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COMPREHENSIVE EYE CARE STRATEGIC PLAN

MADHYA PRADESH

Organised by Directorate of Health Services, Bhopal, MP

February 8th-9th, 2012

Technical Support

Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi

Facilitated by

VISION 2020:The Right to Sight-India

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ORGANISERS Directorate General of Health Services, Madhya Pradesh 1. Dilip Kumar Samantaray Principal Secretary, Health & Family Welfare, Madhya Pradesh 2. Dr. AN. Mittal Director, Directorate of Health Services, Madhya Pradesh 3. Dr. V.A. Joshi Joint Director& State Programme Officer (NPCB) Directorate of Health Services, Madhya Pradesh 4. Dr. Dhanila Narayan Deputy Director (NPCB), Directorate of Health Services, Madhya Pradesh

TECHNICAL SUPPORT Dr. R. P. Centre for Ophthalmic Sciences, AIIMS, New Delhi 1. Dr. Praveen Vashist

Additional Professor and Head, Deptt of Community Ophthalmology 2. Dr. Noopur Gupta

Scientist grade III (Ophthalmologist), Deptt of Community Ophthalmology

FACILITATORS VISION 2020:The Right to Sight - India 1. Col.( Retd.) M. Deshpande, President, VISION 2020:The Right to Sight -India 2. Dr. G. V. Rao, Chief Executive Officer, VISION 2020:The Right to Sight -India

REPORT WRITING 1. Dr. Praveen Vashist

Additional Professor and Head, Deptt of Community Ophthalmology 2. Dr. Noopur Gupta

Scientist grade III (Ophthalmologist), Deptt of Community Ophthalmology 3. Dr. G. V. Rao, Chief Executive Officer, VISION 2020: The Right to Sight - India OTHER RESOURCE PERSONS AND PARTICIPANTS 1. Dr. Uday Gajiwala, Medical Director, Divya Jyoti Trust, Surat 2. Mr. Anand Sudan, SSSN, Chitrakoot, Satna 3. Representatives, Sight Savers International 4. Representatives, CBM 5. Representatives, RIO Bhopal and Medical College Indore 6. District Program Managers 7. Local NGOs

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ACRONYM EXPANSION

AWW Anganwadi Worker

AIIMS All India Institute of Medical Sciences

ASHA Accredited Social Health Activist

ANM Auxiliary Nurse Midwife

CHC Community Health Centre

CSR Cataract Surgical Rate

DPM District Programme Manager

DBCS District Blindness Control Programme

GOI Government of India

GIA Government of India Aid

IEC Information Education Communication

INGO International Non Government Organization

IOL Intra Ocular Lens

ISO International Organization for Standardization

HR Human Resource

HOD Head of Department

HIMS Healthcare Information & Management System

LV Low Vision

MIS Management Information System

MP Madhya Pradesh

MSW Medical social Worker

NABH National Accreditation Board for hospitals

NRHM National Rural Health Mission

NPCB National Programme for Control of Blindness

NGO Non Government Organization

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PHC Primary Health Centre

PG Post Graduate

PPP Public Private Partnership

PGMO Post Graduate Medical officer

PMOA Para Medical Ophthalmic Assistant

RIO Regional Institute of Ophthalmology

RE Refractive Error

SWOT Strengths Weakness Opportunities Threats

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Table of Contents

S No Content Page Number

1 Executive Summary, Objectives, Key Strategies & Recommendations for the State Plan

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2 Profile of Madhya Pradesh 11

3 National Programme for Control of Blindness, Madhya Pradesh: Current Status

13

4 Need Assessment: Eye Care Services 17

5 Group Work 21

5.1 Group Work 1: SWOT analysis 21

5.2 Group Work 2: Division wise discussion and suggestions by the groups

26

6 Recommendations by the groups 28

7 Annexures 31

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1. Executive Summary, Objectives, Key Strategies and Recommendations

 

1.1  Executive Summary:  

National Programme for Control of Blindness (NPCB) was launched in India in the year 1976 with the aim to reduce the prevalence of blindness from 1.4 percent to 0.3 percent by the year 2020. The strategies implemented by NPCB for this purpose are:

• Developing human resources and infrastructure, ensuring optimal utilization • Promoting outreach activities and public awareness • Improving Quality Eye Care services and visual outcome following medical and

surgical management.

  For the past 4 years, the target set by the NPCB were 4,50,000 cataracts and almost 95% was achieved last year with IOL implementation was reported at 98%. The MP State thus, gained widespread acclaim for successfully attaining set targets by the NPCB over the past 4 years. Various eminent International and national Non-Governmental Organizations (INGOs) working in the State, contribute significantly in decreasing the blindness burden in the state.

The State of MP has been striving persistently for its growth in eye care service provision. In order to expand to reach to the unreached, improve the quality and specialties eye care services, it is time for having a strategic direction with 5 year plan. With this vision, Dr. R. P. Centre and VISION 2020: the Right to Sight- India partnered with State Blindness Control Society to provide technical assistance (by Dr. R. P. Centre) and facilitate in developing a State Plan for strengthening Comprehensive Eye Care Services and Resources.

With the active participation from the top and mid level management and clinical & non-clinical staff of District Hospitals, DPMs, RIO, Medical Colleges, Mobile Units, NGOs, the workshop facilitated the development process of a Five-year Eye Care State Plan (2012-2017) for MP. Prior to the workshop, a thorough study of the eye care capacity & services was studied by the team by obtaining necessary secondary data from the State. The team facilitated a workshop on 8th and 9th February 2012.

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1.2. Objectives:

• To develop a State plan for affordable, accessible and effective quality eye care services in the state of Madhya Pradesh

1.3. Keys strategies:

• High volume cost effective Cataract, Refractive Errors and pediatric eye care services

• Strengthen Community Outreach and service marketing • Patient satisfaction and Quality enhancement of services. • Strengthen other specialty services like glaucoma, retina etc.

With efficient processes & systems put in place and improved human resource management the State Blindness Control Society can reach to a level of high performance state for comprehensive eye care services. It is projected that if strategies are implemented, the State can perform nearly 24,48,148 cataract surgeries from 2012- 2017 and will be able to generate sufficient resources from patient revenues for its management and future growth.

1.4. Recommendations 1.4.1. Programme management:

1. More emphasis is required for infrastructure development and human resource availability in the low performing districts, the districts in remote areas or difficult areas. The low performing districts Annupur, Sidhi, Sheopurkala, Harda, Dindori, Alirajpur. The INGOs, local NGOs should be promoted to strengthen the service delivery in these districts.

2. Based on the population and prevalence of blindness as well as the current annual targets, need and unmet services with existing resources should be worked out for setting targets for next five years from 2012 onwards. The targets as per the population needs for cataract and school vision screening for the state have been estimated as follows. The targets for screening children under school vision screening programme are estimated so that children in middle schools can be screened at an interval of three years (in 6th and 9th standard).

Years Cataract School Vision Screening

2012-13 4,70,432 23,23,122 2013-14 4,79,841 23,69,584 2014-15 4,89,438 24,16,976 2015-16 4,99,226 24,65,316 2016-17 5,09,211 25,14,622

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3. Mapping of eye care services specifically the specialty services should be undertaken in the State. It is suggested that specialty services should be made available to all divisions.

4. It is suggested that appraisal should be conducted for ophthalmologists and optometrists with respect to their individual targets as well as the quality of services.

5. Currently, cataract surgical records are not maintained in most of the hospitals. HMIS needs to be implemented in all districts and data needs to be verified by the DPM for its accuracy and reliability. Short-term training of the district programme managers on MIS and record management is necessary. The record keeping should be shifted from manual to MIS.

6. In addition to NPCB funds, state government should earmark funds for training, IEC and assessment and monitoring of blindness control programme in the State.

 

1.4.2. Regional Institute of Ophthalmology, Bhopal and Medical Colleges:  

Strengthening of Regional Institute of Ophthalmology, Bhopal and Medical colleges in MP to provide technical support of high efficiency in ophthalmic services:

1. They should be an integral part of the Blindness Control Programme: The Blindness Control Programme under the Director Health Services and Director Medical Education should work in coordination for blindness control activities in the State. The RIO, Bhopal should be an autonomous agency instead of part of a Medical College for better delivery of eye care services and capacity building.

2. There is a need to the assess the current capacity of RIO, Bhopal in order to further strengthen it as a Centre of Excellence for research, training and service delivery in eye care for this region. This may be taken with NPCB or Dr. R.P. Centre for necessary technical support.

3. All speciality eye care services like Paediatric Ophthalmology Unit, Vitreo-Retina clinic, Low Vision clinic, rehabilitation of the blind etc should be available in the RIO with high output and good quality services. The RIO should have trained ophthalmologists in all the subspecialties. It is essential that the specialty services should be expanded so that these services should be available in all the divisions.

4. RIO should provide facilities for the training and demonstrate the organisation and research in Eye Bank procedures including implantation and grafts.

5. The RIO and Medical colleges should be responsible for training of ophthalmologists and optometrists all over the State. Currently, most of the ophthalmologists have to go to other States for speciality training.

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6. RIO and Medical colleges should be accountable for the referred cases from the district hospital. There should be some feedback information to the district hospital for referred cases.

7. RIO and Medical colleges should stimulate and provide facilities in research at a high level of competence. There is need for conducting surveys on blindness, Vitamin A deficiency, blind school survey etc.

8. The training in Phaco-surgery and availability of Phaco-machines may be considered in all Medical colleges and also at the district hospitals, as well.

 

1.4.3. District Hospitals and secondary level hospitals    

Currently, around 350 ophthalmologists are available in Madhya Pradesh. This includes 227 in the government sector. One third of these posts are vacant and another 40% are non-surgical ophthalmologists. The vacant posts of ophthalmologists should be filled. There is a need to initiate motivation among non-surgical ophthalmologists for pursuing comprehensive medical ophthalmology that should include conducting screening camps, follow up services, Retina, Glaucoma and Low Vision Clinics.

1. The ophthalmologists are not showing interest in specialty training for skill transfer. It is suggested that short-term hospital based programme should be conducted with support of voluntary faculty/ faculty posted in RIO, Bhopal. Agencies like VISION 2020 – INDIA can be one of the resources for such programme.

2. As per NPCB guidelines, 1400 PMOA are required in the State. There is a need to develop training centres either through medical universities or other recognised centres to meet the future demand. All the vacant posts of the PMOA should be filled. Equitable distribution of PMOA, especially in underserved and difficult areas, should be ensured.

3. Team building workshops should be organised for motivation, commitment and improved performance among human resources at all levels of eye care service delivery. This may be done with the support of VISION 2020 - INDIA resources.

4. District mobile unit should be available in all the 50 districts. Currently they are available in 30 districts only.

5. It is recommended that the outreach surgical camps (make shift operation theatres) should be strictly prohibited in the entire State as per the guidelines of NPCB.

6. Regular maintenance of equipment should be undertaken. For this purpose, PMOA or NGO representative may be trained for 6 weeks in equipment maintenance from reputed institutes.

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7. The information about cataract surgical outcomes is not available in most of the hospitals. It is suggested that records maintenance should be ensured at all level. Short-term training of the district programme managers on MIS and record management is necessary. The record keeping should be shifted from manual to MIS.

8. The follow up and monitoring of the operated cases should be ensured; NPCB recommend monitoring of at least 5% of the postoperative cases by DPM. It is not practiced in most of the districts.

1.4.4. Primary Level

1. All CHCs (catering to a population of 50,000 to 100,000 in Madhya Pradesh) should have well equipped Vision Centre with adequate space for refraction facility. A full time Para Medical Ophthalmic Assistant (PMOA) should be posted in each CHC accountable for the screening camps for cataract and school vision screening programme in the CHC.

2. Training of ASHA workers in primary eye care should be adopted at the Vision Centre level to improve awareness, identification and referral of blind patients and children with visual impairment. It is suggested that state government should earmark funds for training and output-based honorarium for these workers as done in other National Programmes. NGOs like Sightsavers may be utilised for effective implementation of this programme.

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2. Profile of Madhya Pradesh Madhya Pradesh often called the Heart of India is a state in central India. Its capital is Bhopal and Indore is the largest city. Madhya Pradesh is the second largest state by area and with over 75 million inhabitants, the sixth largest state in India by population. It borders the states of Uttar Pradesh to the northeast, Chhattisgarh to the southeast, Maharashtra to the south, Gujarat to the west, and Rajasthan to the northwest.

2.1 Districts Madhya Pradesh state is made up of 50 districts, which are grouped into 10 divisions: -

Bhopal, Indore, Jabalpur, Gwalior, Ujjain, Rewa, Sagar, Chambal, Shahdol and Hoshangabad.

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Districts:- Anuppur, Alirajpur, Ashoknagar, Balaghat, Barwani, Betul, Bhind, Bhopal, Burhanpur, Chhatarpur, Chhindwara, Damoh, Datia,Dewas, Dhar, Dindori, Guna, Gwalior, Harda, Hoshangabad, Indore, Jabalpur, Jhabua, Katni, Khandwa, Khargone, Mandla, Mandsaur,Morena, Narsinghpur, Neemuch, Panna, Raisen, Rajgarh, Ratlam, Rewa, Sagar, Satna, Sehore, Seoni, Shahdol, Shajapur, Sheopur,Shivpuri, Sidhi, Singrauli, Tikamgarh, Ujjain, Umaria, Vidisha.

2.2 Government and politics

Madhya Pradesh has a 230-seat state Legislative Assembly. The state also sends 40 members to the Parliament of India: 29 are elected to the Lok Sabha (Lower House) and 11 to the Rajya Sabha (Upper House).  

 

 

 

 

 

 

The Madhya Pradesh's Legislative assembly

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2.3 Demographics

Madhya Pradesh is a medley of ethnic groups and tribes, castes and communities. The population of Madhya Pradesh includes indigenous people and migrants from other states. According to census of 2000, 92% followed Hindu religion while others are Muslim(6%), Jain(0.9%), Christians(0.30%), Buddhists(0.30%), and Sikhs(0.20%).The scheduled castes and scheduled tribes constitute a significant portion of the population of the State. The scheduled castes are 13.14% while scheduled tribes were 20.63%.

No. of Districts – 50

No. of Sub Districts – 342

No. of Towns – 476

No. of Statutory Towns – 364

No. of Census Towns – 112

No. of Villages – 54903

Total Rural Urban

Population Persons 72,597,565 52,537,899 2,005,966

Male 37,612,920 27,142,409 10,470,511

Female 34,984,645 25,395,490 9,589,155

Population (0-6 yrs) Persons 10,548,295 (14.5%)

8,132,745

(15.5%)

2,415,550

(12.0%)

Male 5,516,957

(14.7%)

4,242,585

(15.6%)

1,274,372

(12.2%)

Female 5,031,338

(14.4%)

3,890,160

(15.3%)

1,141,178

(11.9%)

Literates Persons 43,827,193

(70.6%)

28,991,005

(65.3%)

14,836,188

(84.1%)

Male 25,848,137

(80.5%)

17,549,814

(76.6%)

8,298,323

(90.2%)

Female 17,979,056

(60.0%)

11,441,191

(53.2%)

6,537,865

(77.4%)

Sex Ratio 930 936 916

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3. National Programme for Control of Blindness, Madhya Pradesh: Current Status

 

The National Programme for Control of Blindness was launched in the state of Madhya Pradesh in 1978 as a centrally sponsored programme. For the purpose of health, the State has been divided into seven divisions namely Bhopal, Indore, Jabalpur, Gwalior, Ujjain, Rewa and Sagar. Madhya Pradesh has 50 districts, 313 blocks and 52117 villages. Health care services are being provided in the State by 48 district hospitals, 56 civil hospitals, 333 community health centres, 1156 primary health centres and 8860 sub-centres.

3.1 Organizational Setup of Blindness Control Programme Madhya Pradesh

In the non-government set up, 150 NGOs, 56 private institutions and 91 private practitioners are functional to provide eye care services in the state.

3.2 Human Resource and Infrastructure for eye care

3.2.1 Human Resources in Blindness Control Programme in Madhya Pradesh

Working Vacant Total

Class I (Eye Surgeon) 44 56 100

Post  Graduate  Medical  Officer  in  

Ophthalmology 113 14 127

Ophthalmic Assistant   434 163 598

 

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3.2.2 Training of Human Resource in Madhya Pradesh  

IOL Trained Phaco Trained

Class I Eye Surgeon 14 1

PGMO 67 18

Total 81 19

Ophthalmic Assistant Refresher Trained

85

3.2.3 Infrastructure & Equipments The current status of the equipments available in the government hospitals is shown in the table below:

Equipment name From GOI

From State

Total Working Not working

Functional equipments (%)

Operating Microscope

55 7 62 52 10 83.9

A scan Biometer 53 6 59 49 10 83.1 AV Unit 35 - 35 32 3 91.4 Indirect Ophthalmoscope

48 - 48 48 0 100.0

Cryo Unit 42 - 42 40 2 95.2 Fumigator 32 - 32 23 9 71.9 Auto clave 50 - 50 42 8 84.0 Keratometer 53 8 61 60 1 98.4 Slit lamp 54 6 60 58 2 96.7 Yag Laser 20 - 20 19 1 95.0 Streak Retinoscope

42 50 92 89 3 96.7

Tonometer 91 50 141 140 1 99.3 Direct Ophthalmoscope

67 50 117 113 4 96.6

3.3 Cataract Surgical Performance in Madhya Pradesh

In the year 2008-09, 376143 cataract surgeries were performed in the entire State (84% achievement according to target) and 429695 surgeries were conducted in 2010-11. The NGO sector contributes to nearly 47% cataract surgeries performed in the State while the private sector, district hospitals and medical colleges contribute to 37%, 12% and 4%

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cataract surgeries respectively. 32 districts are performing very well while 8 districts show less than 50% performance.

3.4 School Vision Screening Programme

In the year 2010-11, 37791 schools were covered and 3490087 children were reported to be screened by school teachers. Out of these, a total of 72142 students were diagnosed with refractive error and 35990 were provided with free spectacles. Five districts did not provide any spectacles to children diagnosed with refractive error in 2010-11.

3.5 Districts having eye banks

There are around 25 eye banks in the State. In 2010-11, 906 eyes were collected and 454 keratoplasty were performed. The following districts reported having eye bank(s):

Government Sector NGO Sector

Gwalior Bhopal

Indore Sagar

Ratlam Chindwara

Indore

Neemuch

Satna

In the State, all the sub- specialties like Cataract (Phaco, SICS), Cornea, Glaucoma, Squint and Pediatric ophthalmology, Retina, Retinopathy of Prematurity (ROP), Orbit & Oculoplasty, Contact Lens & Low Vision Clinic and emergency services are available however limited to few centres only. There is a huge gap in these eye care specialties services in several parts of the state, and therefore, necessary training to HR, equipment would be required besides the focus on cataract program.

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4. Need assessment for the eye care services

4.1 Magnitude and causes of Blindness in Madhya Pradesh

There is a huge estimated need for all kind of eye care services in the catchments area. For instance, the annual estimated need for eye care services of cataract and refractive errors itself is 3,13,621 blind people (48% of total blind population) and 2,28,682 persons (35% of total blindness burden) respectively. Considering the current capacity in terms of infrastructures, human resources, equipments and current estimated eye care needs in the catchment State of MP (and its respective 50 districts), the State Health Services and State Blindness Control Society has a great potential to tap into the wider market within its catchment areas and offer high volume, high quality and low cost eye care services to meet the need and demand of the area. In addition, State Blindness Control Society may continue its efforts to mobilize resources through grants and donations from NPCB, it may also make proposals for funding from State Government, INGOs where possible. While increasing the service capacity, the State of MP has to strengthen its Human Resource Management Capacity, Quality Improvement of its Services and Outcomes, Systems & Processes for efficient and effective service delivery, optimum utilization of existing NPCB’s Hospital Management Information System (HIMS) for data monitoring, increased community outreach and involvement of satisfied patients, improved IEC campaign using local media customized to the local culture.

 

4.2: Need for diseases control:

4.2.1 Gaps in Cataract Surgical Performance in Madhya Pradesh

In the year 2010-11, 429695 cataract surgeries were performed in the entire State with more than 80% of surgeries were conducted by NGOs and private sector. The performance from the ophthalmologists in district hospitals was around 12% with an average cataract surgery of less than 200 cataract surgeries per ophthalmologists per year.

Proportion of Blindness Numbers Total number of Blind people in Madhya Pradesh (0.9% of total population) 653378

Cataract 48% 313621 Refractive error 35% 228682 Glaucoma 5.1% 33322 Posterior segment including DR 3% 19601 Corneal Blindness including trachoma 1.1% 7187 Others 7.8% 50963

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There is need to increase the cataract surgical outputs by around 10% to meet the population need for the cataract surgery for eliminating avoidable blindness in the State. There is need to give more emphasis on blind patients especially in the remote and underserved areas.

With the available strength of 300 ophthalmologists in the State, the targets can only be achieved if on an average more than 1500 surgeries are performed by each ophthalmologist in the State. Currently, the ophthalmologists in NGO sector are performing surgeries as per this target. There is need to improve the performance in the government sector.

4.2.1.1 Cataract Surgeries: Gaps & Targets as per the population need in MP

Total Population 7,25,97,565 Cataract surgeries 2010-11( against Targets of 450,000) 4,29,695 Cataract surgery required (as per population need) per year 4,70,432 Gap in annual surgeries 40,737 Cataract surgeries required per Million population per year 6,480

4.2.1.2 Cataract surgery targets as per Human Resource Capacity

No. of eye surgeons 300 No. of cataract surgeries per surgeon/week 35 No. of potential cataract surgeries per week 10500 No. of working weeks in a year 45 Human Resource Potential for no. of cataract surgeries per year 472500

4.2.2 Refractive Error Services and School Vision Screening programme

The 17.9% of the population in Madhya Pradesh is estimated of having any type of refractive error including presbyopia in 45 and above age group. The screening of school children is a priority under the National Programme. The programme recommends that the school teachers in the middle schools 3490087? should be trained to screen vision in children. The estimated children enrolled in middle school 6th to 10th standard are around 58 million. Out of these, more than 23 million children should be screened annually assuming that children are screened at the time of entry in 6th standard and then in 9th standard. As per the NPCB reports for the year 2010-11, near 35 million children were screened in Madhya Pradesh in one year. The number is very much higher than the estimated targets. This may be due to more frequent examinations or coverage of even primary classes in some districts.

4.2.2.1 Magnitude of Refractive errors in Madhya Pradesh

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Population Proportion of Population (%)

Prevalence of Refractive error

0-4 years 12% 1% 5-9 years 11% 2% 10-14 years 10% 3% 15-44 years 47% 10% 45+ years 21% 25% 45+ (Presbyopia) 60%

4.2.2.2Refractive errors targets and gaps in Madhya Pradesh

Total Population 7,25,97,565 Estimated number of people with refractive error in all age group including presbyopia 1,30,24003

Estimated number of school children in school (6th-10th standard) 58,07,805

Estimated number of children to be screened by teachers annually

23,23,122

Estimated number of school children requiring spectacles annually

69,  694  

4.2.3. Magnitude of Childhood Blindness in Madhya Pradesh

Total Population 7,25,97,565

Population under 15 years 32% 2,32,31,220

Prevalence of Childhood Blindness 0.8/1000 18585

4.2.4. Magnitude of Diabetic retinopathy (DR) cases in Madhya Pradesh

No. of Persons with Diabetes

14,51,951

DR amongst the diabetics 2,90,390

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4.3. Human Resource Need in Madhya Pradesh

Human Resources Norms MP – As per Vision 2020 targets

Ophthalmic Surgeons 1/50,000 1400 Ophthalmic Assistants 1/50,000 1400

Other Ophthalmic Paramedics Two per Ophthalmic Surgeon 2700

Eye Care Managers 1/500,000 140 Community Eye Specialists 1/5 million 14

4.4. Infrastructure Need in Madhya Pradesh

Infrastructure Norms Number by 2020

Regional Institute of Ophthalmology 1/50mmillion 1

Training Centre-medical Colleges 1/5 million 14

Service centres (secondary level) 1/0.5 million 140

Vision Centres 1/50,000 1400

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5. Group Work

5.1 Group Work 1: SWOT Analysis

During the 2nd day (9th February 2012) of the workshop, a SWOT (Strengths, Weakness, Opportunities and Threats) analysis was done for focusing on strengths and minimizing weaknesses. Key areas included in this group work were human resource optimization & management, infrastructure, service delivery and quality assurance including monitoring, finance, governance, MIS etc.

Strengths and weaknesses (internal environment)

n Strengths

• What are our existing strengths? • What do we do really well? • What makes us different from others?

n Weaknesses

• What areas of work we are not satisfied with? • What can be eliminated? • Complaints about our work?

Threats and opportunities (external environment)

n Threats

• Do we perceive any obstacles in our work from external sources?

• Apprehensions about Funding, Staffing, Technology?

• Political/social/economic opposition to our work?

n Opportunities

• What are the recent favourable trends in our environment?

• Government regulations, Social Patterns, Lifestyle Changes, New Technology

• Are we making use of our expertise and capacity to our best advantage?

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5.1.1. SWOT Analysis by Government Sector (District Hospitals & Medical Colleges)

Strengths Weaknesses General General

Readymade platform for patients to walk in Policy and programmes in place Budgetary provision Free of cost services to needy segment  

Lack of motivation & commitment Attitude towards NGOs Bureaucratic procedures Lack of proper accountability Lack of awareness about policies and guidelines at primary levels  

Human Resource Human Resource Graded system of having specialist Government Policy on training employees

Disproportionate and inadequate staff Burden of non-ophthalmic work Non-optimal utilization of staff Poor team work & in-coordination amongst staff & other departments Posts vacant Lack of continuous trainings Job Turnover (Attrition) Misuse of manpower Performance review systems Promotion system based on seniority rather than performance No dedicated managerial staff

Infrastructure Infrastructure Buildings - well known and accessible Vehicle pool available

Space for dark rooms, DBCS office Building maintenance OT complex-quality and standardization norms only on paper facility for proper sterilization

Quality Quality ISO certified Population survey

Equipment supply Improper record keeping and analysis of data Waiting time for patients more

Management Management Hierarchical structure Planned programmes MIS Funding Various meeting (Purchase committee, HOD, Quarterly) Lateral linkages with other Government department Utilization of resources

Administrative powers with managers Sanctioning system Funds utilization

Marketing & Outreach Marketing & Outreach Funds available for IEC No well defined system

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Field units of health and other departments Service Delivery Service Delivery Government schemes Scope of PPP Sub-specialty department & Eye bank/collection centre Government provides funds for expensive treatment Mobile Van Supporting Satellite vision centre Services Quality affordable & food

Personal rapport with patients Improper Counseling Communication with Pts of Doctor/MSW’s Overcrowding Fire fighting approach

Opportunities Threats Collaboration with NGOs , PPP Human Resource Training – MTs through Medical colleges, Through MTS to District persons ASHA , ANM, AWW & teachers training Recruitment Promotions Job responsibilities and allocation

Political and media interference Human Resource Lack of Trained staff – All types Lack of working hands at all levels Misuse of trained staff

Infrastructure Infrastructure AMC-Repair and maintains policy needs to strengthen

Out dated and out of order equipment

Quality Quality Protocols restricted to Cataract & RE Introduction to Legal protection/ Doctor Indemnity will help Quality measurement tools- NABH, ISO

Quality considerations vs targets vs guidelines Protocols not available for other diseases DR, Glaucoma etc. Medico legal proceedings Research (drug trials)

Management Management Dedicated Clinical Managers In-service Management training

To hire the professionals

Marketing & Outreach Marketing & Outreach Grievance redress committees Tie-up with private Practitioners and organization, specialty camps, marketing, corporate approach

Media

Service Delivery Service Delivery Changes in Govt. Policies Overcrowding

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5.1.2. SWOT Analysis by Non-Government Sector (INGO & Local NGO of MP)

Strengths  and  Weaknesses

STRENGTHHRAvailability  of  skilled  manpower  

Retaining  skilled  manpower  in  rural  areas  

Spirit  of  volunteerismInfrastructureState  of  art  infrastructure/Good  

Equipments

QualityAvailability  of  good  MIS

WEAKNESSHRNon-­‐availability  of  trained  

ophthalmic  nurse  Lack  of  second-­‐line  leadership    Using  Ayurvedic doctorsLack  of  HR  

policies/implementationInfrastructureOne  OT  one  Microscope  QualityImproper  documentationImproper  follow-­‐up

Strengths  and  Weaknesses

STRENGTHManagementPreparation  of  operational  planMarketing  &  OutreachEmpanelment  corporate  Service  DeliveryCommunity  supportTiered  pricing  systemCapability  to  deliver  

comprehensive  eye  care  services

High  volume  extensive    outreach  program

WEAKNESSManagementImplementation  of  planMarketing  &  OutreachImpression  as  free  service  

provider

Service  DeliveryLess  walk-­‐in  patientsGIA  for  cataract  lessLow  priority  for  eye  donation  

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Opportunities  and  Threats

OPPORTUNITIESHROpportunity  for  collaboration  with  in  

NGOsCollaboration  with  GovernmentInfrastructureBurden  of  problem  and  expansion  

opportunities  

QualityGood  clinical  and  surgical  approachQuality  measurement  tools-­‐

NABH/AIOSResearch

THREATS  HRFew  training  institute  Retention  of  ophthalmologists  Not  cooperating  with  leadership  in  

quality  and  system  issuesInfrastructureAvailability  of  regular  electricity  Lack  of  fund  for  building  and  

equipment  maintenanceQualityPerforming  surgeries  in  make-­‐shift  

OTs  Medico  legal  proceedings

Opportunities  and  Threats

OPPORTUNITIESManagementDevelop  second-­‐line  leadershipTo  develop  HR  policy  having  

specialized  person  for  specialist  job.

Gen.  Insurance  schemesMarketing  &  OutreachCollaboration  with  corporateRegular  publicity  from  

government    Competition

THREATS  ManagementChange  in  leadershipAcceptance  to  change  is  very  

low    Marketing  &  OutreachBranding  as  charity  hospitalMisuse  of  name  of  the  

institute

26    

Opportunities  and  Threats

OPPORTUNITIESService  DeliveryGovernment  aid  to  support  

specialist  services  Strengthen  referral  system    To  open  eye  donation  centers  

in  rural  areas  and  in  medical  colleges/district  hospitals

Collaboration  for  transporting  corneas  with  railways/pvtairlines.

THREATS  Service  DeliveryDelayed  GIA  reimbursement    Dependent  of  external  fundingLack  of  system  for  financial  

sustainability

5.2 Group Work 2: Division wise discussion and suggestions of the groups

5.2.1 Human Resources 1. Lack of trained staff-training and refresher trainings to PMOAs 2. Optimise resources-disease load of administrative works : exempt from other

duties from the months of October to March 3. Number of ophthalmologists are less in number and doing other non-ophthalmic

jobs 4. Non-operating surgeons, identify non-operating ophthalmologists and allocate

work accordingly 5. Training in all eye care disease priorities such as DR, Pediatric, Glaucoma,

Retina, Cornea, LV 6. Motivation, commitment and reluctance in human resources-performance based

appraisal and team work may be a solution 7. PMOAs should be under the supervision of ophthalmologists 8. PMOA should be at the level of vision centres 9. Awareness about proper record keeping, quality of services, answerability 10. Training of ASHA workers 11. increase PMOA-vacant posts to be filled 12. Inequitable distribution of PMOA

27    

5.2.2. Infrastructure and Equipment 13. Vision Centres should be developed in PHCs, however adequate space needs to be

provided. 14. Operating microscopes and Phaco machines may be considered after doctors have

undergone Phaco training 15. Regular maintenance of equipment should be undertaken. For this purpose,

maintenance of equipments-PMOA or NGO representative may be trained for 6 weeks in equipment maintenance

16. Lack of office space, administrative powers and managerial staff for DPM. 17. Easy procurement of equipments without delay.

5.2.3. Disease Control 18. Based on the population and prevalence of blindness as well as the current annual

targets, need and unmet services with existing resources should be worked out for setting targets for each district for 2012 onwards

19. Mapping of eye care services in the State including NGOs/private organizations should be done on a priority for better monitoring and referral network

20. Specialty eye care services to be made available to all divisions. 21. Mapping of specialty eye care services in Madhya Pradesh as information is

available to all DPMs

5.2.4. Quality Monitoring 1. No CSR records are maintained and hence a suggestion that such data should be

kept 2. Ensure follow up ; 5% post operative cases to be monitored by DPM 3. HMIS, developed by NPCB, need to be implemented by all DPMs and data need

to be verified by the DPM for its accuracy and reliability. 4. Problems in opening the HMIS and in passwords for the systems. Will be taken up

with NPCB by the SPO for a solution.

5.2.5. Sustainability 5. Co-ordination between NRHM and NPCB 6. Early disbursements of DBCS funds to all NGOs.

28    

6. Recommendations by the groups

6.1. Human Resources

1. Ophthalmologists: Currently 350 ophthalmologists are available in Madhya Pradesh. This includes 227 in Government sector. One third of these posts are vacant and another 40% are non-surgical ophthalmologists. The vacant posts need to be filled. Majority of the ophthalmologists are posted under PG-Medical Officer cadre and have to conduct general duties in the hospital. There is need to initiate motivation among non-surgical ophthalmologists for non-surgical ophthalmic including screening camps, follow up services and retina and glaucoma clinics.

2. The ophthalmologists are not showing interest in specialty training for skill transfer. It is suggested that short-term hospital based programme should be conducted with support of voluntary faculty/ RIO faculty with - in their own hospitals. The agencies like VISION 2020 - INDIA can be one of the resources for such programmes. In the long term, RIOs and medical college in Madhya Pradesh should play mentoring role for the training programmes for the ophthalmologists.

3. As per the NPCB guidelines, 1400 PMOA are required in the State. There is need to develop training centres either through Medical Universities or other recognized centres to meet the future demand. All the vacant posts of the PMOA should be filled.

4. Training in all eye care disease priorities such as DR, Pediatric, Glaucoma, Retina, Cornea, Low Vision should be arranged.

5. Team building workshops should be organized for motivation, commitment and improved performance among human resources. This may be done with the support of VISION 2020 – INDIA resources.

6. Training of ASHA workers in primary eye care should be adopted at the Vision Centre level to improve the awareness, identification and referral of blind patients and children with visual impairment. It is suggested that state government should earmark funds for training and output-based honorarium for these workers as done in other National Programmes. NGOs like Sight savers may be utilized for effective implementation of this programme.

6.2. Infrastructure and Equipment

1. Strengthening of Regional Institute of Ophthalmology, Bhopal and Medical colleges in MP a. They should be an integral part of the Blindness Control Programme: The

Blindness Control Programme under Director Health services and Director Medical Education should work in coordination for blindness control activities

b. There is need to assess the current capacity of RIO, Bhopal in order to further strengthen it as centre of excellence for research, training and service delivery in

29    

eye care. This may be taken with NPCB or Dr. R.P. Centre for necessary technical support.

c. The RIO, Bhopal should be a separate agency instead of part of Medical College. d. All the speciality eye care services like Paediatric Ophthalmology Unit, Vitreo-

Retina clinic, Low Vision clinic etc should be available in the RIO with high output and good quality services. The RIO should have trained ophthalmologists in all the subspecialties.

e. The RIO and Medical colleges should be responsible for training of ophthalmologists and optometrists all over the State. Currently most of the ophthalmologists have to go to other States for speciality training.

f. RIO and medical colleges should be accountable for the referred cases from the district hospital. There should be some feedback information to the district hospital for referred cases.

g. RIO and medical colleges should be involved in research and surveys in the State. There is a need for conducting survey on blindness, Vitamin A deficiency, blind school etc.

h. The training in Phaco-surgery and availability of Phaco-machines may be considered in all medical colleges and also at the district hospitals.

2. District mobile unit should be available in all the districts. 3. It is recommended that the outreach surgical camps should be strictly prohibited in

the entire State as per the guidelines of NPCB. 4. More emphasis is required for infrastructure development and human resource

availability in the low performing districts, the districts in remote areas or difficult areas. The low performing districts Annupur, Sidhi, Sheopurkala, Harda, Dindori, Alirajpur. The INGOs, local NGOs should be promoted to strengthen the service delivery in these districts.

5. All the CHCs (in Population 50,000 to 100,000) should have well equipped Vision Centres with adequate space for refraction facility. A full time Paramedical Ophthalmic Assistant(PMOA) should be posted in each CHC accountable for the screening camps for cataract and school vision screening programme in the CHC.

6. Regular maintenance of equipment should be undertaken. For this purpose, maintenance of equipments-PMOA or NGO representative may be trained in equipment maintenance.

30    

6.3 Disease Control

1. Based on the population and prevalence of blindness as well as the current annual targets, need and unmet services with existing resources should be worked out for setting targets for 2012 onwards. The targets as per the population needs for cataract and school vision screening have been estimated as follows. The district wise targets are also given in the annexure. The district authorities may use these targets for the districts. These targets may be modified for individual districts depending upon other factors like availability of ophthalmologists, NGOs in the area, difficult areas etc.

Years Cataract School Vision Screening

2012-13 4,70,432 23,23,122

2013-14 4,79,841 23,69,584

2014-15 4,89,438 24,16,976

2015-16 4,99,226 24,65,316 2016-17 5,09,211  

25,14,622

2. Mapping of eye care services specifically the specialty services should be undertaken in the state. It is suggested that Specialty services should be made available to all divisions.

6.4 Quality & Monitoring

1. Currently cataract surgical records are not maintained in most of the hospitals. The information about cataract surgical outcomes are not available in most of the hospitals. It is suggested that records maintenance should be ensured at all level. HMIS, developed by NPCB, needs to be implemented in all districts and data need to be verified by the DPM for its accuracy and reliability. Short-term training of the district programme managers on MIS and record management is necessary. The record keeping should be shifted from manual to MIS.

2. The follow up of the operated cases should be ensured; NPCB recommend

monitoring of at least 5% of the postoperative cases by DPM. It is not practiced in most of the districts.

6.5 Budget allocation:

1. In addition to NPCB funds, state government should earmark funds for training, IEC and assessments and monitoring of blindness control programme.

31    

7. Annexures 1. MP_Cataract surgery– Population based Targets

2. School Vision screening – Population based Targets

3. MP_Meeting Agenda

4. List of participants

32    

Annexure 1: MP Cataract surgery– Population based Targets

S.No District Population

Target CSR

Annual Target surgery required as per the population need

2012-13

2013-14

2014-15

2015-16 2016-17

1 Sheopur 687,952 6,480 4,458 4,547 4,638 4,731 4,825

2 Morena 1,965,137 6,480

12,734

12,989

13,249

13,514 13,784

3 Bhind 1,703,562 6,480

11,039

11,260

11,485

11,715 11,949

4 Gwalior 2,030,543 6,480

13,158

13,421

13,689

13,963 14,243

5 Datia 786,375 6,480 5,096 5,198 5,302 5,408 5,516

6 Shivpuri 1,725,818 6,480

11,183

11,407

11,635

11,868 12,105

7 Tikamgarh 1,444,920 6,480 9,363 9,550 9,741 9,936 10,135

8 Chhatarpur 1,762,857 6,480

11,423

11,652

11,885

12,123 12,365

9 Panna 1,016,028 6,480 6,584 6,716 6,850 6,987 7,127

10 Sagar 2,378,295 6,480

15,411

15,720

16,034

16,355 16,682

11 Damoh 1,263,703 6,480 8,189 8,353 8,520 8,690 8,864

12 Satna 2,228,619 6,480

14,441

14,730

15,025

15,325 15,632

13 Rewa 2,363,744 6,480

15,317

15,623

15,936

16,255 16,580

14 Umaria 643,579 6,480 4,170 4,254 4,339 4,426 4,514

15 Neemuch 825,958 6,480 5,352 5,459 5,568 5,680 5,793

16 Mandsaur 1,339,832 6,480 8,682 8,856 9,033 9,214 9,398

17 Ratlam 1,454,483 6,480 9,425 9,614 9,806

10,002 10,202

18 Ujjain 1,986,597 6,480

12,873

13,131

13,393

13,661 13,934

19 Shajapur 1,512,353 6,480 9,800 9,996

10,196

10,400 10,608

20 Dewas 1,563,107 6,480

10,129

10,332

10,538

10,749 10,964

21 Dhar 2,184,672 6,480

14,157

14,440

14,729

15,023 15,324

22 Indore 3,272,335 6,480

21,205

21,629

22,061

22,503 22,953

23 Khargone 1,872,413 6,480

12,133

12,376

12,623

12,876 13,133

24 Barwani 1,385,659 6,480 8,979 9,159 9,342 9,529 9,719

33    

25 Rajgarh 1,546,541

6,480

10,022

10,222

10,426

10,635 10,848

26 Vidisha 1,458,212

6,480 9,449 9,638 9,831 10,028 10,228

27 Bhopal 2,368,145

6,480

15,346

15,652

15,966

16,285 16,611

28 Sehore 1,311,008

6,480 8,495 8,665 8,839 9,015 9,196

29 Raisen 1,331,699

6,480 8,629 8,802 8,978 9,158 9,341

30 Betul 1,575,247

6,480

10,208

10,412

10,620

10,832 11,049

31 Harda 570,302

6,480 3,696 3,769 3,845 3,922 4,000

32 Hoshangabad 1,240,975

6,480 8,042 8,202 8,366 8,534 8,704

33 Katni 1,291,684

6,480 8,370 8,538 8,708 8,882 9,060

34 Jabalpur 2,460,714

6,480

15,945

16,264

16,590

16,921 17,260

35 Narsimhapur 1,092,141

6,480 7,077 7,219 7,363 7,510 7,660

36 Dindori 704,218

6,480 4,563 4,655 4,748 4,843 4,939

37 Mandla 1,053,522

6,480 6,827 6,963 7,103 7,245 7,390

38 Chhindwara 2,090,306

6,480

13,545

13,816

14,092

14,374 14,662

39 Seoni 1,378,876

6,480 8,935 9,114 9,296 9,482 9,672

40 Balaghat 1,701,156

6,480

11,023

11,244

11,469

11,698 11,932

41 Guna 1,240,938

6,480 8,041 8,202 8,366 8,533 8,704

42 Ashoknagar 844,979

6,480 5,475 5,585 5,697 5,811 5,927

43 Shahdol 1,064,989

6,480 6,901 7,039 7,180 7,324 7,470

44 Anuppur 749,521

6,480 4,857 4,954 5,053 5,154 5,257

45 Sidhi 1,126,515

6,480 7,300 7,446 7,595 7,747 7,902

46 Singrauli 1,178,132

6,480 7,634 7,787 7,943 8,102 8,264

47 Jhabua 1,024,091

6,480 6,636 6,769 6,904 7,042 7,183

48 Alirajpur 728,677

6,480 4,722 4,816 4,913 5,011 5,111

49 Khandwa 1,309,443

6,480 8,485 8,655 8,828 9,005 9,185

50 Burhanpur 756,993

6,480 4,905 5,003 5,103 5,206 5,310

Madhya Pradesh 72597565

6,480

470,432

479,841

489,438

499,226 509,211

34    

 Annexure  2:  Annual  Targets  of  School  Vision  Screening  in  Madhya  Pradesh  

S.No     District  Population  district  

Total  RE  including  presbyopia  all  age  

 Children    that  need  to  be  screened  annually    

Estimated  Refractive  error  cases  in  middle  schools  

1   Sheopur   687,952   123,419 22,014 660  2   Morena   1,965,137   352,546 62,884 1887  3   Bhind   1,703,562   305,619 54,514 1635  4   Gwalior   2,030,543   364,279 64,977 1949  5   Datia   786,375   141,076 25,164 755  6   Shivpuri   1,725,818   309,612 55,226 1657  7   Tikamgarh   1,444,920   259,219 46,237 1387  8   Chhatarpur   1,762,857   316,257 56,411 1692  9   Panna   1,016,028   182,275 32,513 975  

10   Sagar   2,378,295   426,666 76,105 2283  11   Damoh   1,263,703   226,708 40,438 1213  12   Satna   2,228,619   399,814 71,316 2139  13   Rewa   2,363,744   424,056 75,640 2269  14   Umaria   643,579   115,458 20,595 618  15   Neemuch   825,958   148,177 26,431 793  16   Mandsaur   1,339,832   240,366 42,875 1286  17   Ratlam   1,454,483   260,934 46,543 1396  18   Ujjain   1,986,597   356,395 63,571 1907  19   Shajapur   1,512,353   271,316 48,395 1452  20   Dewas   1,563,107   280,421 50,019 1501  21   Dhar   2,184,672   391,930 69,910 2097  22   Indore   3,272,335   587,057 104,715 3141  

23  Khargone(West  Nimar)   1,872,413   335,911 59,917 1798  

24   Barwani   1,385,659   248,587 44,341 1330  25   Rajgarh   1,546,541   277,449 49,489 1485  26   Vidisha   1,458,212   261,603 46,663 1400  27   Bhopal   2,368,145   424,845 75,781 2273  28   Sehore   1,311,008   235,195 41,952 1259  29   Raisen   1,331,699   238,907 42,614 1278  30   Betul   1,575,247   282,599 50,408 1512  31   Harda   570,302   102,312 18,250 547  32   Hoshangabad   1,240,975   222,631 39,711 1191  33   Katni   1,291,684   231,728 41,334 1240  34   Jabalpur   2,460,714   441,452 78,743 2362  35   Narsimhapur   1,092,141   195,930 34,949 1048  36   Dindori   704,218   126,337 22,535 676  37   Mandla   1,053,522   189,002 33,713 1011  38   Chhindwara   2,090,306   375,001 66,890 2007  39   Seoni   1,378,876   247,370 44,124 1324  

35    

40   Balaghat   1,701,156   305,187 54,437 1633  41   Guna   1,240,938   222,624 39,710 1191  42   Ashoknagar   844,979   151,589 27,039 811  43   Shahdol   1,064,989   191,059 34,080 1022  44   Anuppur   749,521   134,464 23,985 720  45   Sidhi   1,126,515   202,097 36,048 1081  46   Singrauli   1,178,132   211,357 37,700 1131  47   Jhabua   1,024,091   183,722 32,771 983  48   Alirajpur   728,677   130,725 23,318 700  49   Khandwa(East  Nimar)   1,309,443   234,914 41,902 1257  50   Burhanpur   756,993   135,805 24,224 727  

 Madhya  Pradesh   72597565   13,024,003 2,323,122 69694  

36    

Annexure 3: Meeting Agenda

MADHYA  PRADESH  STATE  LEVEL  PLANNING  MEETING    

VENUE:  Bhopal,  Madhya  Pradesh    

DATE  &  TIME:    

8th  February  2012,  4:00  PM  –  6:00  PM  

9th  February  2012,  9:00  AM  to  5:00  PM  

AGENDA  FOR  8TH  FEBRUARY  2012,  4:00  PM  –  6:00  PM:    

1. WELCOME  NOTE  –  10  MINUTES  Dr.  V.A.  Joshi/  M.P.  government  representative  to  address  the  delegates  and  briefly  discuss  the  purpose  and  agenda  of  the  meeting.  

2. INTRODUCTION  TO  VISION  2020:  THE  RIGHT  TO  SIGHT  –  INDIA    -­‐  10  MINUTES  Dr.    Col  Deshpande  

3. MAGNITUDE  OF  BLINDNESS  AND  STATUS  OF  EYE  CARE  SERVICES  IN  MADHYA  PRADESH  –  30  MINUTES  PRAVEEN  VASHIST  WILL  TALK  ABOUT  THE  PREVALENCE  OF  BLINDNESS,  MAJOR  CAUSES  AND  KEY  

STRATEGIES  OF  PREVENTABLE  BLINDNESS.  This  session  would  also  involve  a  situational  analysis  on  the  state  of  eye  care  services  in  Madhya  Pradesh  focusing  on  current  and  required  human  resources,  training,  finances  &  budgets,  infrastructure  needs.  The  situational  analysis  would  be  performed  based  on  the  study  done  in  2008/  09.    

4. BRAINSTORMING  SESSION  –  60  MINUTES  Dr.  V.A.  Joshi,  Dr.  Praveen  Vashist,  Col.  Deshpande  and  Dr.  G.V.  Rao  would  lead  this  session.    SETTING  TARGETS  FOR  DISEASE,  INCREASING  PRODUCTIVITY-­‐  DEMAND  AND  HR  TRAINING,  INFRASTRUCTURE,      

5. CONCLUDING  REMARKS-­‐  10  MINUTES    Dr.  V.A.  Joshi,  Col.  Deshpande  

 

AGENDA  FOR  9th  February  2012,  9:00  AM  to  5:00  PM  

1. REGISTRATION10.00  AM  –  10.30    AM    

2.  INTRODUCTION  OF  PARTICIPANTS  AND  BRIEFING  OF  DAY  ONE  ACTIVITIES-­‐  DR.  G.V.RAO-­‐  10.30-­‐10.45  

3.  INTRODUCTION  TO  VISION  2020:  THE  RIGHT  TO  SIGHT  –  INDIA  AND  COMPONENTS  OF  A  STATE  ACTION  PLAN  –10.45-­‐10.50  AM–  COL.  DESHPANDE  

5.  Disease  burden  assessment-­‐  using  templates–Dr.  Praveen  Vashist  10.50-­‐11.05  

6.  QUALITY  ASSURANCE  AND  MONITORING  INDICATORS  FOR  STATE  ACTION  PLAN-­‐  DR.  UDAY  GAJIWALA  

11.05-­‐11.20  

37    

7.  IEC,  Integration  and  sustainability  in  eye  care  -­‐11.20-­‐11.50  

• IEC  including  social  marketing  for  eye  care  in  M.P.-­‐  10  minutes  Mr.  Anand  Sudan    

• Integrated  eye  care  in  M.P.-­‐  10  minutes-­‐  Ms.  Archana  Bhambhal  • Sustainability  in  eye  care-­‐  10  minutes-­‐  Mr.  Prateep  Chakrarvati  

 

This  will  be  followed  by  group  discussion  facilitated  by  various  speakers  where  the  following  topics  will  be  discussed  and  based  on  the  inputs  received;  a  state  plan  for  Madhya  Pradesh  would  be  developed  by  participants.  –  2  hours    30  minutes    (  11.50-­‐  1.00  PM)  

a. Disease  burden  and  various  strategies  to  disease  control–  Facilitated  by  Praveen  Vashist  

b. Human  resources  and  training  needs  –Facilitated  by  Mr.  Ananad  Sudan  c. Infrastructure  and  equipment  maintenance  –  Facilitated  by  Col.  Deshpande    d. Quality  assurance,  reporting,  Monitoring  and  accountability–  Facilitated  by  Dr.  Uday  

Gaziwala,  Mr.  Sarfaraj  e. IEC,  Integration  and  sustainability  in  eye  care  –D.  Joshi,  Ms.  Archana  Bhambhal,  Mr.  

Prateep  Chakrarvati  Lunch-­‐1.00  PM  to  2.00PM  

2. PRESENTATION  OF  GROUP  WORK  AND  DISCUSSION–  10  MINUTES  FOR  GROUP  PRESENTATION  AND  

DISCUSSION  (2.00PM  TO  4.00  PM)  MODERATORS-­‐  DR.V.A  JOSHI,  DR.  PRAVEEN  VASHIST,    COL.  DESHPANDE,  DR.  GV  RAO,  DR.  UDAY  

GAJIWALA  3. COMPILATION  OF  WORKSHOP  REPORT-­‐  DR.  NOOPUR  GUPTA  4. DR.V.A  JOSHI,  DR.  PRAVEEN  VASHIST,  COL.  DESHPANDE  will  present  a  brief  summary  of  the  

compiled  report  in  State  Secretariat.    

   

 

38    

Annexure 4: List of Participants

District Name Post 1 Anuppur Dr Janak Sariwal DPM 2 Ashok Nagar Rajeev Tripathi O.A. 3 Balaghat Dr. Vijay Gandhi DPM 4 Barwani S.R. Bamnia Camp Cor. 5 Betul Dr. V.K. Shrivastava DPM 6 Bhind Dr. A.K. Chowdhary DPM 7 Bhopal Dr. K.K. Agrawal DPM 8 Chhatarpur Dr. V.K. Gupta DPM 9 Chhindwara Dr. R.K. Gohiya DPM

10 Datia Dr. D.K. Gupta DPM 11 Dewas Dr. S.K. Saral DPM 12 Dhar Dr. P. Joshi DPM 13 Guna Dr. S.K. Shrivastava DPM 14 Hoshangabad Dr. More DPM 15 Indore Dr. T.S. Hora DPM 16 Jabalpur Dr. D.P. Gurjar DPM 17 Jhabua Dr. G.S. Awasya DPM 18 Katni Dr. Yashvant Verma DPM 19 Khandwa Dr. S.C. Jain DPM 20 Khargone Dr. Vijay Puloria DPM 21 Mandsaur Ramhate Prajapati O.A. 22 Mandla Dr. Tarun Aharwal DPM 23 Narsingpur Dr. R.M. Mishra DPM 24 Neemuch Dr. (Mrs.) S. Bharti DPM 25 Raisen Dr. Arachana Pundhir DPM 26 Rajgarh Dr. S. Yadu DPM 27 Ratlam Dr. Deep Vyas DPM 28 Satna Dr. R.G. Chourasia DPM 29 Sehore Dr. V.K. Shrivastava DPM 30 Seoni Dr. H.P. Puloria DPM 31 Singrauli J.P. Tiwari DPM 32 Shajapur Dr. S.K. Soni DPM 33 Sheopurkala Dr. R.K. Sharma DPM 34 Sidhi Dr. A.K. Diwedi DPM 35 Tikamgarh Umesh Jain O.A. 36 Ujjain Dr. A.S. Tomar DPM 37 Umaria Dr. M. Sharma DPM

Medical College S.N. Medical College Name Post

1 Bhopal Dr. B. Sharma 2 Indore Preeti Rawat Ashok Temle Reh. Asstt.

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Non- Government Organizations S.N. Institute Name Post

1 Sight Savers Mrs. Arachana Bhambal

Sight Savers Mrs. Jay Shree

Sight Savers Ms. Monu Ravindran

Dilip Bhawan 2 Sadguru Seva Sangh Trust Satna Anand Sidhari Head 3 CBM Bangalore Prateep Chakraborty Chief Development Off. 4 Nav Jyoti Trust Gujarat Dr. Uday Gajwela