Avoidable Blindness in India

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Avoidable Blindness in India Early Intervention

• Dr. G.V. Rao
• Country Director
• ORBIS International, India Country Office
• New Delhi

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The Basics A Global Problem

• 161 million visually impaired
• 37 million blind
• 75 of Blindness is avoidable treatable or
  preventable, in a cost effective manner.
• Nine in 10 blind persons live in low income
  countries.

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Global Blindness
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Global Blindness
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Summary of Global Blindness

• Approximately 37 Million
• Increasing by 1-2 Million/ year
• 90 in poor communities of the world
• 60 Treatable
• 20 Preventable

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Definition of Avoidable Blindness

• Avoidable blindness is defined as blindness
  which could be either treated or prevented by
  known, cost-effective means.

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India Profile
2 nd most populous country
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India The scale of things...
Population 1,027 million Children 0-18
380 million (37)
Many states have child populations similar to
large countries
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India Socio Economic Scenario
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Child Health - India

• Under 5 mortality is 85 ranging from 20 140
  from State to State. MP 140 UP Raj. 120
• Lowest Kerala 20
• It is 23 of the total global gt 5 mortality
• It is directly related to childhood blindness

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Indian Demographic Scenario
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Health Expenditure Economic Burden on poor
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Gender Disparity

• Gender disparity are high in almost in every
  sector of health sector
• In addition, there exists spatial disparities
  between urban and rural areas, and across Sates

• RAAB 2007 prevalence of blindness 9.2 in women
  and 6.6 in men (over 50)
• 5 lower rate of IOL implantation
• State to State Cataract Surgical Rate (CSR)
  varies from 500 to 6,000

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India a land of contrasts

• A third of the worlds poor, nearly 400million
  living on less than 1/day
• 46 of children malnourished
• Highest number of illiterate people in the world
• The infant mortality rate of 57/1000 live births.
• Sex ratio of 933 females/1000 males

• Very Rich
• Levels of rising overnutrition
• World class academies and institutes.
• World class health care facilities and booming
  health tourism
• Women with education, power and influence

Source 1) Sample Registration System 2003-
Annual Report, Office of the Registrar General,
India 2) census of India
2001 3) Department of
International Development (DFID)
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Blindness Scenario in India

• Out of 37 million blind globally, India has 12
  million blind the highest globally
• Every year 2 million go blind, 62 from cataract
• Gender bias 1.6 in females and 1.4 in males
• Prevalence in rural 1.63 Urban 1.01
• State wise high prevalence Rajasthan, Madhya
  Pradesh, Bihar, Gujarat,
• Maharashtra, Orissa, Uttar Pradesh, Tamil
  Nadu, Andhra Pradesh and Bengal
• National Program for Control of Blindness
  started in 1976
• From 1978 to 1993, Danida and from 1995 to 2001,
  World Bank supported
• cataract program

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Prevalence of Blindness in India

 

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Blindness Scenario in India
Govt. Hosp.
Pvt. Hosp.
NGO Hosp
Eye Camp
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Emerging priorities and patterns of eye diseases

• Cataract remains the leading cause of blindness
  despite impressive advancements in surgical
  services.
• Uncorrected Refractive Errors is now recognised
  as the second leading cause, followed by
  Glaucoma, cornea.
• Childhood Blindness is now gaining attention.
• Diabetic Retinopathy is now becoming a major
  problem.
• Despite an over increasing need, low vision
  services are dramatically lacking

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Gaps in Eye Care Program

• Poverty
• Eye Care Delivery System
• Quality
• Equity
• Supply and Equipment
• National sub national structures
• Urban - rural divide
• Life style
• Long life expectancy

• Human Resources
• Under utilized HR
• 12,000 ophthalmologist
• Of them 50 surgically inactive
• (Need of 25,000 by 2020)
• The ophthalmology population ratio
• Urban125,000
• Rural 1250,000
• Lack of mid level personnel
• Current 24,000 need 75,000
• Remoteness and lack of
• awareness health promotion

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Top Five INGOs Active in Indian Eye Care Sector
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Childhood Blindness in India

• 320,000 children are blind (19 of the worlds
  blind children)
• 50 of these cases are treatable or preventable
• In addition, an estimated 9.2 million children
  are visually impaired
• Causes Cataract, Ref Errors, Corneal ulcer/
  opacity, ROP, Glaucoma
• Life expectancy of a blind child is assumed to be
  48 years, resulting in a loss of 33 working years
  
• Burden of childhood blindness measured in
  blind-person years is next only to cataract.
• Loss estimated to Indias GNP is US11.1 billion

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Analysis of blindness profile in Blind School
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Corneal Blindness Scenario - India

• Backlog of corneal blind people 1.1 million
• Added every year
  25,000 - 30,000
•  
• Corneas required / year 75,000 -
  1,00,000
• Corneas collected / year 28,000
  - 30,000
• Cornea utilized for sight restoration 12,000 -
  15,000
• Collection vs. Utilization 40-55

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Need for Eye Banking

• Non availability of grafts
• Lack of quality in preservation assessment of
  cornea tissue
• Lack of trained human resources
• Lack of standardized protocols, accreditation
  need for appropriate legislation
• Lack of awareness of eye donation (gap between
  pledge and actual donation)

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Diabetes rising worldwide

• Nearly 171 Million Worldwide have Diabetes
• Likely to double to nearly 366 million by
  2030.

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DR Scenario - India

• An estimated 200 increase in next two decades
• 5.5 Diabetic prevalence Rate
• 1/3 to 1/5 of Diabetic patients have DR
• There may be approximately 11-20 million with
  diabetic retinopathy by 2025
• 75 diabetic for more than 20 years will develop
  some form of diabetic retinopathy
• If not contained, India may be home for the
  largest number of diabetic blind
• (Source WHO)

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Reasons for Rise in Diabetes

• Denial of diabetes and no regular treatment
• Limited awareness of diabetes and related eye
  disease
• Asymptomatic nature of DR gives patient no
  warning
• No routine eye examination as a health seeking
  behavior
• Misconceptions
• Controlling blood sugar levels eliminates the
  risk of visual loss
• If I can see well, why seek medical help

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ORBISs Journey in India
From 1988 to 2008

• In 1988 FEH first landed in India
• In 2000 India Country office started
• Programs undertaken between 2000 to 2002 HBPs,
  Telemedicine, Fellowships, Hospital Cornea
  Retrieval Program and a pediatric project
• Eye Care situational analysis was carried out

• LRSP workshop with stakeholders in 2002
  identified

1.Building capacity of local partners in
Pediatric Eye Care Rationale Highest no. of
blind children, need 100 ped. eye care centers
against the existing 4 2.Building capacity of
local partners in Eye Banking Rationale Against
the annual need of 200,000 corneas, the annual
collection is 20,000 3.Advocacy through
partnership with VISION 2020 Right to Sight,
India National eye care program in 2002 was 100
cataract-centric
Based on the childhood blindness need, ORBIS
developed program business plan to establish 50
centers by 2010 (now further being revised to
2015)
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Program Goal and Strategies 2008 - 10
Capacity Building
Innovative Eye Care Programs ( 3 projects)
Pediatric Eye Care (20 projects)
Corneal Blindness and Eye Banking ( 1 project)

• Training
• Institutional Development
• Rural Eye Care
• Service Delivery
• Quality Assurance System
• Healthcare Technology
• Monitoring Evaluation
• Sustainability

• Cornea collection (HCRP or voluntary)
• Awareness

• Quality Assurance
• Healthcare Financing
• Diabetic Retinopathy

Advocacy ( 1 project)
To influence eye care policies, foster
partnerships/ collaborations with various
stakeholders and create awareness among people on
eye health

• Advocacy
• Public Awareness and Community Education
• Partnership and linkages

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Achievements till date
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ORBISs Achievements
In 2002
In 2008
1.Building capacity of local partners in
Pediatric Eye Care Rationale Highest no. of
blind children, need 100 ped. eye care centers
against the existing 4 (ORBIS goal 50 centers)
1.Building capacity of local partners in
Pediatric Eye Care Achievements 3 POLTCs
established 27 ped. units Established Total
30 units Met 30 need
2.Building capacity of local partners in Eye
Banking Rationale Against the annual need of
200,000 corneas, the annual collection is
20,000
2.Building capacity of local partners in Eye
Banking Achievement Against the annual need of
200,000 corneas, the annual collection is 38,000
(96 increase)
3.Advocacy through partnership with VISION 2020
Right to Sight, India National eye care
program in 2002 was 100 cataract-centric
3.Advocacy through partnership with VISION 2020,
India Founder member for VISION
2020,India Childhood blindness eye banking
given priority
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Childhood Blindness Achievements
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Where we are where we want to be
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Achievements in Eye Banking

• Training in Eye Banking made accessible to 170
  medical and paramedical professionals in India
• 21 Eye Banks strengthened to increase cornea
  collection and utilization

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CSP achievements of Eye Banking
Total Cornea Collected from 3 projects 7,133
from a baseline of 2,538
Total cornea utilized from 3 projects 3,509 from
a baseline of 1,267
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Vision 2020 Right to Sight- India

• This National Forum was established in 2004 in
  collaboration with different International
  Non-Governmental Organizations, National
  Organizations and Government organizations.
• ORBIS International is one of the founder members
  of Vision 2020 Right to Sight- India.

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Advocacy Efforts

• Government approves revised blindness control
  program
• Increased allocation in the XIth five year plan
• Expanded the scope in the Plan to include -
  diabetic retinopathy and glaucoma and child
  blindness apart from cataract.
• 3,000 Vision Centers (each for 50,000 population)
• 30 Eye Banks, 130 Eye Donation center network
• Strengthen 40 voluntary organizations

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Meeting policy makers

• Working with the Brand Ambassador
• Participation at WSD will increase visibility of
  mission
• Charity Concert to raise funds
• Increase visibility of brand ambassdor in IEC
• material to support Vision 2020 mission
• Advocacy film and messages on TV
• Ensure transparency in govt. eye care program by
  better MIS

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Innovative Initiatives

• Two community based eye health financing models
  being tried
• First time all centers of excellences came
  together to design a common course for eye care
  managers
• Quality assurance in eye care was introduced in
  one partner.
• BCC model is developed for Diabetic Retinopathy
  with two partners
• Strategic planning workshops have been conducted
  for 15 eye hospitals and Business Plan developed
  in one partner

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Research Publications

• National Survey to map pediatric eye care and
  cornea services
• Barriers to pediatric eye care study in six
  hospitals
• Public awareness study in Mumbai (study in 4
  hospitals)
• Situational analysis study in Nepal
• Papers published in national and international
  forums
• Equipping Secondary Level Eye Hospitals A manual
• Elected as President of Vision 2020 India
• Felicitation by the Health Minister, VISION
  2020the Right to Sight India

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How we Partner

• Five steps to establish a pediatric eye care
  center
• Introduce child-friendly pediatric eye care
  services
• Build institutional capacity
• Train pediatric eye care teams
• Empower local communities to identify kids with
  eye problems
• Educate parents

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Child friendly ambience
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• Eye Health Promotion is the key to early
  detection.
• Early Detection is the key to early
  intervention.
• Early Intervention is the key to controlling
  avoidable blindness.

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Eye Health Promotion

• Awareness
• Large part of the population whom we are
  targeting are illiterate and under privileged,
  largely in rural also in urban areas
• Lack awareness of such health issue and absence
  of health seeking behavior
• Adopt bottom up approach to create awareness and
  bring behavioral change using multiple mediums
  ranging from folk theatre to community radio,
  panchayat, peer group influence

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Eye Health Promotion
Health Education Eye health promoting behavior,
Uptake of Services, Promotion of awareness,
knowledge, decision making, belief, attitudes,
empowerment Service Improvement Improvement in
the quality and quantity of services Patient
education Community Outreach Testing/ screening
provision of spectacles School health services

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Eye Health Promotion

• Advocacy Networking
• Advocacy for policies that promote eye health
• Support for expansion of eye health services and
  disease prevention in the most needy areas /
  population
• Economic support to increase affordability of
  preventive actions
• Provision of improved services of water, housing,
  sanitation
• Integration of eye health care with
  rehabilitation primary health care initiatives.

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The country recognizes this important
contribution by ORBIS and its dedicated team of
doctors former President of India, Dr. APJ
Abdul Kalam
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• Together we can make a difference.
• Thank you for your kind attention