of considerable importance is the fact that this treatment is not provided at low cost by compromising on quality. A key statistic in medical care is infection rate - and the Aravind system actually has better performance than many Western hospitals. For instance in 2004 it was about 4 per 10,000 cases at Aravind, while the UK published rate was 6 per 10,000.(Interestingly the idea of having two patients in the same operating area is prohibited in many US hospitals because of fears of infection). Aravind also operate a very close outcome monitoring system, especially for cataract surgery, where every case sheet on discharge is fed into the computer and then analysed. In turn this feeds a continuous improvement process - measuring, reviewing and then analysed.