Long Range Strategy Plan ORBIS INTERNATIONAL INDIA

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Long Range Strategy PlanORBIS INTERNATIONAL
INDIA

• Highlights of the Situational Analysis Document
• Keerti Bhusan Pradhan,
• B R Shamanna,
• P K Nirmalan

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This situational analysis document is a draft
document subject to revision finalization after
the deliberations in this workshop. The document
aims to provide a framework for discussion to
guide the initiatives of ORBIS India eye care
program
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Purpose Methods

• Main Purpose
• To drive ORBIS India country offices direction
  in the eye care milieu of the country.
• Methodology
• Primary Secondary information
• Discussions
• Analysis by the consultants based on their
  experience

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GLOBAL BLINDNESS
Millions
50
45
38
31
? 30
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1975
1980
1984
1990
1995
2000
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Prevalence of Blindness (Visual Acuity lt6/60) as
per the National Survey (86-89)  
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Blindness in South East Asia

• Prevalence 0.8 Range 0.3 1.5
• Cataract Major Cause, 50-80
• Other major causes uncorrected refractive
  errors, trachoma, childhood blindness, corneal
  blindness, ocular trauma.
• Cost of Blindness US 5.6 billion annually

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Profile of SEA Region

• 25 of the worlds population
• 33 of the worlds blind
• 40 of the worlds poor
• 50 of the worlds childhood blindness
• 60 of the cataract backlog

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Others
Cornea
Cataract
Glaucoma
Ref.error
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• Eye Care Service Delivery in India
• About 65 of surgical performance in the country
  is performed in the private and voluntary sector
  and only 35 is within the government sector.
• About 11,000 ophthalmologists and an equal number
  of trained and recognized mid level personnel
  (MLP) exist as opposed to the ratio of having at
  least 4-5 MLP for each ophthalmologist. 50 of
  the ophthalmologists are surgically inactive
  within the country.
• The ophthalmologist to population ratio in urban
  India is 125,000 but in rural India it is about
  1250,000.

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Eye Care Service Delivery in India
Rapid assessment surveys in 14 districts in the
country - coverage at 70 IOL surgery increased
to 60 Poor surgical outcomes, as high as 40
post-operatively blind following conventional
ICCE 10 following IOL surgery population
based outcomes
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Current situation - India

• Reasonable facilities and service delivery
  mechanisms that can be utilized.
• Demographic and epidemiological transitions
  increase and change in disease patterns despite
  current intervention levels.
• Unifocal vertical interventions limited
  structure at the community level.
• Need for more public-private coordination efforts
  in eye care in India

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Disease Control Status

• Cataract
• Issues
• Major cause for blindness
• Changing demographics Increasing prevalence and
  incidence
• Only 60 IOL
• Quality of surgery

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Disease Control Status

• Cataract
• Issues
• Geographic coverage
• Socioeconomic issues
• Gender issues

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Disease Control Status

• Cornea
• Issues
• Infectious disease
• Nutritional causes
• Trauma
• Awareness, treatment strategies and access
• Determining the national need for corneas

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Disease Control Status

• Cornea
• Issues
• Eye banking
• Availability of grafts, Capability to graft
• Preservation of graft material
• Standardized protocols, accreditation need for
  appropriate legislation
• Awareness of eye donation (gap between pledge and
  actual donation)

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Disease Control Status

• Childhood blindness estimate 1.5 million
• Issues
• Almost 50 of childhood blindness in India
• Overshadowed by the cataract problem
• Limited epidemiological details
• Cause estimates mainly from blind school data

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Disease Control Status

• Childhood blindness
• Issues
• No service delivery models
• Few pediatric Ophthalmology Units
• Cost effectiveness of service delivery
• Pediatricians and primary care personnel not
  involved

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Disease Control Status

• Refractive errors
• Issues
• Uncorrected refractive errors being recently
  recognized as a problem
• 60-70 of refractive errors can be corrected by
  spectacles
• Accessible, affordable, available spectacles
• Need for service delivery models including
  follow-up

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Disease Control Status

• Low Vision
• Issues
• Low appreciation of need even among eye care
  professionals
• Few Centres trained personnel
• Cost of devices
• Availability acceptability of devices

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Disease Control Status

• Emerging problems
• Diabetic Retinopathy
• Glaucoma
• Age Related Macular Degeneration

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Human resources

• 11,000 Ophthalmic surgeons
• Paramedical staff 15,000
• 15,000 to 20,000 persons in eye care without any
  formal training and qualification

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Human resources

• 80 institutions currently training MLOPs in
  India
• 1300 persons each year
• Fellowship programs
• Optometry, Ophthalmic techniques, Instrument
  maintenance, opticians, management courses

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Human Resources status
and needs in India  
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Major Issues in Blindness Control in India

• Limited levels of coordination among Private,
  Voluntary Public Sectors
• Emphasis on Quantity over Quality
• Excessive reliance on camps and improvised
  facilities previously did not translate into
  expected permanent solutions
• Mismatch in Infrastructure, human resources
  limited training
• Programs unable to redress barriers at the
  community level

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India Vision 2020 Plan of Action

• Revamping of medical Education
• Redeployment of human resources
• Better coordination among all stakeholders
• Better service quality standards protocols
• Due emphasis on preventive eye care
• Strengthen advocacy
• Reduction of disease burden
• Strengthen physical infrastructure and human
  resources
• MIS for better program management
• Central government Advisory role in Policy,
  resource mobilization and program implementation

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Targets 2002 2007 (India Vision 2020)

• Increase CSR to 4,500 by 2005
• 80 operated cases good outcomes
• Increase IOL surgeries to more than 80
• Establish at least 50 pediatric eye units
• Opportunistic high risk screening for glaucoma
  and diabetic retinopathy
• Establish 7,500 more vision centres, 50 more
  training centres, 325 more service centres 7
  more centres of excellence for eye care service
  delivery.
• Integrate components of PEC in PHC and training
  in PEC
• 25 fully accredited eye banks, 50 new low vision
  centres and 20 eye donation centres and
  networking

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Eye Care in the Broader Health Care Agenda of the
country

• National Health Policy 2002 Reduction of
  prevalence of blindness to 0.5 by 2010
• Establishment of a baseline data for incidence of
  blindness by 2005
• Use data for Evidence Based Policy
• Mapping of facilities and infrastructure on a
  country level for comprehensive service delivery
  approach.
• Statutory professional council for paramedical
  personnel

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Role of Stakeholders in Eye Care in India

• Multilateral Bilateral agencies
• WHO
• World Bank
• UNICEF
• DANIDA (DANPCB)
• DFID
• USAID

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Role of Stakeholders in Eye Care in India

• International NGOs Service organizations
  in India
• ORBIS International
• CBM
• OEU
• Rotary International
• International Eye Foundation
• Sight Savers International
• Lions Club International Foundation
• HelpAge India

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Role of Stakeholders in Eye Care in India

• National Institutions/Agencies in India
• Dr. R.P.Centre for Ophthalmic Sciences
• ICMR
• All IOL training centres
• LVPEI
• SN
• AECS
• AIOS
• EBAI
• VCS
• SCEH

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Strategic Opportunities

• We do not present an exhaustive list, but present
  certain broad areas to stimulate discussion that
  may determine specific areas of interest for
  ORBIS-India.

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Strategic Opportunities

• Goals
• Disease Control
• Developing Human Resources
• Strengthening Service Delivery
• Promoting outreach activities and public
  awareness - advocacy
• Develop institutional capacity, partnerships and
  Networking

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Strategic Opportunities

• Potential areas for interventions
• Disease Control
• Approaches
• Research to understand risk factors and disease
  process better
• Research to develop and improve service delivery
  models
• Health economics

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Disease Control

• Cataract
• Understand risk factors better, gender and
  socioeconomic factors
• Alternate service delivery models

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Disease Control

• Cornea
• Develop intervention for corneal abrasions at the
  primary level
• Train ophthalmologists in Mgt of corneal
  infection
• Develop a basic lab set-up
• Study national need for corneas
• Establish eye banks and accreditation process

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Disease Control

• Childhood blindness
• Train Ophthalmologists and a team for pediatric
  eye care
• Establish pediatric eye care units
• Develop service delivery mechanism
• School screening screening for school aged
  children
• Research to understand causes and diseases better

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Disease Control

• Refractive errors
• Develop service delivery models
• Promote refraction training centres
• Promote optical dispensing training centres
  (grinding, fitting)

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Disease Control

• Diabetic retinopathy
• Strengthen tertiary care centres
• Training in management of diabetic retinopathy
• Awareness
• Service delivery models

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Disease Control

• Glaucoma
• Tertiary care centres
• Training in management of glaucoma
• Low Vision
• Tertiary care centres
• Training in management

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Human Resource Development

• MLOP
• Develop curriculum
• Training materials in regional languages
• Body for accreditation
• Develop Management Competence
• Standardized Ophthalmologist training, CME

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Service delivery models

• Need to develop working models of primary eye
  care
• Strengthen tertiary care models
• Develop regionally appropriate IEC materials

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• Advocacy
• Develop partner institutes to COE
• Improve networking between stakeholders
• Low Vision devices production

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Technologies

• Telemedicine
• GIS