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A Global View on Eye Care: Lessons from Kenya, Ethiopia, and Guatemala

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This is the first in a two part series based on my visit to eye care hospitals in Kenya, Ethiopia, and Guatemala. You can read the second post here.

ShiXCWeCNq2AI2zlyFTl4MnGp4Hu_zACraQbdKBpc7YIn July 2014, I went on an eye care adventure to do research for a book I am writing with Vasantha Kumar. The book will share lessons we have learned about how to provide high volume, high quality eye care for all. The lessons in the book are inspired by and taken from some amazing hospitals in low and middle income countries that manage to cure blindness while being innovative, equitable, and financially sustainable. In this first in a series of three blog posts, I want to introduce you to the hospitals and share some of the lessons from my trip to Kenya, Ethiopia, and Guatemala. In the next two blog posts, I will give a more in depth look at hospitals translate these lessons into action and introduce you to some of the inspiring people I met along the way.

The Hospitals

The hospitals I visited were Dr. Daniel Kiage’s Innovation Eye Center in Kisii, Kenya, Dr. Fitsum Bekele’s Fitsum Birhan Specialized Eye Clinic in Mekele, Ethiopia, and Visualiza Eye Clinic in Guatemala City.

The first two hospitals are part of the Hilton Foundation Cataract Initiative. The Cataract Initiative aims to pilot a social enterprise model that improves access to high quality eye surgery in Sub-Saharan Africa. It is a collaboration between Johns Hopkins (USA) and the Lions Aravind Institute of Community Ophthalmology. The Lions Aravind Institute is the nonprofit arm of the Aravind Eye Care System, a pioneering system of high quality and affordable eye care hospitals in India. Johns Hopkins and Aravind provide technical support (training, information technology, processes) to the participating hospitals. The hospitals also receive some financial support from the program. The projected outcomes of the Cataract Initiative over three years are to double the annual cataract surgery output, to maintain the high quality of surgeries, and to train 169 eye health staff at five target eye hospitals.

Visualiza in Guatemala is twelve years old and is already becoming a leader in Latin America. Visualiza was inspired by Aravind, but the founders have very much created their own culturally appropriate model. They provide some interesting alternatives for the book.

In many ways, these hospitals are just beginning their journey to become high quality, high volume eye care hospitals. The level of care I saw and the conversations I had with staff and patients really allowed me to understand what our book needs to be and to offer.

Here are some of the lessons I’d like to share.


It has to be the culture of the organization, not just people acting.”

 – Dr. Ravi – Aravind Eye Care System

“It doesn’t cost more to give patients a good experience and good quality care. It takes less effort and costs you less. If can do it right the first time and every time, this can bring down the cost. If the patient’s question is answered well by the first person they ask, they will not ask it to ten other staff members.”

– Mr. Thulsi – Aravind

Lb5NLHv0x9K4SteLM2zDhGMm1N3vGbHJg6Ez43YdTQ0This trip enlightened me on the importance of the patient centric paradigm. Businesses and organizations tend to work with the idea that “if we do good for our organization, we will do good for our customer or patient,” when in fact it really is the other way around. If you design everything around your patient needs, if your organization is reactive in terms of pricing, location, timing, and process, it can only succeed. I saw this proved time and time again; if your patient is at the core of every choice you make, everything else becomes simple.


The Importance of Trust
Esnl4dA0LeVct6Orc4wcRDd6tTuGaAbF72p_er2wcNgWithout counseling and high quality care, the business model of these hospitals does not work. Our first assumption when thinking about the barrier to treatment in poor, rural areas is often financial. Actually, lack of trust seems to be the biggest barrier. And counseling of patients is the only way to overcome lack of trust. If there is no trust in the quality of care, the poor will exercise their right to choose by not seeking treatment.



Outreach Camps: The Path to Raise Your Awareness

“The involvement of community leaders is important. Community leaders are a low cost way of reaching more patients, and they lend credibility to the process.”

– Dr. Ravi – Aravind

A hospital is there to serve its community. Without understanding who their patients are and what they need, hospitals cannot survive. The ability to adapt to the community and to get involved with it are the keys to success. Outreach is the primary way to achieve this. Community sponsors can cement your knowledge and reputation. A free screening camp in a local village is often a far more effective way to reach the community and build trust than spending large amounts of money on advertising and marketing. Hospitals learn about patient needs, and patients learn about hospital services. Screening camps provide a face to face opportunity for patients to learn to trust the hospital to provide them with the care they need.

Flexible Approach, Reactivity

To keep growing and maintaining high standards, hospitals must be reactive. They must constantly question themselves and their processes. Data is the best way to maintain this flexibility and reactivity. Data allows you to make accurate decisions, cut costs, and provide the services that are needed.

Echo Collins-Egan

Echo Collins-Egan

Echo Collins-Egan currently helps coordinate the Joint Learning Network for Universal Health Coverage and is the former country manager of ACCESS Health Morocco.


  1. Jim Cederberg on March 8, 2016 at 6:23 pm

    A young lady in Kenya for whom I provide a college scholarship needs a lens implant and repair of a synechia. She has access to the Moi University Teaching Hospital in Eldoret, and I can pay for her treatment. I am trying to get input on the quality of care for lens implants and ancillary surgery in that locale and/or facility. Can you provide any insight on this? Thank you.

    • Echo Collins Egan Echo Collins Egan on March 9, 2016 at 5:47 am

      Hi Jim! Unfortunately I am not able to comment on the quality of care given at that hospital. It would probably be best to get in touch with an organisation/hospital/doctor in Kenya to get this sort of insight. I wish the young woman you sponsor every luck with the surgery. Best wishes, Echo

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