AKHAND JYOTI EYE HOSPITAL

AKHAND JYOTI EYE HOSPITAL

Redefining access to eye care in low-income regions of India 

To address the need of stimulating an awareness drive across the Indian eye care landscape, a spark illuminated in Mastichak, Bihar that has turned to be a beacon of changing eye care landscape today – Akhand Jyoti. The mission was simple but adamant – eliminating curable blindness by delivering better eye care treatment to the low-income/ underprivileged sections of society. It started with the realisation that came to Mr. Mritunjay Tiwary who recognised low-grade eye care facilities across the poor section of India, especially in the state of Bihar.

Since then, there was no turning back and with time, his solemn oath to provide underprivileged Indian society with high-quality eye care became more and more steadfast. In this endeavour, he was joined by Dr. Ajit Poddar who is the Medical Director and Strategic Implementation Team member of Akhand Jyoti.

We sat down for a virtual conversation with both the leading faces and conversed on various aspects of the organisation to allow the global audience to get an in-depth view of the Akhand Jyoti Eye Hospital. This non-profit unit of the Yugrishi Shriram Sharma Acharya Charitable Trust (YSSACT) has been well-acclaimed for being a secular, professionally managed non-profit organisation, conceptualised in 2004.

Akhand Jyoti started treating people blinded by cataracts in December 2005, principally in one of the poorest Indian states, Bihar, and today ranks among the top five eye hospitals in India. To help eliminate curable blindness and visual impairment by providing affordable and accessible eye health services in low-income regions while empowering women to achieve this is their vision till 2026.

“We strive to provide affordable, accessible, sustainable, quality curative and preventive eye care services while enabling underprivileged rural girls to lead the blindness elimination drive. Though owning the reputation of one of the prominent and biggest eye hospitals in Eastern India, our headquarter, a 190+ beds eye hospital is located in the remote Indian village of Bihar – Mastichak.

In the capital city of Bihar i.e. Patna, we operate a 35-bed hospital, 40- bed hospital in Dalsinghsarai in Samastipur district of Bihar, 60-bed hospital in Purnea in Bihar, a 50-bed hospital in Ballia in Uttar Pradesh, and 24 Primary Vision Centers in Siwan, Piro, Gopalganj, Dumraon, Mahua, Dhaka, Kochas, Areraj, Bidupur, Raghunathpur, Paliganj, Begusarai, Bhore, Riga, Guthani, Bhabua, Chennai, Akorhi Gola, Ramnagar, Bettiah, Kursela, Ekma, Kalyanpur and Hasanpur,” conveyed the duo of leaders.

better avenues to earning bread and butter that leads to social betterment. Education, health, nutrition, skills and assets, all led to human development status in any community where eyesight plays a significant role and hence, addressing eye health issues is extremely important to ensure the betterment of the people, especially those below the poverty line.

“Blind-free Bihar is the single-minded motive with our operations. For the past 14 years, we have been heavily active in Bihar and Eastern UP regions to restore the eyesight of the poor populations. We are relentlessly working towards becoming the Center of Excellence in the eye care space,”-said Dr. Poddar.

It is believed that Bihar has a 10x lower Doctor per patient ratio along with an 8x lower patient access to hospital Bed ratio compared to a developed state. Hence, under its Blindness Elimination program, Akhand Jyoti intends to enable an annual output of 265,000 surgeries (75% of which will be free) over the next 3-5 years.

THE USP

•  A well-acclaimed eye hospital in Eastern India and amongst the top 5 in India.
• Screens over 5,39,000 patients annually (398,000 at eye camps, over 68,000 through direct walk-in at Akhand Jyoti surgical centres, and over 73,000 through direct walk-in at Akhand Jyoti vision centres.)
• Performs over 75,000 sightrestoring surgeries annually, 80% of which are done for free for poor patients.
• State-of-the-art equipment and facilities to offer high-quality eye care delivery. Measures such as this ensure high surgery success rates.
• Well- established 5 surgical centres with 375 beds.
• Owns and operates 24 vision centres spread across Bihar and plans to open 150 of them by 2026.
• A strong team of 29 Ophthalmologists and 805 other staff.
• Across the rural hinterlands of Bihar, it is facilitating girls’ education, skilling, employment, and empowerment programme, which ensures the much-required human resource of optometrists (locally known as junior doctors) forming the backbone of the Blindness Elimination programme.
• Building the 1st of its kind Centre of Excellence (CoE) in eye care in Bihar, live by October 2023. A 500-bed, India’s largest standalone eye hospital of 173,00 sq. ft. built up area.
• The largest cataract (and IOL) department in the region is dedicated to excellence in highquality, high-volume cataract surgeries.
• The CoE will have an enormous infrastructure for various speciality eye services, with 11 operation theatres, and an academic and research wing. It will enhance Akhand Jyoti’s total annual surgical output to 180,000 surgeries.
• Using solar power to generate a portion of the electricity at its base hospital, thereby becoming more environmentally sustainable and leaving a lesser carbon footprint.

THE EXTENSIVE OUTREACH PROGRAMME
The special outreach programme conducted by Akhand Jyoti covers the north and southwest regions of Bihar and eastern Uttar Pradesh. This is in regard to offering eye care services not easily accessible to the poorest of people. With a strong outreach team supplemented by a large volunteer/community organiser base, their outreach activities are about holding eye screening camps, making door-to-door visits in villages, and screening children for eye problems at village schools – thereby combing the rural pockets to find out neglected patients.

“We identify a district and its blocks for outreach interventions, based on geographical presence and coverage requirements. After doing thorough research the outreach manager chooses a spot – easily accessible with larger coverage of the catchment area in the identified block. However, post-COVID.

crisis Akhand Jyoti has innovated a new outreach system based on a combination of two models. Currently, the outreach team along with qualified optometrists following all possible COVID-safe measures makes door-to-door visits in an identified area to find out poor patients requiring free surgical intervention. Following the door-to-door identification activity date and time is shared with the identified patients, on which they are collated and brought for surgery to the nearest Akhand Jyoti surgical facility,” reveals the luminary.

OVERALL EVALUATION OF THE IMPACT SCALE
Why no talk about the impact that the hospital has had in the past 9 years via its blindness removal campaign. Here, are the relevant facts and figures1. 23,467 eye camps organised
2. 4,022,033 eyes screened
3. 576,615 surgeries performed of which 466,219 were done free of cost for poor patients
4. 304,244 spectacles dispensed for correction of refraction errors
5. 11,153,230 caregivers freed (usually an average of 2 persons are needed to look after a blind person over a 24 hour period)

FOOTBALL TO EYEBALL
Akhand Jyoti has innovated a unique programme where a total of 355 rural girls are at various stages between education and employment. “Each of the 24 vision centres of Akhand Jyoti is led by one of these girls as Chief Optometrist & Vision Centre Head. Many girls have done/ pursued master’s and/ or BBA/ MBA courses to further develop themselves.

The girls represent more than 70% of the managerial and clinical staff at Akhand Jyoti. These girls are the key human resources who make the Blindness Elimination programme a success,” claims the duo. Moreover, it has also trained over 55 girls on short 3 to 6 months courses to work as opticians, optical counsellors, and receptionists at its various vision centres.

ROADBLOCK AMID THE DESTINATION
Needless to mention, the sole priority is to comb out poor bilateral cataract patients whose blindness can be easily restored by a simple sight-restoring surgery, which could do wonders for the lives of such people. Finances and demotivation are the major impediments in this direction. Further, they do not have easy access to eye care in their geographies. The most prominent challenge in eliminating curable blindness is to find these hidden patients from the nooks and crannies of the rural hinterlands. Though Akhand Jyoti deals with this hurdle through its unique outreach programme, it still remains a considerable challenge.

80% of Akhand Jyoti’s sight-restoring surgeries are done free of cost for the poor. The revenue generated from the remaining 20% though helps in supporting free surgeries, is not adequate to completely bear the cost of free surgeries. This makes Akhand Jyoti reliant on external donations from individuals and organisations. Continuously raising this money year after year always remains a big challenge, till Akhand Jyoti reaches a ratio of 70% free and 30% paid surgeries, which would greatly help mitigate the need for donor funds.

Akhand Jyoti believes in the mantra of “working where it matters” in other words Akhand Jyoti will never have its operations in a thriving metropolis, where there are other eye care service providers, and where the patients in general are better off compared to the ones in the rural towns and villages. Saying this, it is always more challenging to establish and operate a vision centre or a hospital in a rural area. To address this, Akhand Jyoti tries to harness certain local human resource and utilise indigenous businesses of the area where it ventures into.

“The in-house pool of trained women optometrists who are groomed by Akhand Jyoti from their high school days for a period of 6 years or more, from the the backbone of its eye care services in these remote locations, where perhaps an optometrist from a city will not be comfortable working. Convincing and getting good doctors and key seniorlevel staff, to leave city life, and come and working in a remote location is also a constant challenge, which Akhand Jyoti regularly mitigates through various.

career-building opportunities, amenities, and by providing a unique and one of its kind work environment, where there is a lot of opportunity for learning,” conveys Mritunjay Tiwary. Furthermore, increasing the bed capacity is one of the greatest legacies that the institution wishes to create to eliminate curable blindness from Bihar. It plans to increase its current bed capacity from 375 beds to 1,120 beds by 2026, which would augment its surgical output operations.

Addressing the overall condition of women in the rural and backward sections of the states of Bihar and Uttar Pradesh, Dr Ajit Poddar says, “Such regions are amongst the most vulnerable and affected in terms of poverty. In a highly patriarchal society like Bihar, women face considerable hardships and discrimination. Social evils such as child marriage, dowry, domestic violence, low female literacy rate, and low female labour participation rates are rampant in the state.

It is well documented that removing gender-based discrimination and improving gender parity is key to pulling up low-income geographies. In other words, empowering women leads to reducing poverty. And, this will ultimately lead to improved attitudes toward women’s overall health and wellbeing. By 2030 Akhand Jyoti plans to train 1,500 rural girls as professionally qualified optometrist to drive its Blindness Elimination programme.”

R&D INDUCING AN IMPACT
With the manta ‘to do more from less’, Akhand Jyoti’s steadfast conviction has emphasised indigenous in-house research and development to mediate improved practices and increase its output while pursuing the highest standards. Hence, it has been engaged in the following academic and research and development activities:

• Diploma & Bachelor’s course in Optometry.
• Affiliation with local Government University for B-Optometry in the final stage.
• Structured Comprehensive Ophthalmology Fellowship Programme.
• In-house Journal club.
• Collaboration and networking with Aravind Eye Hospital, Shroff’s Charity Eye Hospital and Moorfields Eye Hospital, UK.
• Regular internal CME and lectures for fellows.
• Training new surgeons on Eye-Si Surgical Simulator.
• Wet-Lab Training for new surgeons.
• Dedicated Training OT.

A GLANCE AT THE LEADERSHIP
The leadership team at Akhand Jyoti has been formulated by bringing people from different walks of life/ backgrounds. Individuals who believe in a unified effort to ensure substantial and long-lasting social changes in low-income states, starting in Bihar. Mr Mritunjay and Dr. Ajit proceeded with explaining that at the apex of the leadership pyramid sits the 7-member Board of Trustees, who have the legal responsibility of overseeing the Yugrishi Shriram Sharma Acharya Charitable Trust (YSSACT), and in order to provide the topmost level of input to the organisation, they meet at least thrice a year.

The group comprises active, agile and senior-level industry leaders and key persons in their field of expertise. Neither the Board of Trustee nor the Advisory Board members are involved in the day to-day management of the Akhand Jyoti Eye Hospital activities, which allow it to witness independent oversight of, and guidance to, Akhand Jyoti’s executive management team. For seamless business continuity, the following governance bodies oversee the day-to-day activities within Akhand Jyoti:

• Strategy Implementation Team (SIT): This 6-member SIT is jointly chaired by the Akhand Jyoti Project Head and Medical Director and is responsible for the day-to-day operations of Akhand Jyoti.
• Project Management Committee (PMC): This 6-member PMC is chaired by an Akhand Jyoti Trustee and is responsible for overseeing all new capital projects.
• Quality Steering Committee (QSC): This 4-member QSC is chaired by the Medical Director & Project Head, supported by the Senior Manager Quality and is responsible for defining, implementing, and monitoring compliance with clinical and non-clinical quality standards.

The insightful leadership team of the organisation immensely focuses on creating leaders for tomorrow. This assertion could be proved by the facts revealed by Mr. Mritunjay and Dr. Ajit Poddar, “Akhand Jyoti believes in harnessing leadership skills from an early age. The girls who join our “Football to Eyeball” rural girls’ education, skilling, employment, and empowerment programme are trained in leadership from the very beginning. Playing football on the village field, at times even with boys, helps in creating the much-required confidence, which would go a long way in their career and life.

The girls’ empowerment programme follows a system of mentor mentee knowledge sharing, where a group of 10 girls are mentored by a senior girl, who reports to the Manager, who in turn reports to the Project Head. With time, apart from becoming qualified optometrists, doing MBA and other leadership courses further skills these girls, and become adept for leadership positions in the organisations. These girls represent more than 70% of managerial and clinical staff at Akhand Jyoti today.”

RECOGNITIO TO SUPPORT THEIR CAUSE
The institution has never compromised on quality for quantity. Owing to its dedicated team of senior consultants who are constantly in sync with the working of junior consultants, they have been able to add value to the eye care health space. Estimated by WHO, hospitals performing large volumes of cataract surgeries have an acceptable surgical complication level of up to 5%, while Akhand Jyoti’s is less than 2%, which is significantly lower than many hospitals of similar size or even bigger.

Pioneering the drive of rendering highvolume, high quality surgeries at par l, it happened to establish distinct benchmarks among the community of eye care service providers in India. Therefore, in June 2019, Akhand Jyoti won the prestigious “Shri Dharamsey Nensey Oman” award conferred by the International Agency for the Prevention of Blindness (IAPB) and Vision 2020.

Moreover, the thought leadership portrayed by Mr. Mritunjay Tiwary has been recognised as the “Access Champion” by the Organization of Pharmaceutical Producers of India (OPPI) for his unequalled contribution to rural healthcare and improving access to the poorest section. Proving the accountability and good governance procedures ensured by Akhand Jyoti, it has also become a recipient of Guidestar India Gold Certification.

Well, all these marvellous achievements bring attention to the fact that Akhand Jyoti’s success is driven by its work culture. Every employee is groomed to harness the essential values of compassion, respect, commitment, and teamwork. Adapting these values allows them to go a long way in providing a warm and personal touch to every patient and improves the patient’s experience at the hospital. This motivates them to come back and also bring their family and peers under the hospital’s service parasol. Word-of-mouth advertising has been the key distinguished of the hospital’s growth so far.

THE FUTURE PROJECTS
When asked to reveal future annual capacities that they wish to reach by 2026, the duo elucidated that the organisation is into establishing an infrastructure with:
1. 6 surgical centres
2. 150 vision centres
3. 1,120 beds
4. 270,000 surgeries
5. 200,000 walk-in OPD at surgical centres
6. 600,000 walk-in OPD at vision centres
7. 1,100,000 walk-in OPD at outreach camps
8. All speciality eye care services and Academic & Research wing in place 750 girls at different stages of education and/ or employment from the ‘Football to Eyeball’ programme. To know more visit www.akhandjyoti. com

PEARLS OF WISDOM SHARED BY THE ‘VISIONARIES’
Unimaginable success follows by harnessing the power of innovation and cultivating local knowledge while
embracing new technologies. No matter what we do, human beings should be at the heart of any operation. Hence, while encouraging and nurturing local talent it is also important to attract professionals from other places, who are inspired by the organisation’s vision and mission.

Learning is the key to growth, always ensure it happens at every level at various capacities, may it be in micro-practices or in trailblazing macro changes. Finally, values are the most important – for Akhand Jyoti, it’s the 4 values of Commitment, Compassion, Teamwork, and Respect that ensures growth and success.

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