long range strategy plan orbis international– india highlights of the situational analysis...
TRANSCRIPT
Long Range Strategy PlanORBIS INTERNATIONAL–
INDIA
Highlights of the Situational Analysis Document Keerti Bhusan Pradhan,
B R Shamanna, P K Nirmalan
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
Purpose & MethodsMain 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
Prevalence of Blindness (Visual Acuity <6/60) as per the National Survey (86-89)
Category
Prevalence (%)
States & regions of the country
Low Prevalence
Less then 1 Punjab, Himachal Pradesh, Delhi, West Bengal, & N.E. States
Moderate Prevalence
1 to 1.49 Gujarat, Haryana, Kerala, Bihar, Karnataka, Andhra Pradesh and Assam
High Prevalence
1.5 to 1.99 Maharashtra, Orissa, Tamil Nadu & Uttar Pradesh
Very High Prevalence
2 and above
Madhya Pradesh, Rajasthan and Jammu & Kashmir
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
Profile of SEA Region
• 25% of the world’s population
• 33% of the world’s blind
• 40% of the world’s poor
• 50% of the world’s childhood blindness
• 60% of the cataract backlog
Eye Care Service Delivery in IndiaAbout 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 1:25,000 but in rural India it is about 1:250,000.
Eye Care Service Delivery in IndiaAbout 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 1:25,000 but in rural India it is about 1:250,000.
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
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
Disease Control Status
• Cataract–Issues:
• Major cause for blindness
• Changing demographics = Increasing prevalence and incidence
• Only 60% IOL
• Quality of surgery
Disease Control Status
• Cataract–Issues:
• Geographic coverage
• Socioeconomic issues
• Gender issues
Disease Control Status• Cornea
– Issues:
• Infectious disease
• Nutritional causes
• Trauma
• Awareness, treatment strategies and access
• Determining the national need for corneas
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)
Disease Control StatusChildhood 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
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
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
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
Disease Control Status
• Emerging problems
– Diabetic Retinopathy
– Glaucoma
– Age –Related Macular Degeneration
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
Human resources
• 80 institutions currently training MLOP’s in India
• 1300 persons each year
• Fellowship programs
• Optometry, Ophthalmic techniques, Instrument maintenance, opticians, management courses
Human Resources status and needs in India
Category Current 2005 2010 2015 2020
Ophthalmologists 11,000 15,000 18,000 21,000 25,000
Mid Level Personnel
24,000 40,000 51,000 62,000 73,000
Eye Care Managers 200 500 1,000 1,500 2,000
Community Eye Health Specialists
20 50 100 150 200
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
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
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
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
Role of Stakeholders in Eye Care in India
• Multilateral & Bilateral agencies
– WHO
– World Bank
– UNICEF
– DANIDA (DANPCB)
– DFID
– USAID
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
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
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.
Strategic Opportunities
• Goals– Disease Control– Developing Human Resources– Strengthening Service Delivery– Promoting outreach activities and public
awareness - advocacy– Develop institutional capacity,
partnerships and Networking
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
Disease Control
Cataract–Understand risk factors better,
gender and socioeconomic factors
–Alternate service delivery models
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
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
Disease Control
• Refractive errors– Develop service delivery models
– Promote refraction training centres
– Promote optical ‘dispensing’ training centres (grinding, fitting)
Disease Control
• Diabetic retinopathy– Strengthen tertiary care centres
– Training in management of diabetic retinopathy
– Awareness
– Service delivery models
Disease Control
• Glaucoma– Tertiary care centres– Training in management of glaucoma
Low Vision– Tertiary care centres – Training in management
Human Resource Development
• MLOP– Develop curriculum– Training materials in regional
languages– Body for accreditation– Develop Management Competence– Standardized Ophthalmologist
training, CME
Service delivery models
• Need to develop working models of primary eye care
• Strengthen tertiary care models
• Develop regionally appropriate IEC materials
Advocacy
Develop partner institutes to COE
Improve networking between
stakeholders
Low Vision devices production