From Darkness to Light

O loss of sight, of thee I most complain!….

Blind among enemies, O worse than chains, dungeon or beggary, or decrepit age! Light, the prime work of God, to me is extinct, and all her various objects of delight annulled, which might in part my grief have eased. Inferior to the vilest now become of man or worm; the vilest here excel me, they creep, yet see; I, dark in light, exposed to daily fraud...

-John Milton

Milton was expressing a primal sentiment as ability to see is critical for realization of human potential. This sentiment is shared by at least 12 million people in India who fall in the category of blind (visual acuity less than 6/60). In many cases this fate is totally avoidable or can be corrected by simple interventions. For example, in the year 2008-09, the country performed nearly 5.8 million cataract surgeries with 94% inter-ocular lens (IOL) implantation. In layman terms this means blindness was either prevented or corrected in 5.4 million people in one year. This was one of the activities of National Programme for Control of Blindness (NPCB) which has made a commendable progress in terms of Cataract Surgical Rate and the momentum thus generated would continue in future also.

National Programme for Control of Blindness (NPCB) is now more than thirty years old, launched in 1976 as 100% centrally sponsored scheme has the professed goal of reducing blindness prevalence to 0.3% by the year 2020. Blindness prevalence stood at 1% in 2006-07, down from 1.1% in the year 2001-02. Refractive errors are other important cause of vision impairment and are being addressed effectively through institutional and outreach activities. School Eye Screening is an important strategy wherein eyes of children studying in schools are screened for vision impairment and glasses distributed free of cost to students from poor socio-economic strata. Corneal blindness is being addressed through eye banking activities and a new thrust has been given for eye donation and corneal transplantation.

With the approval of Rs 1250 crores and implementation of Eleventh Plan (2007-12) the programme has taken a lead in addressing other issues of blindness in a comprehensive manner. These include Diabetic Retinopathy, Glaucoma, Childhood blindness, Low Vision and ocular injuries in a mission mode through successful Public Private Partnership. The endeavor of the programme is to eliminate all causes of avoidable blindness and to reach a sustainable level where-in all people have access to level appropriate eye care service. Tele-ophthalmology a new information technology tool has been introduced under the programme for reaching the undeserved population in rural & tribal areas. The results are very encouraging and being scaled up in a phase manner.

The programme has been fully integrated under National Rural Health Mission (NRHM) to enhance the reach and coverage including utilization of services of community link worker like Accredited Social Health Activist (ASHA) and Anganwadi workers. State Blindness Control Societies and District Blindness Control Societies have been merged State Health Societies and District State Societies formed under the NRHM umbrella. Under NRHM facility for IOL implantation are to expanded to at least Taluka level.

Other new initiatives include funding for construction of eye wards and dedicate eye OT especially in North East State and Hilly/underdeveloped States and appointment of eye surgeons, eye donation counselors and Para-Medical Ophthalmic Assistant (PMOA) especially for the new or district where there are none. The recurring expenditure of such workforce will be borne by Government of India till the term of eleventh plan period and thereafter it would be taken up by respective State/UTs. Funding for provision of latest equipment and instruments for establishing & strengthening eye care services in government institutions i.e. vision centre at Primary Health Centre (PHC), Community Health Centre (CHC) through district hospital and medical colleges are being developed into centre of excellence for providing pediatric ophthalmology retina units/low vision units.

Non-governmental sector providing free services to needy population are being supported through recurring and non-recurring grant as per the approved schemes. Capacity building of health personnel is another important strategy for improving their skills and updating them on issues relevant to the programme for delivery of eye care services. The Government coordinates the in-service training of eye surgeons working in public sector and provides funding to States/UTs for other health care staff including medical officers, paramedical and community link workers. Advocacy and social mobilization including Information, Education and Communication (IEC) activities have made a impetus in improving community awareness.

Funds utilization is an indicator for planned activities being under taken and during last five years utilization has been to the tune of nearly 100% of the allocation. National Programme for Control of Blindness (NPCB), through State/UTs and all other stakeholders and partners are consistently moving forward in advancement of comprehensive eye care services and hopefully would be able to bring the level of blindness in the country from current status of 1.0% to 0.3% by the year 2020.