National Programme for Control of Blindness 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%. Target for the 10th Plan is to reduce prevalence of blindness to 0.8% by 2007 prevalence of Blindness is 1% (2006-07 Survey).
The plan of action and activities of ‘National Programme for Control of Blindness (NPCB) in India can be described under three headings: Basic programme components, Programme organization Strategic plan for ‘Vision 2020: Right to Sight’ in India.
The basic components of NPCB since its inception includes the following : Extension of eye care services. Establishment of permanent infrastructure. Intensification of eye health education
It is being done through the state and district mobile units by adopting an ‘eye camp approach’ and by enlisting the participation of voluntary organisations. The following facilities are being provided in remote areas: 1. Medical and surgical treatment for the prevention and control of common eye diseases. Eye camp approach is of great help in reducing the backlog of cataract by mass surgeries. Recent emphasis is on reach-in-approach. 2. Detection and correction of refractive errors.
3. Thorough ocular examination including vision of school children for early detection of eye diseases and promoting ocular health 4. Rehabilitation training of visually handicapped. 5. General survey for prevalence of various eye diseases
The ultimate goal of NPCB is to establish permanent infrastructure to provide eye care services. It is being done in three-tier system i.e., peripheral, intermediate and central level.
A wide range of eye conditions can be treated/prevented at the grass root level by locally- trained primary health workers. Peripheral sector for primary eye care at PHC and subcentre levels is being strengthened by: Providing necessary equipment, Posting a paramedical ophthalmic assistant, and Organising refresher courses for doctors and other staff of PHC on prevention of blindness.
Secondary eye care involves Definitive management of common blinding conditions such as cataract, glaucoma, trichiasis, entropion and ocular trauma.
Tertiary eye care services include the sophisticated eye care such as retinal detachment surgery, laser treatment for various retinal and other ocular disorders, corneal grafting andother complex forms of management not available in secondary eye care centres.
An apex National Institute of Ophthalmology has been established at Dr. Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi. This institute has been converted into a centre of excellence to provide overall leadership, supervision and guidance in technical matters to all services and technical institutions under the programme.
Intensification of eye health education is being done through mass communication media (television talks, radio talks, films, seminars and books), School teachers, social workers, community leaders, Mobile ophthalmic units, and existing medical and paramedical staff. Main stress is laid on care and hygiene of eyes and prevention of avoidable diseases.
1. Central level ‘National Programme Management Cell’ located in the office of Director General Health Services (DGHS), Department of Health, Government of India (GOI). To oversee the implementation of the programme three national bodies have been constituted as below: National Blindness Control Board, chaired by Secretary Health to GOI. National Programme Co-ordination Committee, chaired by Additional Secretary to GOI. National Technical Advisor Committee, headed by Director General Health Services, GOI.
l. Procurement of goods (major equipments, bulk consumables, vehicles, etc.) 2. Non-recurring grant-in-aid to NGOs. 3. Organizing central level training courses. 4. Information, education and communication (IEC) activities (prototype development and mass media). 5. Development of MIS, monitoring and evaluation.
6. Procurement of services and consultancy. 7. Salaries of additional staff at the central level.
A ‘State Programme Cell’ is already in place for which five posts including that of a Joint Director (NPCB) have been created.State-level activities include: l. Execution of civil works for new units. 2. Repairs and renovation of existing units/ equipments. 3. State level training and IEC activities. 4. Management of State Project Cell. 5. Salaries for additional staff.
‘District Blindness Control Societies’ have been established. District blindness control society The concept of ‘District Blindness Control Society (DBCS)’ has been introduced, with the primary purpose to plan, implement and monitor the blindness control activities comprehensively at the district level under overall control and guidance of the ‘NPCB.
achieve the maximum reduction in avoidable blindness in the district through optimal utilisation of available resources in the district
1. To make control of blindness a part of the Government’s policy of designating the district as the unit for implementing various development programmes. 2. To simplify administrative and financial procedures. 3. To enhance participation of the community and the private sector.
Each DBCS will have a maximum of 20 members, consisting of 10 ex-officio and 10 other members with following structure: Chairman: Deputy Commissioner/District Magistrate. Vice-Chairman: Civil Surgeon/District Health Officer. Member Secretary: District Programme Manager (DPM) or District Blindness Control Co-ordinator(DBCC),
Members will include District Eye Surgeon, District Education Officer, President local IMA branch, President Rotary Club,• Advisor of the society is the State Programme Manager. Technical guidance is provided by the Chief Ophthalmic Surgeon/Head of the Ophthalmology Department of Medical College
1. Annual district action plan is to be submitted by DBCS. Funding will be in two instalments through GOI/SBCS. 2. NGO participation made accountable; allotted area of operation. 3. Revised guidelines for DBCS — capping of expenditure; phasing out contract managers. 4. Emphasis on utilization of existing government facilities.
5. Gradual shift from camp surgery to institutional surgery. 6. Development of infrastructure and manpower for IOL surgery
Adopted at a meeting held in Goa on October 10-13, 2001 and constituted a working group. The draft plan of action submitted by the ‘Working Group’ includes following strategies: A. Strengthening advocacy B. Reduction of disease burden C. Human resource development, and D. Eye care infrastructure development
The essence of these activities is: Public awareness and information about eye care and prevention of blindness. Introduction of topics on eye care in school curricula. Involvement of professional organizations such as All India Ophthalmological Society (AIOS), Eye Bank Association of India (EBAI) and Indian Medical Association (IMA) in the NPCB.
To strengthen the functioning of District Blindness Control Society (DBCS). To enhance involvement of NGOs, local community societies and community leaders. To strengthen hospital retrieval programmes for eye donation through effective grief counselling by involving volunteers, Forensic Deptt., Police etc.
Target diseases identified for intervention under ‘Vision 2020’ initiative in India include: Cataract, Childhood blindness, Refractive errors and low vision, Corneal blindness, Diabetic retinopathy, Glaucoma, and Trachoma (focal)
Objective. To improve the quantity and quality of cataract surgery.Targets and strategies include: To increase the cataract surgery rate 6000 by 2020. IOL surgery for >80% by the year 2005 and for all by the year 2010. YAG capsulotomy services at all district hospitals by 2010.
Achievements : Performance of Cataract Surgery: has been steadily increasing as indicated below Year Target Achievement % Surgery with IOL 2002-03 40,00,000 38,57,133 77 2003-04 40,00,000 4200138 83 2004-05 42,00,000 4513667 88 2005-06 4513000 4905619 90 2006-07 4500000 5040089 93 2007-08** 5000000 4068027 92
Prevalence of childhood blindness in India 0.8/1000 children Common causes are vitamin A deficiency, measles, conjunctivitis, ophthalmia neonatorum, injuries, congenital cataract, retinopathy of prematurity (ROP), and childhood glaucoma. Refractive errors are the commonest cause
Is to eliminate avoidable causes of childhoodblindness by the year 2020. Strategies and activities 1. Detection of eye disorders. At the time of primary immunization, At school entry, and Periodic check up every 3 years for normal and every year for those with defects.
Prevention of xerophthalmia Prevention and early treatment of trachoma by active intervention Refractive errors to be corrected at primary eye care centres. Childhood glaucomas to be treated promptly. Harmful traditional practics need to be avoided. Prevention of ROP
3. Curable childhood blindness due to cataract,ROP, corneal opacity and other causes to be taken care of by the experts at secondary and tertiary level eye care services. Targets include: Establishment of Paediatric Ophthalmology Units. Establishment of refraction services and lowvision centers
Targets.1. Refraction services to be available in all primary health centres by 2010.2. Availability of low-cost,good quality spectacles for children to be insured.3. Low vision service centres are to be established at 150 tertiary level eye care institutions.
As per the ‘National Survey on Blindness’ (1999-2001, Govt. of India Report 2002)9 glaucoma is responsible for 5.8% cases of blindness in 50+ population. Failure of early detection of the disease poses a management problem towards controlling glaucomatous blindness.
Following measures are recommended for opportunistic glaucoma screening (case detection) Opportunisitic screening at eye care institutions should be done in all persons above the age of 35 years, those with diabetes mellitus, and those with family history of glaucoma. Community based referral by multi-purpose workers of all persons with dimunition of vision, coloured haloes, rapid change of glasses, ocular pain and family history of glaucoma. Opportunistic screening at eye camps in all patients above the age of 35 years.
Following recommendations are made: Awareness generation by health workers. All known diabetics to be examined and referred to Eye Surgeon by the Ophthalmic Assistant. Confirmation by fundus fluorescein angiography (FFA) and laser treatment of diabetic retinopathy at tertiary level.
The major causes of this blindness are corneal ulcers due to infections, trachoma, ocular injuries and keratomalacia caused by nutritional deficiencies. Objectives are: To reduce prevalence of preventable and curable corneal blindness. To identify the infants at risk in cooperation with RCH programme.
Includes all categories of paramedics who work full time in eye care. 1. Hospital-based MLOP. These include etc. 2. Community-based MLOP include those with outreach/ field functions such as
D. Eye care infrastructure development Centres of Excellence 20 Professional leadership CME , Research Tertiary Laying of Standards & QA Strategy development Training Centres 200 Tertiary eye care including retinal surgery, corneal transplantation , Glaucoma surgery Training & CMESecondary Service Centres 2000 Cataract surgery Other common eye surgeries Facilities for refraction Referral services Vision centres 20000Primary Refraction & prescription of glasses Primary eye care School eye screening programme Screening & Referral services