Table 4 T-HOPE framework: comparision of eye care programs (two programs)

Overview

Program Eye Care 1 is a for-profit program that provides eye care services and specializes in cataract surgeries using a high-volume, low-cost approach. It operates several vision centers, a surgical hub, and provides outreach activities in the national capital.

Program Eye Care 2 is a not-for-profit rural hospital that focuses on performing high-volume, low-cost eye surgeries in the country. The hospital is located in one major city, with a satellite facility in a second city.

Population Coverage (A1)

Program Eye Care 2 has 80 % market share for its operations compared to 2.5 % for Program Eye Care 1.

In 2012, the program’s market share was estimated at 2.5 % in the urban part of the country.

In 2011, the program had approximately 80 % of the market share within its catchment area.

Health Output (A2)

Program Eye Care 2 provides more than 30 times as many eye surgeries a year as Program Eye Care 1.

5,400 cataract surgeries were performed from 2010–2012.

95,243 surgeries were performed from 2010–2011.

Affordability (B1)

Both programs are providing eye surgeries that are much lower in cost and performed more efficiently than their private and public competitors. Indeed, both programs provide surgeries that are approximately half the cost of similar services in the local context.

As of 2013, cataract surgeries cost approximately US$465, half the national average of US$1240.

The cost of cataract surgery is US$33 for a middle class patient compared to around US$50–US$60 in bigger cities.

Pro-Poor Targeting (B3)

Both programs focus on serving the poor, although a higher proportion of Program Eye Care 1’s patients are from an economically disadvantaged group.

85 % of patients treated are living at the bottom of the pyramid.

The program focuses on serving impoverished, rural communities. Over 50 % of the services it delivers are free or subsidized for poor patients.

Clinical Quality (C1)

Both have surpassed the WHO’s recommended guidelines for visual acuity after cataract surgery, suggesting quality is high.

While 53 % of patients had visual acuity less than 20/200 before surgery, 87 % ended up with best corrected visual acuity (BCVA) greater than 20/60 (equivalent to the WHO benchmark of 6/18).

From 2007–2008, 81 % of patients receiving small incision cataract surgery operations had BCVA <3/60 (blinding cataract) before surgery; BCVA at 6 weeks after operation was ≥6/18 in 87 % of operated eyes. (The WHO recommends that after cataract surgery, at least 85 % of operated eyes should have visual acuity ≥6/18 and less than 5 % of operated eyes should have BCVA <6/60) [33].

Non-Economic Efficiency (C5)

Program Eye Care 2’s surgeons are able to perform 100 times as many surgeries as their local competitors, while Program Eye Care 1 performs 10 times as many as their local competitors. While these differences seem substantial, with the comparison in Program Eye Care 2’s favor, it should be noted that Program Eye Care 2 is more established than Program Eye Care 1, having launched 10 years earlier.

Program surgeons perform 100 cataract operations per month, compared to an average of 7–10 per month conducted in private hospital settings.

On average, 250–300 cataract surgeries are performed per day, compared to 3–5 surgeries a day performed by the nearby government hospital. Due to its innovative operational practices, its surgeons can perform a cataract surgery in one third of the industry standard time.