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Training of young village girls as ophthalmic paramedics, Tamil Nadu
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Subject Area="Human Resources." Objective="Improved workforce efficiency."
Details for Reform Option "Training of young village girls as ophthalmic paramedics, Tamil Nadu"

Background: There are estimated to be 12 million blind people in India. Ophthalmologists in India are few in comparison to the large eye morbidity. At the same time nurses are not trained in ophthalmology and require an extra year’s training to assist an ophthamologist. Action: Aravind Eye Hospital, Madurai, has developed a new cadre of staff – Mid Level Ophthalmic Personnel (MLOP) – by training local village girls (from poor households, aged 17 to 18 years old and educated to 12th standard High School Certificate but with no work experience) to assist doctors. After training, they can undertake tasks such as patient evaluation, conducting diagnostic tests, surgical assistance, counselling etc. The training, done in-house, takes two years, the girls are paid a salary of INR 2,500 and provided with free accommodation in a nearby hostel and subsidised food. The course starts with 4 months basic training after which an assessment is conducted to determine their area of specialisation. The speciality training lasts 8 months. During the second year, they are allowed to practice under supervision and after their final assessment, 99% are absorbed by the hospital. This training programme is now recognised by the Joint Review Council and the Joint Commission for Allied Health Personnel in Ophthalmology (JCAHPO), USA. Results: The hospital estimates that the availability of MLOPs makes the ophthalmologists two to three times more effective. It employs four MLOPs for every one ophthalmologist. They allow the doctors to perform a much higher number of surgeries and free them from carrying out time-consuming tasks such as taking a patient’s history, explaining the consequences of surgery and showing them how to use eyedrops. It is also a cost-effective measure as trained ophthalmic nurses are significantly more expensive to employ.

Cost Approximately INR 600 per trainee per month.
Place Aravind Eye Hospital, Madurai, Tamil Nadu, since 1979.
Time Frame It took 10 years to define and redefine the curriculum to the model used today. Two years to train each new intake.

Time saving: It reduces the time that the doctor needs to spend on routine activities. Skill specific: The MLOPs are trained to specialise in just one activity - counselling, refraction (basic vision testing), surgical assistance etc – according to their individual skills. Efficiency: It increases the efficiency of doctors. Cost-effective: Employing MLOPs is significantly cheaper than employing trained nurses. Empowering: Provides village girls with secure, financially-viable and culturally-acceptable employment.


Possible opposition: Initially there was some opposition from ophthalmologists Short-term: The hospital has found that after five years many of the girls leave to get married. But it still judges the scheme to be cost-effective.


An institution that can provide training staff and facilities. Secure accommodation so that the girls’ parents will feel comfortable with them working away from home.

Who needs to be consulted

Ophthalmologists. Parents, who need to be assured about the security of their daughters.



The new cadre has been operating successfully at Aravind hospitals for the past 25 years and the curriculum has been internationally recognised.

Chances of Replication

Replicable if at an institution with training staff and facilities as in this case.


A similar course was tried for men but it was found that women were more loyal, more disciplined and were likely to stay in post for longer (despite the marriage drop-out rate). Although it has been internationally recognised, the hospital is currently seeking official recognition for its course from the Government of India. The hospital also conducts 1,500 outreach eye camps a year in Tamil Nadu and trained a separate cadre of MLOPs, who are capable of doing all tasks, to facilitate these camps.


Submitted By

Sara Joseph, Researcher, ECTA, New Delhi. September 2004.

Status Active
Reference Files
PROD82.jpg Ophthalmic Paramedics undergoing training at Aravind Eye Hospital, Madurai
PROD82-1.jpg Trained Ophthalmic Paramedic checking a patient’s eye pressure at Aravind Eye Hospital, Madurai
PROD82-2.jpg Trained Ophthalmic Paramedic counsels a patient before operation at Aravind Eye Hospital, Madurai
mlop1-updated for web.ppt Role of Mid Level Ophthalmic Personnel (MLOP)
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