The Himalayan Cataract Project

By Kevin Schulman, Summer Hu, Jiayin Xue, Susan Qi
2021 | Case No. A237 | Length 15 pgs.

Cataracts robbed an estimated 65 million people around the world of their vision. In the Himalayas, where hundreds of thousands of people went needlessly blind from cataracts, doctors Sanduk Ruit and Fred Hollows began to tackle this health crisis in 1995 with the Himalayan Cataract Project, believing they could adopt new techniques and lens technology to scale high-quality, high-volume, and low-cost cataract operations in remote communities.

This case study details the development of the Tilganga Institute of Ophthalmology (TIO) in Kathmandu, Nepal, including efforts to establish cost-effective cataract treatment centers and ophthalmic education programs to train current eye care technicians and specialists, as well as the next generation of eye care leaders. Students will also understand the time-driven activity-based costing analysis process, as TIO needed to calculate resource needs as the institute expanded services into rural areas, where eyecare needs were high but patient resources were limited. What would this analysis reveal about ways to ensure safe, effective cataract surgery in other low-income countries—and were there also takeaways that might inform cataract surgery practices in the United States and other high-income countries?

Learning Objective

This case is designed to help students learn how to conduct a health care costing exercise, using a time-driven activity-based costing (TDABC) approach. This involves three core steps: (1) creation of process maps; (2) estimation of costs through the synthesis of cost and time data; and 3) calculating both direct and indirect costs based on these resources and costs.
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