Operation eyesight

Operation eyesight

1. Overview of Operation Eyesight and Scope for Partnership Dr. Santosh Moses Country Manager - India

2. We have been in existence for 52 years! Couple of years ago we celebrated our 50 th anniversary!

3. We decided to go around and find out how effective we have been.. We asked our partners: Have your eliminated avoidable blindness from your service areas? No! Our partner hospitals deliver quality eye care services to the poor free of cost!! Then why??

4. This year we did the same We asked our partners: Have your eliminated avoidable blindness from your service areas? Yes in many villages! I have been told Operation Eyesight is the only INGO that has been able to achieve this Vision 2020 India has awarded us this year for declaring a village blindness free on WSD So how do we do it?

5. Beginnings Inspired by Dr . Ben Gullison, a Canadian doctor Founded in 1963 by Art Jenkyns, a Calgary businessman First program partner: Arogyavaram Eye Hospital, Andhra Pradesh Original focus: cataract elimination in developing countries 5 Who are we? BEN GULLISON ART JENKYNS

6. Who are we? OUR VISION: For all the world to see. OUR MISSION: To eliminate avoidable blindness.

7. Our work in India is centered on two key thematic areas : Hospital Based Community Eye Health Programme Hospital Improvement Programme Operation Eyesight’s interventions in India

8. Hospital Based Community Eye Health Programme Through this programme in service areas of partner hospitals we: Establish Vision Centers at the community level and link them up with secondary and tertiary eye hospitals Empower target communities to take responsibility for their eye health Deliver blindness free villages on a sustainable basis within 4 to 5 years Eliminate Vitamin A blindness among under 5 children Achieve full immunization coverage and ensure all women undergo ante-natal care and post – natal care leading to reduced maternal and infant mortality rates Ensure malnourished children access services available at the Anganwadi centers leading to reduced child mortality rates

9. Hospital Improvement Programme Through this programme we: Establish/ strengthen secondary eye hospitals Improve quality of eye care services: Build capacities of medical and non-medical staff Introduce/ strengthen protocols and standards Treat poor patients free of cost including surgeries: Introduce/ strengthen cross subsidy financial management system that ensures completely free treatment for the poor (average 52% of patients surgically treated free of cost) Make hospitals self sustaining Promote optical Promote pharmaceutical shops

10. Reaching out to the marginalized In 2013 we have: Screened over 3 million for potentially blinding conditions Surgically treated over 120,000 (Over 50% of them totally free) many of whom who would have gone needlessly blind Dispensed spectacles to over 128,000

11. Intervening in very remote areas In the Aravalli Desert Hills of Rajasthan In the riverine island of Majuli, Assam In the tea gardens of West Bengal In the Marathawada region of Maharashtra In the far North East in Meghalaya

12. Key achievements in the last 51 years Developed/ supported over 100 eye hospitals across India to deliver quality eye care services Built capacities of over 2,000 medical and para-medical staff 1 st INGO to venture into urban slum eye health programmes Focused on quality over quantity and the shift to development Promoted financial sustainability through the cross subsidy model and through establishment of optical shops and pharmacy stores Launched an innovative community eye health approach which targets the root causes of avoidable blindness leading to promotion of sustainable blindness free villages Developed a new model of partnerships (NFTP) 12 Operation Eyesight in India

13. OE India Programme Partners 46 partners 60 projects Over 600 Women Community Health Workers Covering 12.5 million people Screening 3 million annually Surgically treating over 125,000 annually

14. Impact of our work Increased knowledge and positive behavioral change towards eye health in over 85% of the target population Strong linkages between target community, vision centers and the secondary center Integrated primary eye care services into primary health care system leading to decreased infant and maternal mortality rates Improved quality of life – 85% of the those treated for blindness return to their livelihood activities, 90% of those treated for blindness perform their daily duties independently Blindness free villages a reality in upto 90% of the areas where HBCEHPs are implemented

15. Paradigm shift: Non-financial Technical Partnerships No more fund driven but knowledge driven Hospital partners implement our model (HBCEHP) with their own resources We provide full fledged technical support – from conceptualization to recruitment to capacity building to execution to evaluation We provide limited financial support to select hospitals that are remotely located for capacity building and establishment of vision centers We are different and unique – The only INGO which is sought for its technical expertise

16. How does NFTP work We have a five year strategy Community Eye Health Hospital Improvement We and the partner hospital jointly agree on the objectives, outcomes and reporting requirements of a program We do not provide financial assistance; instead, the partner invests its own resources to implement the project

17. How does NFTP work We provide technical support to our partners in the following areas : Community Eye Health and Primary Health - select geographical areas, conduct assessment, launch and sustain Hospital Based Community Eye Health projects in the partner hospital’s service area Hospital Improvement - conduct quality assessment, provide clinical and related services such as infrastructural development and restructuring; developing and strengthening systems and protocols; human resource development and capacity building; and strengthening planning, review and reporting systems Organizational development – strengthen governance, financial and human resource management Programme development – strategic and operational planning, proposal development, monitoring and evaluation systems

18. North East India Comprises: Seven sister states – Assam, Arunachal Pradesh, Meghalaya, Manipur, Tripura, Mizoram and Nagaland Sikkim Parts of North Bengal (Districts of Darjeeling, Jalpaiguri and Alipurduar & Cooch Behar ) More than 2,000 km of boundary is shared with other countries: including Nepal , China, Bhutan, Burma and Bangladesh.

19. North East India – Health Profile Key Indicators National Averages Assam Arunachal Pradesh 50+ population 13% of total population 12% 0.11% Children (< 16 years) 36% of total population 29% 38% Poverty level(% of people living below poverty line) 23.6% of total population 36% 33% Blindness Prevalence (<6/60) 1.1.% 3.05% 3% CSR (Cataract Surgical Rate) 450/ lakh - - CSC (Cataract Surgical Coverage) 70% 25% 20% MMR 450 per 1 lakh 400 400 IMR per 1000 live births 57 66 61 U5MR 74 85 87 Immunization coverage (BCG,DPT, Polio & Measles) 43.50% 31% 28% Gr 111 Malnutrition (% of u5 weight/ age criteria) 15.80% 11.1% 11.4% Indicators of utilization of ICDS services (% of children u5 who utilized any service) 33% 30% 15% % of children with diarrhea who received ORS 26% 13% 13% % of Children between 6 - 35 months who are anemic 79% 77% 77% % of Pregnant women between 15-49 years who were anemic 58% 72% 72%

20. North East India – Health Profile State Arunachal Pradesh Tamil Nadu Eye Surgeons 0.8 per lakh population (7) 2 per lakh population (1,200) PMOA’S 12 600 Medical Colleges 22 Regional Institutes of Ophthalmology 1 District Hospitals 10 26 NGO Eye Hospitals 1 >100 Comparison of infrastructure and human resources status

21. RANKING AND MAPPING OF DISTRICTS BASED ON SOCIO-ECONOMIC AND DEMOGRAPHIC INDICATORS Fort Aguada Fort Aguada

22. Operation Eyesight’s intervention in the NE Started exploratory visits in 2010 Mapped regions of high need and existing eye hospitals 1 st partner in 2011 Chandra Prabha Eye Hospital, Jorhat Partnered to implement a HBCEHP in arguably the most difficult region in the NE

23. Majuli Island, Assam Home to around 150,000 people. Populated mainly by the MISHING tribes Dependent mainly on agriculture primarily cultivation of rice Majuli is battered by floods for atleast 3 months in a year

24. Health status - Majuli Transportation to the main land is only through a ferry twice a day Poor access to the main land and with very limited medical facilities on the island have resulted in poor health care delivery Absolutely no eye care facilities at all

25. Operation Eyesight & Chandra Prabha Eye Hospital, Jorhat We launched a Hospital Based Community Eye Health Project (HBCEHP) in Majuli in 2011

26. HBCEHP Majuli – Women Community Health Workers (WCHWs) 10 Women Community Health Workers were recruited and trained by Operation Eyesight team for over 25 days These WCHWs conduct door to door survey, eye and general health education events, liaise with Government Primary Health Care personnel, Organize screening programmes and ensure patients undergo treatment

27. HBCEHP Majuli – Door to door survey A comprehensive door to door survey was conducted over 3 months in all houses on the island covering a population of 123,000 people Results of the survey: 6% of the total population identified with cataracts 6% of the population identified with other blinding conditions 2% of the population are blind because of preventable causes

28. HBCEHP, Majuli – Screening Programmes Screening programmes are conducted by the hospital’s clinical team once a week at various parts of the village. Persons identified by the WCHWs during the survey are motivated to attend the screening programmes After ensuring that all patients from suffering from blinding conditions are treated, screening programmes will be phased out

29. HBCEHP, Majuli – Vision Centers 1 Vision Center has been established on the Island to ensure that permanent eye care facilities are available on the Island 1 more in the other end of the Island will be established by end of this year Average opd is 15

30. HBCEHP, Majuli – Chandra Prabha Eye Hospital First and final link in the project Provides surgical treatment of the highest quality for all patients from Majuli Island free of cost An affiliate hospital of L.V.Prasad Eye Institute

31. In two year since it’s launch: Blindness prevalence of 2.23% 13,090 persons screened by hospital’s medical team 3,400 surgeries performed 1,623 spectacles dispensed Immunization coverage increased from 43 to 54%

32. Scaling up Assam Implementing HBCEHP in 6 Districts Supported establishment of 4 Vision Centers Partnering with SSN, Guwathi; CPEH, Jorhat and Tezpur Eye Hospital, Tezpur Built capacities of 12 hospital staff and 52 CHWs

33. Scaling up Meghalaya Implementing HBCEHP in 2 Districts including an urban slum MEHP in Shillong City Partnering with Bansara Eye Center, Shillong through the Government of Meghalaya 42 CHWs trained

34. Scaling up Proposed to implement a District Blindness Prevention Project in Papum Pare District In partnership with RK Mission Hospital, Itanagar Arunachal Pradesh

35. Scaling up North Bengal Implementing HBCEHP in 6 Districts Supported establishment of 4 Vision Centers Partnering with SGLEH, Siliguri; TSSK, Malda and Alipurduar LEH, Alipurduar Built capacities of over 60 hospital staff and 32 CHWs

36. Key Learning Blindness prevalence is 1.3-1.5% in North Bengal and over 2.2% in Assam There are good eye hospitals to partner with in the region Focus should be on expanding their areas of work both vertically and horizontally Utilize existing resources – HR, Public Health System etc. Local community participation is critical Similar results can be achieved if the methodology/ approach is sound and all stakeholders are committed

37. Challenges still to be addressed Other areas of eye health still need support: Sub-specialty care Pediatrics Cornea Low Vision and Rehab Partnership with Governments and North East Council Partnership with NGOs and INGOs in other sectors of development Insurgency affected states

38. So what is in it for us?? We have a vested interest We want to have a greater presence in this region of the country The need is great in this region We can together make a difference

39. Our relationship with Lions Our Lions Partners Greater Lions, Siliguri ALEH, Alipurduar OEU Lions, Shreeramnagar ULEH, Udgir DSKEI, Latur TSSK, Malda RRLEH, Nidadavole I look at you as potential partners

40. Thank you No region is too difficult to deliver. If there is a will there is a way

41. Dr. Santosh Moses [email protected] 91-8008500550 If we travel alone we can travel faster If we travel together we can travel further