National Programme for Control of Blindness Blindness Visual

National Programme for Control of Blindness

Blindness Visual acuity of less than 3/60 or its equivalent OR Ø Inability to count fingers in daylights at a distance of 3 meters. Ø India has 11 million blind persons Ø Prevalence of blindness in India is 1. 1% Ø In population of above 50 years it was 8. 5%(presenting vision <6/60 in better eye), but according to WHO it was 5. 34%(using presenting vision <3/60 in the better eye for international comparison. ) Ø

Global Blindness Scenario n n Every five seconds one individual in the world goes blind. Globally, there are nearly 45 million blind people and almost 135 million with low vision. Nine of the ten who are blind live in developing countries. Three quarters of the world’s blindness is avoidable (preventable or curable).

Causes of Blindness In Developed countries • Accidents • Glaucoma • Diabetes • Vascular disease(HT) • Cataract • Degeneration of ocular tissue In South East Asia § Cataract § Uncorrected refractive error § Glaucoma § Corneal opacity

Causes of Blindness In India o Cataract (62. 6%) o Refractive Error(19. 7%) o Glaucoma(5. 8%) o Posterior segment pathology(4. 7%) o Corneal opacity(0. 9%) o Others (6. 2%) Childhood Blindness § Xerophthalmia § Congenital cataract § Congenital glaucoma § Optic atrophy § Uncorrected refractive errors

Epidemiological factors AGE : young and Middle n SEX : more prevalence in female. n Malnutrition n Occupation n Social class: more in poorer n Social factors : quakes, ignorance, poverty, low hygiene, inadequate health services. n

Prevention of Blindness Ø Ø Initial assessment Methods of intervention primary eye care Secondary care Tertiary care Specific programme Long term measures Evaluation

National Programme for Control of Blindness Launched in 1976 n Goals - To reduce prevalence of blindness to less than 0. 3% - To establish infrastructure and efficiency levels in programme to be able to cater new cases of blindness each year to prevent future backlog. n

Objectives n n n To reduce the backlog of blindness through identification and treatment of blind To develop eye care facility for every district To develop human resources for eye care services To improve quality of service delievery To secure participation of civil society and private sector.

Tenth five year plan n To reduce prevalence of blindness to 0. 8% by 2007. n To increase cataract surgery rate to 450 per lac population. n Improvement in visual outcome of cataract surgery by performing IOL implantation in >80% by 2007 n Development of 50 pediatric ophthalmology units. n Facilities for early diagnosis and treatment of glaucoma and diabetes retinopathy. n Setting up 20000 vision centers in rural areas. n Development of 25 fully functional eye bank networks. n Developing human resources and institutional capacity

Strategies Strengthening service delievery n Developing human resources for eye care n Promoting outreach activities and public awareness n Developing institutional capacity n

Organization n National level Directorate General of Health Services Ministry of Health & Family Welfare National Programme Management Cell 1)Technical Division(Deputy Director General) 2)Administrative Division(Add. Secretary/ Joint Secretary) § State Level: State programme cell § District Level: District Blindness Control Society 1)District Hospital a)Ophthalmic surgeons b)District Mobile Unit 2)District Health Officer a)CHC - M. O. ; PMOA b)PHC – M. O.

Activities n • • • Cataract operation Creation of Regional Institutes of Ophthalmology (RIO) to provide specialty services and referral support to other institutions. There are 11 RIOs in the country today. The R. P. Center for Ophthalmic Sciences, AIIMS is the apex institution under the program. The RIOs are located at Hyderabad (S. D. Eye Hospital), Calcutta, Gawhati, Bhopal, Sitapur, Patna, Tiruvananthapuram, Madras, Ahmedabad and Bangalore. Upgrading eye departments and strengthening medical colleges and district hospitals. Dedicated eye wards, eye OTs and ophthalmic equipments are provided to medical colleges and district hospitals. Personnel from these institutions are being trained in latest surgical methods at the recognized training centers. Creation of Central and District Mobile Units to provide cataract surgical services in the rural and remote areas of the country. mobile units arrange eye camps at the CHCs/PHCs and the medical officers have to play a vital role.

Activities (cont. ) n n n n Involvement of NGOs-Eye camps, Eye banks Civil works Training Commodity assistant IEC – posters, video, radio In local languages. Monitoring and Evaluation Collection and utilization of donated eyes

Refractive errors in school children n Initially the activity was undertaken in a few districts in the country but now the programme has been extended to the whole country. • Training of Paramedical Ophthalmic Assistants (PMOAs) for manning the refraction services at the CHCs/upgraded PHCs. Training of school teachers and referral to a PMOA is the modality adopted for vision screening in schools. Creation of dark room facilities at CHCs/Upgraded PHCs. Provision of spectacles to the school children, operated cataract patients and other poor, needy working population. • • •

Other major activities Control of Vit. A deficiency n Control of trachoma- to reduce severity, lower the incidence and prevalence of trachoma a) Chemotherapy- mass therapy - selective therapy b) Surgical correction c) SAFE strategy n

District Blindness Control Society (DBCS) n n Major objective is “To achieve the maximum reduction in avoidable blindness in the district through optimal utilization of available resources in the district”. This society acts to implement, monitor and keep the financial account of the programme under chairmanship of District Magistrate/Collector.

Functions n n n To assess the magnitude and spread of blindness in the district by means of active case finding village wise to be recorded and maintained in Blind Registers To organize screening camps for identifying those requiring cataract surgery and other blinding disorders, organize transportation and conduct of free medical or surgical services including cataract surgery for the poor in Government facilities or NGOs supporting the programme; To plan and organize training of community level workers, teachers and ophthalmic assistants/nurses involved in eye care services;

Functions (cont. ) n n n To procure drugs & consumables including micro-surgical instruments required in the Government facilities; To receive and monitor use of funds, equipments and materials from the government and other agencies/donors; To involve voluntary and private hospitals providing free/subsidized eye care services in the district and identify NGO facilities that can be considered for non-recurring grants under the programme; To organize screening of school children for detection of refractive errors and other eye problems and provide free glasses to poor children; To promote eye donation through various media and monitor collection and utilization of eyes collected by eye donation centers and eye banks.

Functions (cont. ) n Community based rehabilitation programme for the incurably blind, visual impaired, disabled and handicapped persons.

Infrastructure n n n At top – National Institute of ophthalmology At state – 19 state ophthalmic cells and 63 medical colleges. At District – 307 DBCS, 351 district hospitals and 221 district mobile units. At PHC – 4458 PHCs have ophthalmic services. In country 60 governmental and 25 private eye banks functioning. 300 operation theaters and eye wards are constructed in states having high prevalence rate of cataracts

Role of WHO n n n n Establishment of 40 intra country specialty center Survey on childhood blindness to estimate prevalence and causes of blindness In children below 15 years. Study on refractive errors in school dropouts. Establishing national surveillance unit at AIIMS. Launch workshop on “Vision 2020: The right to sight”. Publication of newsletters and other prototype material under NPCB. Publication of training modules for various categories.

Role of DANIDA n n n Manpower development Establishment of management systems at state level Establishment and development of monitoring and evaluation system Preparation of health education material, teaching and information aids Training

Role of World Bank n n n n Assisted in cataract blindness project. Upgradation of ophthalmic services. Expanding coverage in rural and tribal areas. Establishment and functioning of DBCS Training of ophthalmic manpower. Improvement of management systems. Providing IOL implants. Creating awareness about programme in masses.

VISION 2020 n n The Right to Sight is an international campaign to create awareness and mobilize additional resources for preventing and treating blindness. It is a partnership between the countries, the World Health Organization and non-governmental organizations to reduce avoidable blindness by the year 2020. This 20 year program is divided into four phases of given years each. Priority is given to control of the following in the first phase: cataract, trachoma, refractive error and low vision and childhood blindness.

VISION 2020 The three essential elements: 1)disease control 2) human resource development 3) infrastructure development have been identified at the global level includes center of excellence(20) , training centers (200) , service centers (2000) and vision centers (2000). n