NPCB
- 1. NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS SREE VISHNU.V 3rd yr MBBS
- 2. OUTLINE OF THE PRESENTATION • INTRODUCTION • OBJECTIVES • STRATEGIES • PREVENTION OF BLINDNESS • ORGANIZING STRUCTURES • VISION 2020
- 3. • NPCB was launched in the year 1976. • “Eye Health for All” • 100% CENTRALLY sponsored scheme. • GOAL: to reduce the prevalence of blindness from 1.4% to 0.3% , by 2020. • Incorporated with Trachoma control programme - which started in 1968 • As per the survey conducted by NPCB on avoidable blindness during 2006-07, the prevalence rate has decreased from 1.1% (2001-02) to 1% (2006-07) INTRODUCTION
- 4. Definition of BLINDNESS WHO defined blindness as “visual acuity of less than 3/60 or its equivalent” • According to NPCB: Inability of a person to count fingers from a distance of 6 m. Vision 6/60 or less with best possible spectacular correction. Diminution of FIELD OF VISION to 20 degrees or less in better eye.
- 5. Main causes of Blindness in INDIA are 62.60% 19.70% 0.90% 5.80% 1.20% 0.90% 4.70% 4.19% Cataract Refractive Error Corneal Blindness Glaucoma Surgical Complication Posterior Capsular Opacification Posterior Segment Disorder Others
- 6. OBJECTIVES The main objectives of the programme in the 12th Five Year Plan period are: • To continue three ongoing signature activities: i. 66 L cataract surgeries per year; ii. School eye screening & distribution of 9 L free spectacles every year for refractive error; iii. Collection of 50000 donated eyes per year for Keratoplasty. • To reduce the backlog of blindness through identification and treatment of blind. • To develop Eye care facilities for every 5 lac population.
- 7. • To improve the quality of service delivery by strengthening and upgradation of RIOs, district & Medical colleges. • To develop additional human resources for delivering high quality comprehensive EYE CARE. • To enhance the community awareness on eye care • Increase and expand research for prevention of blindness & visual impairment. • To secure participation of Voluntary organisations in eye care.
- 8. STRATEGIES ADOPTED TO ACHIEVE THE OBJECTIVES 1. Free cataract surgery through health care delivery system & by the involvement of NGO sector & private practitioners. 2. Emphasis on eye care programme by covering other diseases such as Diabetic retinopathy, Glaucoma, corneal transplantation, retinal surgery, childhood blindness etc. 3. Screening of population above 50 yrs of age. 4. Organisation of screening eye camps and fixed eye care facilities.
- 9. 5. Provision of glasses by screening of children for identification & treatment of refractive errors 6. Information Education Communication (IEC) activities for creating awareness in the community. 7. Regional Institutes of Ophthalmology and Medical Colleges of the states to be strengthened with latest equipments & training of manpower so that they can be upgraded as Centres of Excellence in the regions. 8. PHCs by establishing vision centres with a PMOA in position. 9. District hospitals to be strengthened by upgrading infrastructure & providing
- 10. TREATMENT OF CATARACT Year Target No. of Cataract operations performed % surgery with IOL 2012-13 66,00,000 63,02,894 95 2013-14 66,00,000 62,63,150 95 2014-15 66,00,000 64,19,933 95 2015-16 66,00,000 63,04,177 95 2016-17 66,00,000 64,81,435 95 2017-18* 66,00,000 6,06,321
- 11. TREATMENT/MANAGEMENT OF OTHER DISEASES Year No. of persons with other eye diseases treated Target Achievement 2012-13 72,000 2,55,804 2013-14 72,000 2,12,596 2014-15 72,000 2,42,830 2015-16 72,000 3,12,925 2016-17 72,000 4,04,677 2017-18 72000 51,180 Note:- 1. The figures of physical performance for the year 2017-18 are based on reports received from States/UTs upto 14.07.2017.
- 13. CHANGING CONCEPTS IN EYE HEALTH CARE Primary eye care Promotional & protection of eye health On-spot treatment of commonest eye diseases Improve coverage and quality Establishment of National Programme Need for PHC approach Team Concept Deprofessionalisation, VHG, Ophthalmic assistant, MPW, Voluntary agencies Epidemiological Approach Measurement of Incidence, prevalence, risk factors of disease
- 14. Components for action in N.H.P. PREVENTION OF BLINDNESS 1) INITIAL ASSESSMENT METHODS OF INTERVENTION EVALUATION Primary care Secondary care Tertiary care Specific programmes LONG TERM MEASURES
- 15. 2) METHODS OF INTERVENTION PRIMARY EYE CARE Treatment and prevention at grass-root level by locally trained peripheral health workers. (VHG, MPW) (acute conjunctivitis, opthalmia neonatorum, trachoma, superficial foreign body, xeropthalmia) Provided with essential drugs ; Topical tetracycline, Vit. A capsules, eye bandages, shields, etc. Trained to refer difficult cases (eg. Corneal ulcer, penetrating foreign bodies, painful eye conditions & infections which do not respond to treatment) to nearest PHC & district hospital. Promotion of personal hygiene, sanitation, good diet, safety in general.
- 16. SECONDARY CARE Definitive management of common blinding conditions such as cataract, trichiasis, entropion, ocular trauma, glaucoma, etc. PHC’s and district hospitals where eye departments or eye clinics are established. Mobile clinics- • Disadv- lacks permanence, • Adv- problem specific; best use of local resource, • provide inexpensive eye care Eye camp approach- cataract, general eye health, surveys.
- 17. TERTIARY CARE At National /Regional capitals, often associated with Medical colleges & Institutes of Medicine (National Institute for Blind, Dehradun) Sophisticated eye care- Retinal detachment , Corneal grafting Eye banks- Maximum states passed Corneal grafting Acts Education of blind in special schools and employment.
- 18. SPECIFIC PROGRAMMES 1) TRACHOMA CONTROL • Early diagnosis and treatment • Mass campaigns with Top. Tetracycline • Improvement of SE conditions • Trachoma Control Programme launched in 1963; merged NBCP in 1976. 2) SCHOOL EYE HEALTH SERVICES • Screened & treated for refractive errors, squint, ambylopia, trachoma • H.E. – good posture, proper lighting, avoidance of glare, angle between books and eye.
- 19. 3) VIT. A PROPHYLAXIS • 2 lakh IU given orally at 6 monthly intervals 1-6 yrs 4) OCCUPATIONAL EYE HEALTH SERVICES • Education, protective devices, • improve safety of machines, • proper illumination, • pre-placement examination.
- 20. 3) LONG TERM MEASURES • Improving quality of life, modifying factors responsible for persistence of eye health problems. • Poor sanitation , lack of adequate safe water supplies, increase intake of food rich in Vit. A, lack of personal hygiene. Health Education: • Create community awareness of the problem • Motivate community to accept total eye health programmes. • To secure community participation. 4) EVALUATION Evaluation of objectives.
- 21. ADMINISTRATION CENTRAL STATE DISTRICT Opthalmology section, Directorate General of health services, Ministry of HFW State ophthalmic cell, DHS, State health societies District blindness control society
- 22. SERVICE DELIVERY & REFERRAL SYSTEMS TERTIARY SECONDARY PRIMARY Regional institutes of Opthalmology & Centres of excellence District hospital and NGO eye hospital Subdistrict level hospitals/CHCs MOUs, upgraded PHCs,
- 23. ORGANIZING STRUCTURE For effective coordination and convergence following structure is proposed at various levels under the scheme: A. CENTRAL LEVEL Programme organisation is the responsibility of the National Programme Management Cell located in the office of DGHS. Three national bodies have been constituted: 1. National Blindness Control Board 2. National Programme Coordination Committee 3. National Technical Health Services
- 24. Central level activities: • Procurement of goods. • Non-recurring grant-in-aid to NGOs. • Organizing central level training courses. • Information, Education & Communication activities. • Development of MIS, monitoring & evaluation. • Procurement of services and consultancy. • Salaries of additional staff at the central level
- 25. B. STATE LEVEL A State Programme Cell is in place for which 5 posts including a Joint Director have been created. • STATE LEVEL ACTIVITIES: 1. Execution of civil works for new units. 2. Repairs & renovation of existing units. 3. State level training & IEC activities. 4. Management of State Project Cell. 5. Salaries for additional staff.
- 26. C. DISTRICT LEVEL DBCS • DISTRICT BLINDNESS CONTROL SOCIETY 1994-1995. • Function monitor and implement NPCB at district level. AIMS & OBJECTIVES: 1. To assess the magnitude of blindness in the district level. 2. To conduct eye camps and cataract surgeries with the help of NGOs and district mobile ophthalmic units. 3. To procure and distribute the drugs and other consumables.
- 27. 4. To provide financial assistance to NGOs to perform cataract surgeries. 5. To promote eye donation. 6. To monitor the utilization of the eyes collected by the collection centres and eye banks. 7. To monitor the implementation of NPCB at district level. 8. To arrange for school eye screening for detection of refractive errors in children and distribution of spectacles
- 29. COMPOSITION • Chairman: Deputy commission/ District magistrate • Vice chairman: District Health Officer • Member secretary: District Programme Manager • Technical advisor: HOD of Ophthalmology / Chief Ophthalmic Surgeon • Members: Medical Superindendent / District Surgeon , DEO , Representatives of NGOs. • Due to formation of NRHM under 11th FIVE YEAR PLAN , DBCS has been merged with District Health Society (DHS).
- 32. VISION 2020: THE RIGHT TO SIGHT • It is a global initiative to reduce avoidable blindness by the year 2020. • Globally, target diseases are: 1. Cataract 2. Refractive errors 3. Childhood blindness 4. Corneal blindness 5. Glaucoma 6. Diabetic retinopathy
- 33. Cataract Trachoma Onchocerciasis Childhood blindness Refractive Errors and Low vision 50% global incidence 146 million people worldwide 17 million people affected 1.5 million children are blind Backlog: 20 million unoperated cases cataract surgery performance rate- 10 million annually Targets projected 32 million cataract surgeries by year 2020 10.6 million adults have sequelae (trichiasis,entropion) More in Africa, China, Middle-east. SAFE strategy adopted Targets : eliminating trichiasis/entropion and reducing prevalance of trachoma to 5%. 0.3-0.6 million are blind. African and Latin- American countries Target : establish National programmes after effective surveillance such as by 2020 no new cases are reported. 1.3 million in Asia & Africa. Targets : To eliminate Vit. A def. diseases and achieve nil incidence in all countries. Services developed for treatable diseases: cataract, glaucoma, ROP Refraction and evaluation for pt`s requirement of corrective devices. Manufacture of proper devices
- 34. PROPOSED STRUCTURE C.O.E 20 Training centers Tertiary care including Retinal surgery, Corneal transplant. 200 Service Centers 2000 Cataract Surgery Other common eye surgeries Facilities for refraction Referral services Vision Centers 20,000 Refraction and prescription of glasses Primary eye care School eye screening Screening and referral services