NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS

 National Programme for Control of Blindness was
launched in the year 1976 as a 100% Centrally Sponsored
scheme with the goal to reduce the prevalence of
blindness from 1.4% to 0.3%.

 Target for the 10th Plan is to reduce prevalence of
blindness to 0.8% by 2007 prevalence of Blindness is 1%
(2006-07 Survey).

 The plan of action and activities of ‘National
Programme for Control of Blindness (NPCB) in India
can be described under three headings:

 Basic programme components,
 Programme organization
 Strategic plan for ‘Vision 2020: Right to Sight’ in India.

 The basic components of NPCB since its inception
includes the following :

 Extension of eye care services.
 Establishment of permanent infrastructure.
 Intensification of eye health education

 It is being done through the state and district mobile
units by adopting an ‘eye camp approach’ and by
enlisting the participation of voluntary organisations.
The following facilities are being provided in remote
areas:
 1. Medical and surgical treatment for the prevention
and control of common eye diseases.
Eye camp approach is of great help in reducing the
backlog of cataract by mass surgeries.
Recent emphasis is on reach-in-approach.

 2. Detection and correction of refractive errors.

 3. Thorough ocular examination including vision of
school children for early detection of eye diseases and
promoting ocular health

 4. Rehabilitation training of visually handicapped.

 5. General survey for prevalence of various eye
diseases

 The ultimate goal of NPCB is to establish permanent
infrastructure to provide eye care services.

It is being done in three-tier system i.e.,
peripheral,
intermediate and
central level.

 A wide range of eye conditions can be
treated/prevented at the grass root level by locally-
trained primary health workers.

Peripheral sector for primary eye care at PHC and
subcentre levels is being strengthened by:
 Providing necessary equipment,
 Posting a paramedical ophthalmic assistant, and
Organising refresher courses for doctors and other
staff of PHC on prevention of blindness.

 Secondary eye care involves
 Definitive management of common blinding
conditions such as
 cataract,
glaucoma,
trichiasis,
entropion and
ocular trauma.

 Tertiary eye care services include the sophisticated eye care
such as

 retinal detachment surgery,
 laser treatment for various retinal and other ocular disorders,
 corneal grafting and
other complex forms of management not available in
secondary eye care centres.

 An apex National Institute of Ophthalmology has
been established at Dr. Rajendra Prasad Centre for
Ophthalmic Sciences, New Delhi.

 This institute has been converted into a centre of
excellence to provide overall leadership, supervision
and guidance in technical matters to all services and
technical institutions under the programme.

 Intensification of eye health education is being done
through

 mass communication media (television talks, radio
talks, films, seminars and books),
 School teachers, social workers, community leaders,
 Mobile ophthalmic units, and existing medical and
paramedical staff.

 Main stress is laid on care and hygiene of eyes and
prevention of avoidable diseases.

 1. Central level
 ‘National Programme Management Cell’ located in the
office of Director General Health Services (DGHS),
Department of Health,
Government of India (GOI).

 To oversee the implementation of the programme
three national bodies have been constituted as below:
 National Blindness Control Board, chaired by
Secretary Health to GOI.
 National Programme Co-ordination Committee,
chaired by Additional Secretary to GOI.
 National Technical Advisor Committee, headed by
Director General Health Services, GOI.

 l. Procurement of goods (major equipments, bulk
consumables, vehicles, etc.)

 2. Non-recurring grant-in-aid to NGOs.

 3. Organizing central level training courses.

 4. Information, education and communication (IEC)
activities (prototype development and mass media).

 5. Development of MIS, monitoring and evaluation.

 6. Procurement of services and consultancy.

 7. Salaries of additional staff at the central level.

 A ‘State Programme Cell’ is already in place for which five
posts including that of a Joint Director (NPCB) have been
created.

State-level activities include:
 l. Execution of civil works for new units.
 2. Repairs and renovation of existing units/ equipments.
 3. State level training and IEC activities.
 4. Management of State Project Cell.
 5. Salaries for additional staff.

 ‘District Blindness Control Societies’ have been
established.

 District blindness control society
 The concept of ‘District Blindness Control Society
(DBCS)’ has been introduced, with the

 primary purpose to plan, implement and monitor the
blindness control activities comprehensively at the
district level under overall control and guidance of the
‘NPCB'.

 achieve the maximum reduction in avoidable
blindness in the district through optimal utilisation of
available resources in the district

 1. To make control of blindness a part of the
Government’s policy of designating the district
as the unit for implementing various development
programmes.

 2. To simplify administrative and financial procedures.

 3. To enhance participation of the community and the
private sector.

 Each DBCS will have a maximum of 20 members,
consisting of 10 ex-officio and 10 other members with
following structure:
 Chairman: Deputy Commissioner/District
Magistrate.
 Vice-Chairman: Civil Surgeon/District Health
Officer.
 Member Secretary:
District Programme Manager (DPM) or
District Blindness Control Co-ordinator(DBCC),

 Members will include
District Eye Surgeon,
District Education Officer,
President local IMA branch,
President Rotary Club,

• Advisor of the society is the State Programme
Manager.

 Technical guidance is provided by the Chief
Ophthalmic Surgeon/Head of the Ophthalmology
Department of Medical College

 1. Annual district action plan is to be submitted by DBCS.
Funding will be in two instalments through GOI/SBCS.

 2. NGO participation made accountable; allotted area of
operation.

 3. Revised guidelines for DBCS — capping of expenditure;
phasing out contract managers.

 4. Emphasis on utilization of existing government facilities.

 5. Gradual shift from camp surgery to institutional
surgery.

 6. Development of infrastructure and manpower for
IOL surgery

 Adopted at a meeting held in Goa on October 10-13,
2001 and constituted a working group.
 The draft plan of action submitted by the ‘Working
Group’ includes following strategies:

 A. Strengthening advocacy
 B. Reduction of disease burden
 C. Human resource development, and
 D. Eye care infrastructure development

The essence of these activities is:

 Public awareness and information about eye care and
prevention of blindness.

 Introduction of topics on eye care in school curricula.

 Involvement of professional organizations such as
All India Ophthalmological Society (AIOS),
Eye Bank Association of India (EBAI) and
Indian Medical Association (IMA) in the NPCB.

 To strengthen the functioning of District Blindness
Control Society (DBCS).

 To enhance involvement of NGOs, local community
societies and community leaders.

 To strengthen hospital retrieval programmes for eye
donation through effective grief counselling by
involving volunteers, Forensic Deptt., Police etc.

 Target diseases identified for intervention under
‘Vision 2020’ initiative in India include:
 Cataract,
 Childhood blindness,
 Refractive errors and low vision,
 Corneal blindness,
 Diabetic retinopathy,
 Glaucoma, and
 Trachoma (focal)

 Objective. To improve the quantity and quality of
cataract surgery.

Targets and strategies include:
 To increase the cataract surgery rate 6000 by 2020.
 IOL surgery for >80% by the year 2005 and for
all by the year 2010.
 YAG capsulotomy services at all district hospitals by
2010.

 Achievements :
 Performance of Cataract Surgery: has been
steadily increasing as indicated below
Year Target Achievement % Surgery with
IOL
2002-03 40,00,000 38,57,133 77

2003-04 40,00,000 4200138 83

2004-05 42,00,000 4513667 88

2005-06 4513000 4905619 90

2006-07 4500000 5040089 93

2007-08** 5000000 4068027 92

 Prevalence of childhood blindness in India 0.8/1000
children
 Common causes are
 vitamin A deficiency,
 measles,
 conjunctivitis,
 ophthalmia neonatorum,
 injuries,
 congenital cataract,
 retinopathy of prematurity (ROP), and
 childhood glaucoma.
 Refractive errors are the commonest cause

 Is to eliminate avoidable causes of childhoodblindness
by the year 2020.
 Strategies and activities

 1. Detection of eye disorders.
 At the time of primary immunization,
 At school entry, and
 Periodic check up every 3 years for normal and
every year for those with defects.

 Prevention of xerophthalmia

 Prevention and early treatment of trachoma by active
intervention

 Refractive errors to be corrected at primary eye care
centres.

 Childhood glaucomas to be treated promptly.

 Harmful traditional practics need to be avoided.

 Prevention of ROP

 3. Curable childhood blindness due to
cataract,ROP, corneal opacity and other causes to be
taken care of by the experts at secondary and tertiary
level eye care services.

 Targets include:

 Establishment of Paediatric Ophthalmology Units.

 Establishment of refraction services and lowvision
centers

 Targets.
1. Refraction services to be available in all primary
health centres by 2010.
2. Availability of low-cost,good quality spectacles for
children to be insured.
3. Low vision service centres are to be established at
150 tertiary level eye care institutions.

 As per the ‘National Survey on Blindness’ (1999-2001,
Govt. of India Report 2002)9 glaucoma is responsible
for 5.8% cases of blindness in 50+ population.

 Failure of early detection of the disease poses a
management problem towards controlling
glaucomatous blindness.

 Following measures are recommended for opportunistic
glaucoma screening (case detection)

 Opportunisitic screening at eye care institutions
should be done in all persons above the age of 35 years,
those with diabetes mellitus, and those with family
history of glaucoma.

 Community based referral by multi-purpose workers
of all persons with dimunition of vision, coloured haloes,
rapid change of glasses, ocular pain and family history of
glaucoma.

 Opportunistic screening at eye camps in all patients
above the age of 35 years.

Following recommendations are made:

 Awareness generation by health workers.

 All known diabetics to be examined and referred to
Eye Surgeon by the Ophthalmic Assistant.

 Confirmation by fundus fluorescein angiography
(FFA) and laser treatment of diabetic retinopathy at
tertiary level.

 The major causes of this blindness are corneal ulcers
due to infections, trachoma, ocular injuries and
keratomalacia caused by nutritional deficiencies.

Objectives are:
 To reduce prevalence of preventable and curable
corneal blindness.
 To identify the infants at risk in cooperation with RCH
programme.

 Includes all categories of paramedics who work full
time in eye care.
 1. Hospital-based MLOP. These include etc.
 2. Community-based MLOP include those with
outreach/
 field functions such as

Mid-Level Ophthalmic Personnel (MLOP).

Hospital-based MLOP Community-based MLOP

Ophthalmic primary eye
nurses, careworkers
ophthalmic
technicians, ophthalmic
optometrists, assistants.
orthoptists

 D. Eye care infrastructure development

Centre's of Excellence 20
Professional leadership
CME , Research
Tertiary Laying of Standards & QA
Strategy development
Training Centre's 200
Tertiary eye care including retinal surgery, corneal
transplantation , Glaucoma surgery
Training & CME

Secondary Service Centre's 2000
Cataract surgery
Other common eye surgeries
Facilities for refraction
Referral services

Vision centre's 20000
Primary Refraction & prescription of glasses
Primary eye care
School eye screening programme
Screening & Referral services

NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS

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