Updated Mar 05, 2020

High-volume cataract surgery & training model as the cornerstone to strengthening national systems of eye care

http://www.cureblindness.org

Julie Bond

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Stage 5: Scaling

Registered in United Statesin United States

Focus Areas:

Technical and Vocational Education and Training (TVET), Non-communicable Diseases, Vision and 1 MoreSEE ALL

Technical and Vocational Education and Training (TVET), Non-communicable Diseases, Vision and Health SystemsSEE LESS

Implemented In:

Bhutan, Nepal, Ethiopia and 3 MoreSEE ALL

Bhutan, Nepal, Ethiopia, India, Ghana and South SudanSEE LESS

6
Countries Implemented In
923,050
Customers
25
Employees
$89,225,740
Funds Raised to Date

Problem

Avoidable blindness is a global epidemic with tragic consequences and identifiable solutions. Thirty-six million people are blind worldwide, another 246 million struggle with low vision. Yet 80% of this burden is treatable or preventable. Ninety percent of the afflicted live in low- to middle-income countries with an estimated 60% of blindness experienced by women. The tragedy of inadequate eye care reverberates throughout a society: lives are shortened, dependency is created both to family and the state, communities are robbed of laborers, and children are denied an education. In these economies, lost productivity from blindness causes $49 billion annual loss. Blindness was not included in the UN Millennium Development Goals, leading to inadequate global focus and insufficient capital investment. Globally, cataracts are the leading cause of blindness, where they contribute to this endemic cycle of poverty. The global backlog of cataract blindness is at risk for increasing due to lack of funds, aging populations, a severe shortage of ophthalmologists, barriers to access, and low-quality care, stunting development of eyecare systems in low-income nations. However, cataract surgery is one of the most cost-effective health interventions in medicine -- comparable to immunizations for immediate and permanent impact. With a material cost of $25, cataract surgery can restore sight and life to a blind person in 10 minutes. This is not a temporary fix – it is a permanent cure. Few medical interventions exist that have as immediate, enduring, and transformative an impact.

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Solution

HCP|CureBlindness’ solution to reversing avoidable blindness uses the elimination of cataracts as the cornerstone to strengthening national eyecare. We are presently accelerating the expansion of our community- and systems-based approach to training, equipping and providing sight-restoring surgery. It combines a low-cost, low-tech, high-volume surgical method with a multi-tiered training approach for all levels of ophthalmic personnel, focusing on high-volume surgical exposure. Addressing traditional barriers (personnel shortages, volume and quality of care), we are scaling across distinct geopolitical and national systems - private (i.e., Nepal), public (i.e, Ethiopia) and public-private (i.e., Ghana, India) so we ensure solutions are replicable in any country context. High-volume, high-quality surgery creates synergies necessary for scale, lowering cost per surgery and allowing high-yield, mentor-based skills transfer to occur concurrently at all levels. In this way, volume drives capacity development and quality, while increasing economic efficiency. Financially viable and self-sustaining healthcare must be anchored around centers of excellence (COE) that provide the highest standard of clinical care and training, while also generating revenues essential for growth. For example, our flagship partner, Tilganga Institute of Ophthalmology in Nepal, generates profits from patient care, intraocular lens manufacturing, and its refractive surgery center. These profits are reinvested in training capacity and hospital expansion while also subsidizing charitable care. Quality cataract surgery, with premium options for paying patients, drives demand and cost recovery. The unique marriage of high-volume, low-cost systems with profit structures that subsidize care for the poor is the foundation for the compassionate capitalism model. HCP|CureBlindness’ South Asian partner institutions train visiting personnel who then become trainers in their home countries. Indeed, ophthalmologists who trained under programs at these Nepali and Indian institutions now direct residency programs in Ethiopia and Ghana. Training at scale also occurs in-country. Surgical teams from the USA, India and Nepal provide exposure training and direct skills transfer at both hospital-based workshops and high-volume surgical outreaches. HCP|CureBlindness has grown steadily since the 1990s, increasing our investment in targeted, strategic growth. Our decentralized operating model minimizes administrative overhead and efficiently focuses resources on program activities. Since 2016, our partner networks have grown by 91% in Ethiopia, 225% in Ghana, and 13% in Nepal. Surgical volumes have risen by 19.8% and training by 69%. Further investment is critical to the revolutionary scale of our goals. Studies have shown a 400% return on every dollar invested in eliminating blindness. With further investment, we can reach a tipping point where low- and middle-income countries can address the vision problems of their citizens and serve as leaders for others.

Target Beneficiaries

While cataracts affect predominantly older populations, often 50 and older, HCP|CureBlindness provides sight-restoring surgery to people across the entire age spectrum. This is the case in the countries in which we work because cataracts can affect people at younger ages, due to trauma, genetics, nutrition, exposure to smoke, exposure to UV rays, and lack of early detection. HCP|CureBlindness also trains clinicians across multiple ophthalmic subspecialties (pediatric ophthalmology, oculoplastics, glaucoma, retina, refractive surgery, cornea, etc.) and thus our partners also provide comprehensive eyecare to people across the entire age spectrum beyond the provision of cataract surgery. HCP|CureBlindness and its partners provide care regardless of gender, age, politics, religion, ability to pay, etc. We serve populations in some of the most remote and difficult-to-reach locations in the world. Many populations are considered minorities or experience cultural or religious persecution. Some studies indicate that blindness affects 60% women in low- to middle-income countries. While this information is inconclusive at this time, HCP|CureBlindness and its partners strive to ensure equal access and care across gender, monitoring service trends through our data analysis.

Innovation Description

HCP|CureBlindness’ innovation to reversing avoidable blindness uses the elimination of cataracts as the cornerstone of national eyecare strengthening. It is a grassroots, community-based model that combines a low-cost, low-tech, high-volume surgical method with a multi-tiered training approach for all levels of ophthalmic personnel, focusing on high-volume surgical exposure. In our lean, efficient model, surgical teams can perform over 1,000-1,500 surgeries in one week, while simultaneously teaching the next generation of surgeons, nurses, and technicians through high-volume exposure. With clinical and surgical exposure comes higher quality care, which drives patient demand. Highly-skilled clinicians often seek more advanced, specialized training. HCP|CureBlindness also supports subspecialty training and the development of ophthalmic residency programs to grow each country’s clinical eyecare foundation. This action-based approach to national eyecare development from the ground-up builds local leadership and empowerment. Our model has proven successful in countries with varied geographies and political and national healthcare systems, demonstrating clinical outcomes rivaling the West at a fraction of the cost. HCP|CureBlindness began its work in 1994 in Nepal, where alongside our sister institution, Tilganga Institute of Ophthalmology, we helped one of the poorest countries in Asia reverse its rate of blindness. Over 10 years, the prevalence of blindness fell by 58% with a 1,900% increase in cataract surgeries and Nepalese ophthalmologists are among the world’s finest. These efforts yielded a sustainable and replicable solution for eradicating cataract blindness: our innovations in surgical technique, supply chains, and delivery systems enable this high-volume, high-quality cataract surgery at material costs of $25. We have made enormous strides in replicating this model in South Asia and Sub-Saharan Africa, with a thriving network of well-positioned and capable partners. Together HCP|CureBlindness and its partners have: screened 11,101,500 individuals performed 970,596 sight-restoring surgeries trained 18,000 eye care professionals (552 ophthalmologists) from 43 countries established 3 dedicated eye hospitals/training institutes

Milestone

Date Unknown
New Country Implemented In
South Sudan
Date Unknown
New Country Implemented In
Ghana
Date Unknown
New Country Implemented In
Ethiopia
Date Unknown
New Country Implemented In
Nepal
Date Unknown
New Country Implemented In
Bhutan

Supporting Materials

HCP-AnnualReport-2018-Digital-orientation-null.pdf