environment  Who/ what is the “competition”  Policies – optometry, taxes, customs Model financial return/break even point Identify inputs needed and budget www.iefusa.org

PROCUREMENT PHASE

1 Optometrist 2 Opticians 2 Sales People-also fit spectacles ► Personnel needed  Optometrist, who does refraction?

 Sales, workshop, accounting, security staff ► Facility set up  IEF ►    Location, accessibility, visibility Refraction, sales, workshop?

Procure equipment, inventory Appropriate equipment How much inventory to have on hand?

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COORDINATED IMPLEMENTATION

  IEF  ► Management structure  Establish clear lines of authority, accountability, transparency Staff policies Accounting procedures and policies Procurement procedures and policies www.iefusa.org

EXIT PHASE

► Monitor management ► Monitor quality ► Monitor procurement ► IEF ► Monitor growth in patient services Monitor revenue generation www.iefusa.org

IEF OPTICAL SERVICES MODEL

► 7 Opticals in 12 hospitals in Africa, India, Latin America - different approaches: ► Improve existing services: Guatemala, India (1), Honduras  Eye unit takes ownership vs. consignment   IEF ► Start from scratch: Malawi (2), India (1)  Increase equipment, inventory and staff Identify space Follow phases of planning, procurement, implementation www.iefusa.org

COST IEF Model

► Optical shop with workshop: equipment, stock, supplies, furniture only - $40,00-$50,000 US IEF ► 1-2 year period of IEF planning, site visits, technical assistance, monitoring, etc. – average $20,000 US www.iefusa.org

60000 40000

IEF

20000 0 140000 120000 100000 80000 2006

Blantyre Penya Optical

Financial 2005 Revenue Expenditure Hospital acct Equity Stock

► ► ► ► ► 20,240 examined, 8,109 refracted 52% female, 7% children 40 average refractions per day 25 average pair glasses per day Contribute 15% of monthly gross sales revenue to hospital sustainability fund

IEF 100,000 200,000 300,000 600,000 500,000 400,000 US $ 900,000

Percent contribution optical revenue of all revenue

800,000 700,000 Malaw i 88% El Salvador 18% India GNRC 12% Guatemala 30% Patients Optical

IEF

Percent contribution optical revenue of all revenue

Blantyre – LSFEU/ Penya Optical India – Gomabai N&RC India – Vision Centers Guatemala – Visualiza (2 units) El Salvador ClaraVision Optical Patients Optical Patients Optical Patients Optical Patients Optical Patients 88% 12% 12% 88% 86% 14% 30% 70% 18% 82% $127,176 $17,968 $51,422 $373,440 $10,515 $1,669 $255,355 $599,507 $48,534 $220,412

CHALLENGES

► Procurement process   Supplier relationships; burdensome foreign exchange process Burdensome customs policies and procedures  Devaluation IEF ► ► Transfer of profits  Affordable pricing in crowded market  Robbing Peter to pay Paul Affordable vs. free www.iefusa.org

WHY THIS MODEL?

► Why hire an optometrist?

  Capture patients not coming through eye clinic Ophthalmic staff dedicated to treatment and surgery ► Why 2 sales and 2 technicians?

 IEF  Optical Service should be large enough to handle an increasing volume, be financially sustainable, and earn profit for eye unit’s sustainability fund ► Why have a workshop on site?

For patient convenience and rapid fulfillment of prescriptions www.iefusa.org

CONCLUSIONS

► Clear purpose is critical ► Run as a business ► Commitment essential ► Need to manage agreements ► IEF ► Attention to quality is critical Continuous management required www.iefusa.org

►

ACKNOWLEDGEMENTS

MALAWI (Lilongwe): Drs. Moses Chirambo, Joseph Msosa, and optometrist Kiran Kumar.

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MALAWI (Blantyre): Drs. Gerald Msukwa, Khumba Kalua, Nkume Batumba, and optometrist Navin Kumar.

►

INDIA (GNRC): Mr. S. Parawal

►

INDIA (Theni Vision Centers): Dr. P. Namperumalsamy, Mrs. Preethi Pradhan, and Mr. R.D. Thulasiraj

► ► IEF ►

GUATEMALA: Drs. Mariano Yee, Nicolas Yee, Mr. Juan Francisco Yee, and optometrist Dr. Kim Yee EL SALVADOR: Drs. Juan Miguel Posada Fratti, Julio Caballero, and Mrs. Ena de Posada HONDURAS: Dr. Juan Odeh-Nasrala, Mr. Rene Arturo Lopez Torres, and Mrs. Odeh-Nasrala