 In 1976, when Aravind started, 1.5% of India's 650 million people were blind, 80% due to cataract. This translated to about 8 million people being blind due to cataract. This required a high volume approach to make a dent. Aravind, when it started, had its mission of eliminating needless blindness and for it to achieve it, the high volume approach was a necessity and not an option. Effective service delivery in any organization requires a strong and equal focus both on demand and supply. In a high volume operation, it mandates that there is a steady and a large flow of patients into the system and matching processes which deal with that volume that's coming in in an efficient manner. On the demand front, Aravind's focus was on those affected by cataract but were not accessing care and they constituted a larger proportion. The approach included awareness creation, diagnosis, service delivery and follow-up. This took the form of outreach screening camps organized by local communities. At these camps, comprehensive examinations were carried out, glasses and medicines were prescribed and those requiring cataract surgery were transported immediately to one of the base hospitals. Further investigations were then carried out and patients were operated the following day and transported back the day after. After five weeks, Aravind team went back to the campsite for follow-up. In recent years, Aravind has been setting up a network of vision centers to provide primary eye care and currently they are in over 50 locations. Through outreach and vision centers, Aravind admits and does about 100,000 cataract surgeries each year. Additionally, about 100,000 come directly to the paying section and 50,000 to the subsidized section of the hospital taking the total to 250,000 cataract surgeries being done annually. This requires Aravind to perform 750 to 1500 surgeries each day. This is achieved through detailed daily micro-planning to ensure adequate staffing, supplies and equipment including sterile surgical instruments. Each surgeon operates on two tables supported by two scrub nurses and a circulating nurse. Thus minimizing the wait for patients or equipment. This process combined with a highly motivated workforce has ensured high output. Such high volume is enabled when quality is integrated with it. Higher productivity is possible by eliminating unnecessary remedial work and quality has got to be consistent since services are offered day after day. This means that robust systems have to be in place and quality cannot be left to chance. At Aravind, quality systems are built on the foundation of standardized protocols, good medical records and more importantly an organizational DNA that fosters a culture of continuous improvement. There are close to 400 doctors in the system with about half of them in training. Thus it becomes vital for everyone to follow a common protocol in patient treatment. Standardization is enforced using simple techniques like checklist that are integral part of the medical records. This allows complications and outcomes to be more directly attributed to processes. The scheduling of patients matches the complexity of the case to the surgeon skills and experience. Trainees and junior doctors handling the simple ones and the more skilled surgeons handling the challenging cases. A robust outcome and complications monitoring system captures data on every surgery. Every day, a sample of patients give feedback on their experience and satisfaction through a structured questionnaire or focus group discussions. This provides a better insight into ward drive satisfaction and areas needing improvement. Staff members collect and record data relating to quality. In addition, they also do the analysis and review. This results not only in continuous quality improvements but more importantly in strengthening quality consciousness and patient centricity across the hospital. The business model of any organization is largely governed by its purpose and philosophy. Aravind's purpose of eliminating needless blindness resulted in policies such as no one will be turned away for want of money. Reaching out proactively those who are not accessing care. Equity that is the core aspects of care around safety outcome and maintaining patient dignity are the same regardless of the patient's paying capacity. The hospital has to be self-reliant in providing patient care so these formed the non-negotiable policies. Financial sustainability is essentially maintained by a simple formula of keeping the cost to be less than the revenues. Aravind chose its income to come predominantly from patient services to ensure sustainability. Reflecting the paying capabilities, the Aravind pricing covered the full range from market rates for the paying patients to a negative price for the rural poor. Negative price means that Aravind spent money on patients in the community to enable access by transporting them. Zero was also a legitimate price point. The pricing structure was transparent and easy to comprehend which built patient trust. The patients coming to the hospital could self-select to be seen at the paying or free facility. Ambience and facilities like air conditioning was what the paying patients paid for. Some same clinical quality was ensured by rotating the staff between the two facilities. The focus on equity also gave birth to aural lab which made available good quality eye oils at low cost. On the cost front they were kept to a minimum by focusing on productivity, eliminating waste and efficiently managing bottlenecks. This was also helped by viewing costs from the patient's perspective. They were reduced through leveraging scale, completing the entire care cycle including surgery in a single visit and rationalizing the number of follow-up visits. This approach helped Aravind's financials to become robust, not only covering the cost of free care and subsidized care but also financing the building of new hospitals and purchase of equipment. This comprehensive approach of focusing on demand, supply side in terms of building capacity, quality and ensuring financial viability has helped to provide cataract services consistently and sustainably in large volumes.