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Re-imagining eyecare post-COVID lockdown

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RD Thulasiraj, Executive Director, LAICO, Aravind Eye Care System gives his insights on how the paradigm in eyecare ecosystem is on managing the challenges in the demand and supply side of health services in the times of COVID-19

COVID-19 has widely impacted the healthcare ecosystem in India. As the focus and resources in the recent times have shifted to the fight against the pandemic, most non-COVID health services encounter financial setback. Eyecare ecosystem in India is facing similar challenges, with lower patient footfalls, postponement of elective surgeries and shutting down of outreach campaigns; challenging the sustainability of many hospitals.

The paradigm in the eyecare ecosystem is on managing the challenges in the demand and supply side of health services. With reduced capacity to provide eyecare brought about by the social distancing norms and decontamination protocols, staff retention and engagement has become a major concern for organisations. Many of the hospitals are compelled to either cut down on the staff strength or offer reduced salaries. Safety of staff and patients is also becoming a challenge, as India lifts the lockdown in stages. Efficient patient flow, while following social distancing norms in limited hospital spaces is an issue, many hospitals are deliberating on.

To strengthen financial sustainability of eyecare hospitals, it is important that we build up the patient flow capacity of hospitals while following all safety measures and social distancing norms to safeguard the patients and staff.

It is important for the eye hospitals to establish their patient care capacity following the COVID-19 protocols and then work on measures to enhance this capacity. Hospitals should work towards matching the patient inflow to the hospital’s capacity during the course of the day to ensure that the capacity is fully utilised.

Once full capacity utilisation is ensured, the hospitals can then look at the number of visits made by a patient to complete a treatment. By minimising the number of visits, we not only ensure safety of patients and reduce their costs, but also improve capacity of hospitals to provide healthcare services to others in need. Similarly, hospitals can refine the protocols to reduce the time a patient spends in the hospital, which again will enhance the capacity. Rationalising investigations, minimising cross referrals and restoring to e-consultation, where possible, can be effective tools to reduce the time a patient spends in the hospital. Investing in people, equipment and technology will reap high returns in future.

Another significant way to enable social distancing and improving efficiency is re-engineering the way we have been using hospital spaces. Moving registration, history taking, insurance procedures and health education to patients’ homes can significantly reduce their time at the hospital, which again will enhance the throughput.

And finally, integrating tele-consultation into regular care giving is an imperative to increase the capacities. Hospitals must also shift eyecare services to vision centres where possible. Lack of transportation and accessibility are common concerns, which makes vision centres more accessible than secondary or tertiary eye hospitals. Investment in primary eyecare (vision centres) is critical to ensure accessible eyecare for all.

Adopting these measures can have significant impact in enhancing capacities by as much as 20-30 per cent as a conservative estimate and doubling of capacities as highball estimate. Needless to say, this will help hospitals increase new patient intake and enhance revenues. If we do things right, we can increase the patient flow to anything between 1.2 – 1.5 times the pre-COVID era and attain the pre-decided yearly financial goals by the end of 2020.

Eyecare fraternity should also consider innovations at the demand side. We need to reverse the ownership of eye health back to communities, schools and industries. As care-receiving stakeholders take ownership of their eye health, we can expect reduced need for outreach and enable sustainable demand for eye care.

The pandemic hasn’t affected the need of eyecare services. It has, in fact, given the eyecare ecosystem a rationale to re-imagine its approaches and bring about a paradigm shift in how we collectively envision eye health in India.

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