NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS
The National Programme for control of blindness was launched in the year 1976 as a 100percent centrally sponsored Programme and incorporate the earlier trachoma control Programmes started in the year 1968.
The programme was launched with the goal to reduce the prevalence of blindness from 1.4 to 0.3 % .As per 2006-07 survey the prevalence of blindness was 1.0 %
Objectives in 12th five year plan :-
1. To continue three ongoing signature activities, i.e.,
a. Performance of 66 lacs cataract operations per year;
b. School eye screening and distribution of 9 lacs free spectacles per year to school children suffering from refractive errors; and
c. Collection of 50,000 donated eyes per year for keratoplasty .
2. To reduce the backlog of avoidable blindness through identification and treatment of curable blind at primary, secondary and tertiary levels, based on assessment of the overall burden of visual impairment in the country;
3. Develop and strengthen the strategy of NPCB for "Eye Health for All" and prevention of visual impairment, through provision of comprehensive universal eye-care services and quality service delivery;
4. Strengthening and upgradation of Regional Institutes of Ophthalmology (RIOs) to become centre of excellence in various sub-specialities of ophthalmology and also other partners like Medical Colleges, District Hospitals, Sub-district Hospitals, Vision Centres, NGO Eye Hospitals;
5. Strengthening the existing infrastructure facilities and developing additional human resources for providing high quality comprehensive eye care in all districts of the country;
6. To enhance community awareness on eye care and lay stress on preventive measures
7. Increase and expand research for prevention of blindness and visual impairment; and
8. To secure participation of voluntary organizations private practitioners in delivering eye care.
Salient features/strategies adopted to achieve the objectives are:
1. Continued emphasis on free cataract surgery through the health care delivery system as well as by the involvement of NGO sector and private practitioners.
2. Emphasis on the comprehensive eye care programmes by covering diseases other than cataract, like diabetic retinopathy, glaucoma, corneal transplantation, vitreo-retinal surgery, treatment of childhood blindness etc.
3. Reduction in the backlog of blind persons by active screening of population above 50 years age, organizing screening eye camps and transporting operable cases to fixed eye care facilities.
4. Refractive error comprises a major part of avoidable blindness. Screening of children for identification and treatment of refractive errors and provision of free glasses to those affected and belonging to poor socio-economic strata.
5. Coverage of underserved area for eye care services through public-private partnership.
6. Capacity building of health personnel for improving their knowledge and skill in delivery of high quality eye services.
7. Information Education Communication activities for creating awareness on eye-care within the community.
8. Regional Institutes of Ophthalmology and Medical Colleges of the states to be strengthened in a phased manner with latest equipments and training of manpower so that they can be upgraded as Centres of Excellence in the regions.
9. The district hospitals to be strengthened by upgrading infrastructure, equipment and providing adequate manpower like ophthalmologists and PMOAs on contractual basis and provide earmarked funds for basic medicines and drugs.
10. Continuing emphasis on primary healthcare (eye care) by establishing vision centres in a ll PHCs with a PMOA in position.
11. Multipurpose District Mobile Ophthalmic Units for better coverage.
To avoid duplicity of work, State Ophthalmic Cell has been merged with State Blindness Control Society, and after the launch of NRHM, State Blindness Control Societies have been further merged with State Health Society. Likewise, District Blindness Control Societies have also been merged with District Health Societies. Facilities for intra-ocular lense implantation have been expanded to taluka level.
The problem of blindness is acute in rural areas, and hence the programme has tried to expand the accessibility of eye services in these areas. At present there are 80 central mobile units attached to medical colleges and 341 district mobile units to provide eye care in mobile eye camps. These units have a vehicle, ophthalmic surgeon and other paramedical staff. Most of the cataract surgeries in rural population are conducted through these mobile camps. Primary health centres are the basic units in the rural areas.
Organizational structure for National Programmes for control of blindness
SCHOOL EYE SCREENING PROGRAMME :
6-7 per cent of children aged 10- 14 years have problem with their eye sight affecting their learning at school. Children are being first screened by trained teachers. Children suspected to have refractive error are seen by ophthalmic assistants and corrective spectacles are prescribed or given free for persons below poverty line.
COLLECTION AND UTILIZATION OF DONATED EYES :
During 2015- 16 nearly 24,510 donated eyes were collected for corneal implantation . Hospital retrieval programme is the major strategy for collection of donated eyes, which envisage motivation of relatives of terminally ill patients, accident victims and others with grave diseases to donate eyes.
Eye donation fortnight is organized from 25th August to 8th September every year to promote eye donation/eye banking. Gujarat, Tamil Nadu, Maharashtra and Andhra Pradesh are leading states in this activity .
The voluntary organizations such as Lions International and its branches. Rotary International and its branches, NSPB India etc. are encouraged to organize eye camps in remote rural and urban areas as per guidelines, with the permission from the state authorities.
They have been active in providing eye health education, preventive, rehabilitative and surgical services for control of blindness.
Community health education is a built-in component at all levels of implementation of National Blindness Control Programme. The programme also includes regular eye check-up and provision of vitamin A prophylaxis and service facilities in rural areas.
WHO assistance for prevention of blindness :
This includes intra-country fellowships in corneal transplantation, vitreo-retinal surgery, lasers in ophthalmology and paediatric ophthalmology; pilot survey on childhood blindness in Delhi; training in district programme management; study on situational analysis of eye care infrastructure and human resources in India; high quality workshops in eye care for faculty of medical colleges; and developement of plan of action for "Vision 2020 : The Right to Sight" initiative.
Vision 2020 : The Right to Sight
It is a global initiative to reduce avoidable (preventable and curable) blindness by the year 2020. India is also committed to this initiative.
The plan of action for the country has been developed with following main features :
1. Target diseases are cataract, refractive errors, childhood blindness, corneal blindness, glaucoma, diabetic retinopathy.
2. Human resource development as well as infrastructure and technology development at various levels of health system. The proposed four tier structure includes Centres of Excellence (20), Training Centres (200), Service Centres (2000), and Vision Centres (20,000).
Universal eye health : a global action plan 2014- 2019
WHO estimates that in 2010 there were 285 million people visually impaired, of which 39 million were blind.
If just the two major causes of visual impairment were considered priorities and control measures were implemented consistently by providing refractive services and offering cataract surgery to the people in need, two-thirds of the visually impaired people could recover good eye sight.
Provision of effective and accessible eye care services is the key to control measures.
The preference should be given to strengthening eye care services through their integration into the primary health care and health system development, as almost all causes of visual impairment are avoidable, e.g., diabetes mellitus, smoking, premature birth, rubella, vitamin A deficiency etc., and visual impairment is frequent among older age groups. Improvements in the areas of maternal, child and reproductive health and the provision of safe drinking water and basic sanitation are important.
Eye health should be included in the broader non-communicable and communicable disease frameworks, as well as those addressing ageing populations.
There are three indicators to measure progress at the national level.
They are:
1. The prevalence and causes of visual impairment. As a global target, reduction in prevalence of avoidable visual impairment by 25 per cent by 2019 from the baseline of 2010 has been selected for this action plan;
2. The number of eye care personnel: and
3. Cataract surgical service delivery. The cataract surgical rate (number of surgeries performed per year, per million population) and cataract surgical coverage (number of individuals with bilateral cataract causing visual impairment, who have received cataract surgery on one or both eyes).
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