Npcb by pushkar dhir


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Npcb by pushkar dhir

  2. 2. INTRODUCTION • NPCB  launched in the year 1976 ,Centrally Sponsored scheme . • Goal to reduce the prevalence of blindness to 0.3% by 2020. • To achieve this target min. of 21 million cataract operations are to be performed. • Survey on Avoidable Blindness conducted under NPCB during 2006-07 showed reduction in the prevalence rate of blindness from 1.1% (2001-02) to 1% (2006-07). • 230 crore approved by empowered programme committee (EPC) for 2013-14 for NPCB.
  3. 3. THE ORGANISATION CENTRAL • Ophthalmology Section, DGHS,MOHFW • Procurement of goods • Grant –in Aid to NGOs • Organizing central level trainning courses • Monitoring & evaluation • Procurement of consultancy &services STATE • State opthalmic cell, DHS, State health societies • Coordinate and monitor with all the District Health Society • Procure equipment and drugs which required in GOI facilities • Receive and monitor use of funds, equipments and material from the Government • Promote eye donation & monitor the districts for collection and utilization of eyes collected by eye donation centres and eye banks. DISTRICT • District blindness control society • Organize screening camps for identifying those requiring cataract surgery and other blinding disorders • Organize screening of school children. • Procure drugs and consumables • Promote eye donation • Regular screening for cataract and other diseases in the out
  4. 4. Service Delivery & Referral Systems Tertiary level (Regional Institute of Ophthalmology/ Centres of Excellence in Eye care & Medical colleges Secondary Level (District Hospital & NGO Eye hospital) Primary Level (Sub district level hospitals/CHC/Mobile Ophthalmic units, PHC /Panchayats)
  5. 5. Definition of Blind under NPCB • Inability of a person to count fingers from a distance of 6 meters or 20 feet Technical Definition • Vision 6/60 or less with the best possible spectacle correction • Diminution of field vision to 20° or less in better eye
  6. 6. Main causes of Blindness in India are 62% 20% 1% 6% 1% 1% 5% 4% Cataract Refractive Error Corneal Blindness Glaucoma Surgical Complication Posterior Capsular Opacification Posterior Segment Disorder Others
  7. 7. Objectives of the Programme are • To reduce the backlog of blindness through identification and treatment of blind. • To develop Eye Care facilities for every 5 lac population • To develop human resources for providing Eye Care Services. • To improve quality of service delivery by establishing Regional institute of • ophthal , up gradation of medical colleges & district hospital. • To secure participation of Voluntary Organizations in eye care. • To enhance community awareness on eye care
  8. 8. INFRASTRUCTURE DEVELOPMENT UNDER NPCB At RP centre and 10 other Regional Institutes of Ophthal, a National institute of Ophthal has been established for manpower develop, research and referral services. Medical colleges are upgraded under NPCB & at certain med institutes & paramedical ophthalmic assistants are trained. Eye banks have been developed in govt and non-govt sectors. >500 Dist hospitals have been equipped with ophthalmic equipments and requisite manpower is posted. DBCS was started as pilot project in 5 districts and now over a 500 centres under the chairmanship of DC/Dep Com have been set up. Prevalance of Blindness being acute in rural areas, NPCB has tried to expand the accessibility to these areas by the means of PHC, mobile eye units
  9. 9. Inclusion of NPCB in Prime Minister 20 point programme in 1982. World Bank:1994-95 to 2002 Expanding coverage in rural and tribal areas Training of ophthalmic manpower. Improvement of management system Providing IOL implants DANIDA: Man power development Establishment & development of monitoring and evaluation system at state level Training Preparation of health education material, teaching & information aids. WHO: 40 intra country fellowship in Institutes of excellence Survey on childhood blindness in East Delhi to estimate prevalence & causes of blindness in children <15 yr. Study on refractive errors in school drop outs. Establishing National Surveillance Unit. Launch work shop on vision 2020. BOOST UP FOR NPCB
  10. 10. Performance of Cataract Surgery: 1985- 2003
  11. 11. Revised Strategy of NPCB
  12. 12. Construction of dedicated Eye Wards and Eye Operation theaters in Districts Appointment of Ophthalmic Surgeons and Ophthalmic Assistants in new districts Appointment of Ophthalmic Assistants in PHCs/ Vision Centers where there are none (at present ophthalmic assistants are available in block level PHCs only) Appointment of Eye Donation Counselors Grant-in-aid for NGOs for management of other Eye diseases other than Cataract like DR, Glaucoma Management, Laser Techniques, Corneal Transplantation, VR Surgery Treatment of childhood blindness etc of Rs. 750 per case for Cataract/IOL Implantation Surgery and Rs.1000 per case of other major Eye Diseases .For North-Eastern States, Hilly and Desert Areas Rs. 850 for Cataract and Rs.1100 for other major Eye Care Management is proposed. Special attention to clear Cataract Backlog and take care of other Eye Health Care Centers from NE States. Telemedicine in Ophthalmology {Eye Care Management Information and Communication Network} Involvement of Private Practitioners.
  13. 13. A COMBINED EFFORT OF WORLD HEALTH ORGANIZATION & NGOS Launched in Geneva on Feb 18, 1999, to combat problem of avoidable blindness in the world.
  14. 14. Helen Keller Worldwide FOUNDING MEMBERS OF VISION 2020  WHO  IAPB  ChristoffelBlind mission.  Helen Keller Worldwide.  SightSavers International.  ORBIS International
  15. 15.  Al Noor Foundation.  American Academy of Ophthalmology.  Asian Foundation for the Prevention of Blindness.  The Canadian National Institute for the Blind.  The Carter Centre.  Foundation Dark and Light Blind Care.  The Fred Hollows Foundation.  IMPACT – EMRO  International Centre for Eye Care Education.  IFOS  International Trachoma.  Internazionale per la prevensione della Cecita.  Lighthouse International.  Lions Club International Foundation.  Operation Eye sight Universal.  Royal National Institute for the Blind.  SEVA Foundation.  Vision 2020 Australia.  Vision 2020 UK.  World Council of Optometry. SUPPORTING MEMBERS
  16. 16. • Present estimation: – 45 million people blind + – 135 million visually disabled Present situation Worldwide Low Vision Blind < 6/18 - 3/60 Or less than 20 deg Visual field < 3/60 Best corrected VA International classification ignores the burden of uncorrected refractive error WHO defination
  17. 17. Global Distribution of Blindness by Cause Cataract 42 % Trachoma 15 % Glaucoma 14% Oncho. 1 % Other 28 % Macular degeneration Diabetic retinopathy + Refractive errors (uncorrected)
  18. 18.  Without intervention the number of people with blindness might reach 76 million by 2020.  Global ageing of populations makes world blindness increase by about 2 million annually.
  19. 19. AIM OF THIS INITIATIVE • To INTENSIFY AND ACCELERATE present prevention of blindness activities so as to achieve the goal of eliminating avoidable blindness by the year 2020. • Globally 5 conditions have been identified:  Cataract  Trachoma  Onchocerciasis  Childhood blindness  Refractive errors and Low Vision. Chosen on basis of contribution to burden of blindness and feasibility&affordability of interventions to control them. Over the period 1995-2002, glaucoma and DR have been included
  21. 21. Cataract Trachoma Onchocerciasis Childhood blindness Refractive Errors and Low vision 50% global incidence 146 million people worldwide 17 million people affected 1.5 million children are blind Backlog 20 million unoperated cases cataract surgery performance rate- 10 million annually Targets projected : 4000/million population/year = 32 million cataract sxy by year 2020 10.6 million adults have sequele( trichiasis,entropion). More in Africa, China, Middle-east. SAFE strategy adopted Targets : eliminating trichiasis/entropion and reducing prevalance of trachoma to 5%. 0.3-0.6 million are blind. African and Latin- American countries Target : establish National programmes after effective surveillance such as by 2020 no new cases are reported. 1.3 million in Asia & Africa. Targets : To eliminate vit a def diseases and achieve nil incidence in all countries. Services developed for treatable dis : cataract, glaucoma, ROP Refraction and evaluation for pt`s requirement of corrective devices. Manufacture of proper devices
  22. 22. Vision 2020 in India: Launched in 2001. Inculcated in 2002 with NPCB for future planning for control of blindness. Target diseases :  Cataract,  Childhood blindness,  Ref Errors & Low Vision,  Corneal blindness,  DR, glaucoma,  Trachoma (focal basis).
  23. 23. Strategies for corneal blindness • Major obstacle in tackling corneal blindness is the wide gap b/`w the requirement and availability of donor corneas for which recommendations include:- o Strengthening of hospital corneal retrieval systems. o Assessment of persons needing corneal grafting. o For vit a def related diseases: focus on eco backward classes is needed Strategies for glaucoma and DR • Immediate term : training ophthalmologists to handle these conditions. Comprehensive eye evaluation via better clinical practice in slit lamp biomicroscopy, AT, disc and retinal evaluation and gonioscopy. • Intermediate term: o Residency training prog in med colleges. o Training of MLOP in handling these conditions in peripheries. o Training non ophthalmic physicians on clinical profile of these conditions. o Public education • Long term: o To provide high quality eye care at all levels
  24. 24. Global trends : • Over 1995 – 2002, constant factors – ageing, population growth and underdevelopment. • Chronic diseases as glaucoma and DR have shown an increase incidence due to change in life expectancy and life-styles. • Strategy is to bring about awareness of these conditions and also about the compliance and adherence to Rx schedules. • Need an effective Public health approach • This can happen with HRD & Infrastructure appropriate technology.
  25. 25. COST EFFECTIVENESS OF VISION 2020 • Frick and Foster calculated $ 102 billion of economic gain if VISION 2020 is successful. Benefits of vision 2020:  Blindness alleviation to 50 million.  Enhanced ophthalmic training.  Paramedical training.  Creation and upgradation of facilities.  Access to modern technology.
  26. 26. Rural eye camps  Camps – effective modality for medical service delivery on a mass scale and it is cost effective.  In ophthalmology – effective strategy to combat illness at grassroots level.  Over the years, Ophthalmic camps have become cataract centered.  Other eye camps –  One day screening camps:  Glaucoma, DR,School screening or refraction camps
  27. 27. Rural eye camps
  28. 28. In last few years, surgical camps are being phased out by the govt. because – Certain surgical camps as 1986 Khurja and Muradabad camps have shown disastrous results. These have led to a decrease in credibility of the surgical eye camps.
  29. 29. Protocol of a surgical camp OT installation protocol and procedure 1. Planning : informing organizer about camp methodology and requirements like generators, adequate OT facility and location. 2. Camp site feasibility study 3. Surgical team : surgeons, optometrists, OT technicians, camp coordinator. 1. Advisable to get a running OT in a govt. setup or private hospital freshly whitewashed or painted. 2.Cleaning with detergent and disinfectants. 3. All openings and cracks are sealed. 4. AC and other electrical appliances installed. 5. Furniture and microscopes cleaned and installed. 6.Fumigation for 36-48 hrs & after every day of surgery.
  30. 30. PREOP TREATMENT POST OPERATIVE CARE CONCLUSION 1. Broad spectrum topical a/b. 2. Topical povidone iodine. 3. Local hygeine. 4. Continuation of systemic med. 5. Pt`s personal hygeine and cleanliness 1. Daily exam in the postop period. 2. Topical and sysytemic med 3. Complications recognized and managed at the earliest 4. At discharge: VA ( PH). First follow up date notified 5. Follow ups at 6th and 8th wks. • Surgical camps though being phased out are an effective way to reach distant rural and tribal population and also an effective means to control cataract blindness – backlog + new cases.