National Programme for Control of Blindness.pptx

A ppt on National Program for Control of Blindness

1. National Program for Control of Blindness

2. Introduction Types of blindness Economic Blindness – inability to count fingers from a distance of 6 metres with the better eye, with the best possible correction Legal blindness – vision less than 6/60 or 20/200 or less in the better eye, with correction, and/or a visual field less than 10 degrees centrally constitutes legal blindness Social blindness is the degree of disability that hampers an individual from socially interacting with the family and peer in satisfactory manner Absolute blindness – inability to perceive light in any eye

3. WHO has defined blindness as Visual acuity of less than 3/60 or its equivalent, and for the non-specialized personel , it is further describes as inability to count fingers in daylight at a distance of 3 metres

4. WHO – ICD Visual acuity NPCB Low vision Category (1) <6/18 – 6/60 Low vision Category (2) <6/60 – 3/60 Economic blindness Blindness Category (3) <3/60 – 1/60 Social blindness Category (4) <1/60 – perception Manifest blindness Category (5) No perception of light Absolute blindness

5. Poor are less likely to gain access to health and those who are suffering from eye sight defect may loose their jobs and face a steep reduction in income. So poverty is caused by blindness and vice versa. There is another angle to the problem – blindness is also associated with inequality : in education, in recreation, in jobs, in social status that affects mental and social life of individual and social life of individual and family.

6. Burden of disease Globally, at least 2.2 billion people have a near or distance vision impairment. In at least 1 billion – or almost half – of these cases, vision impairment could have been prevented or has yet to be addressed. This 1 billion people includes those with moderate or severe distance vision impairment or blindness due to - unaddressed refractive error (88.4 million), cataract (94 million), age-related macular degeneration (8 million), glaucoma (7.7 million), diabetic retinopathy (3.9 million), as well as near vision impairment caused by unaddressed presbyopia (826 million)

7. In India As per survey in 2001-02, prevalence of blindness is estimated to be 1.1%. Rapid Survey on avoidable Blindness conducted under NPCBVI during 2006-07 showed reduction in the prevalence of blindness from 1.1% (2001-02) to 1% (2006-07). Various activities/initiatives undertaken during the Five Year Plans under NPCBVI are targeted towards achieving the goal of reducing the prevalence of blindness to 0.3% by the year 2020.

8. The major causes of blindness Cataract Refractive errors Glaucoma Corneal pathologies

9. Major causes of childhood blindness Visual impairment due to uncorrected refractive errors Vitamin A deficiency Developmental cataract Retinal conditions Optic atrophy Congenital anomalies

10. According to NPCB pilot survey 2001 – 2002, the major blinding conditions, in 50+ year population are cataract (62.6%), uncorrected refractive errors (19.7%), corneal opacity (0.9%), glaucoma (5.8%), posterior segment disorders (4.7%), and surgical complications (1.2%)

11. Health Policy National Programme for Control of Blindness & Visual Impairment (NPCBVI) was launched in the year 1976 as a 100% Centrally Sponsored scheme with the goal to reduce the prevalence of blindness from 1.4% to 0.3%. Health Policy 2002 has set up a goal of reducing prevalence rate of blindness less than 0.5% by 2010. India was the first country to launch national level blindness control program

12. Goals To reduce the prevalence of blindness from 1.49% to less than 0.3% To establish an infrastructure and efficiency levels in the program to be able to cater new cases of blindness each year to prevent future backlog.

13. Objectives To reduce the backlog of blindness through identification and treatment of blind To develop comprehensive eye care facilities in every district To develop human resources for eye care services To improve quality of service delivery To secure participation of civil society, NGOs, and the private sector in eye care, and To enhance community awareness on eye care

14. Strategies The four pronged strategy of the program is a. Developing institutional capacity – by improving institutional infrastructure. Other NGOs and private sectors are involved in strengthening the capabilities b. Development of manpower – by strengthening technical and managerial capacity of the eye care staff of different levels by training man power for management at district level and by training of manpower of surgical services

15. c. Strengthening service delivery – improving the physical, technical and managerial capabilities of medical colleges, district hospitals, community health centres , primary health centres and selected non profit institutions d. Promotion of outreach activities and public awareness program – District blindness Control society is in a position to start eye care activities on its own and may take the help of IEC system and attempt should be made to reach maximum number of people through IEC campaign.

16. Activities 1 .Cataract operation – to strengthen eye care services by IOL implantation with the assistance of World Bank. Minimum target for cataract surgery rate per lakh population was set as 400 per year. 2. Involvement of NGOs – To organize eye camps in remote rural and urban areas along with District Health Organization. Grant in aid is provided through District Blindness Control Societies throughout the country 3. Civil works – construction of eye wards, OTs

17. 4. Training – Training to surgeons both as trainers and as surgeons who will be implanting IOLs. 5. Commodity assistant – Commodities like sutures, IOLs, indirect ophthalmoscopes, slit lamps, etc are procured and distributed to states and DBCS. 6. IEC – posters, video spots, radio jingles etc in all regional languages 7. Management Information system – software developed to facilitate data completion at 25 sentinel surveillance units in medical colleges

18. 8. Monitoring and Evaluation – Rapid assessment survey, facility survey and a beneficiary assessment survey 9. School eye screening program – Children are first being screened by trained teachers. Children suspected to have refractory errors are confirmed by ophthalmic assistants. Corrective spectacles are prescribed or provided free of cost. 10.Collection and Utilization of Donated eyes – Currently nearly 20,000 donated eyes are collected per annum in India. Many donation programs are operating in the country for donation.

19. Other Major activities 1.Control of Vitamin A deficiency – Main cause of nutritional blindness in children. 2.Control of Trachoma – Chemotherapeutic intervention to reduce the severity, lower the incidence and in the long run decrease the prevalence of trachoma. - Mass treatment – for the entire community (tetracycline / 1%erythromycin for 5 days each month for 6 consecutive months) - Selective treatment – in communities with low prevalence, treatment is given to individuals after case identification

20. Organisation NPCB is managed by the Directorate General of Health Service, Ministry of Health and Family Welfare, New Delhi. At the ministry level, there is National Program Management Cell, which has 2 divisions. 1.Technical division 2.Adminstrative division

21. National Program Management Cell State Program Cell District Blindness Control Society District hospital District Health officer Ophthalmic surgeon District mobile unit CHCs PHCs

22. District Blindness Control Society The main objective is to achieve the maximum reduction in avoidable blindness in the district through optimal utilization of available resources in the district Planning for national program for prevention and control of blindness was carried out from central level till 1990. To start planning at the peripheral level the program was finally decentralized.

23. The program includes a.Comprehensive eye care – provide total eye care by integrating the curative, preventive and rehabilitative activities b.School eye screening – this program has been taken up for correction of refractive errors in school children c.Community based rehabilitation – program for the incurably blind, including visual impaired, disabled and the handicapped persons.

24. NRHM & DBCS Due to implementation of NRHM, the State and DBCS are merged with State Health Societies and DHSs. They are authorized to undertake various activities related to Information, Education and Communication at the district level. Local IEC activities include identification and motivation of potential beneficiaries, information through media, educating voluntary groups and teachers and other community based volunteers and ASHA workers under NRHM. Interpersonal communication is the most effective method for motivation of the target population, such persons may be given one day orientation on blind registry, motivation and assistance in getting services for the affected population.

25. Role of International Agencies – WHO WHO is assisting NPCB in organizing in following areas 1.Forty intra-country Fellowship in Institutes of Excellence under various specialities including corneal transplantation, vitreo -retinal surgery, lasers in ophthalmology and pediatric ophthalmology 2.Survey on childhood blindness in East Delhi to estimate prevalence and causes of blindness in children below 15 years of age 3.Study on refractive errors in school dropouts 4.Establishing National Surveillance Unit at RP Centre AIIMS, New Delhi 5.Launch workshop on Vision 2020 6.Publications of newletters and other prototype material under NPCB 7.Publication of training modules 8.Celebrating World Sight Day on October 11 th every year

26. Role of International Agencies - Danida The GoI has signed an agreement with the Denmark to receive assistance in following activities : a.Manpower development b.Establishment of management systems at state level b.Establishment and development of monitoring and evaluation system d.Preparation of health education material, teaching and information aids E.Training

27. Role of International Agencies – World Bank World Bank had assisted Cataract Blindness Control Project, in which 554 crores had been spent for next 7 years Major inputs of the projects were - upgrading the ophthalmic services, expanding the coverage in rural and tribal areas, establishment and functioning of District Blindness Control Society, training of ophthalmic manpower, improvement of management system, providing IOL implants and creating awareness about the program in the masses.

28. Vision 2020 It has been estimated that blindness cost the world 25 billion annually in lost productivity The cost is 3 times higher if the cost of rehabilitation care givers are included A global initiative has been initiated to reduce avoidable blindness by the year 2020. India has also committed to this initiative. Plan of action for the country has been developed with the following main features.

29. a. Target diseases – Cataract, refractive errors, childhood blindness, corneal blindness, glaucoma, diabetic retinopathy b. Preventive interventions by strengthening of Vitamin A supplementation, prevention of trauma to the eyes in industry, agriculture and household etc. restricted use of steroid combinations, screening, referral and treatment of minor ailments at primary level integrate with immunization, ICDS, RCH program; school eye screening program for detection and correction of refractive errors; IEC for public awareness

30. C. Human resource development – Augmenting middle level ophthalmic personnel and increasing the capacity and skills of available human resources in various areas of ophthalmology d. Infrastructure development – Proposed structure includes centres of excellence (20), training centres (200), service centres (2000), and vision centres (20,000).

31. Vision Centre at Primary level Refraction and prescription of glasses Primary eye care School eye screening program Screening referral services Service Centres at the secondary level Cataract surgeries Other common eye surgeries Facilities for refraction Referral services

32. Training centre at the tertiary care level Tertiary eye care including retinal surgeon, corneal transplant, glaucoma surgery Training and CME Centre for Excellence Professional leadership Strategic development CME Laying of Standard and Quality assurance Research

33. Towards Universal Eye Health – A Global Action Plan 2014 – 2019 The global action plan 2014 – 2019 aims to sustain and expand efforts by Member states, the Secretariat and International partners to further improve eye health and work towards attaining the vision. Its goal is to reduce avoidable visual impairment as a global public health problem and to secure access to rehabilitation services for the visually impaired by improving access to comprehensive eye care services.

34. Five Principles and approaches underpin the plan a.Universal access and equity b.Human rights c.Evidence based practice d.a life course approach e.empowerment of people with visual impairment

35. Objectives Need for generating evidence on the magnitude and causes of visual impairment and eye care services and using it to advocate greater political and financial commitment to eye health Encourage the development and implementation of integrated national eye health policies, plans and programmes to enhance universal eye health with activities in line for strengthening health systems to improve health outcomes Multisectoral engagement and effective partnerships to strengthen eye health