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Long Range Strategy Plan ORBIS INTERNATIONAL– INDIA

Long Range Strategy Plan ORBIS INTERNATIONAL– INDIA. Highlights of the Situational Analysis Document Keerti Bhusan Pradhan, B R Shamanna, P K Nirmalan.

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Long Range Strategy Plan ORBIS INTERNATIONAL– INDIA

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  1. Long Range Strategy PlanORBIS INTERNATIONAL– INDIA Highlights of the Situational Analysis Document Keerti Bhusan Pradhan, B R Shamanna, P K Nirmalan

  2. 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

  3. Purpose & Methods Main 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

  4. GLOBAL BLINDNESS Millions 50 45 38 31 ? 30 28 1975 1980 1984 1990 1995 2000

  5. 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 Prevalence of Blindness (Visual Acuity <6/60) as per the National Survey (86-89)

  6. 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

  7. 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

  8. Others Cornea Cataract Glaucoma Ref.error

  9. Eye Care Service Delivery in India • About 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.

  10. 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

  11. 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

  12. Disease Control Status • Cataract • Issues: • Major cause for blindness • Changing demographics = Increasing prevalence and incidence • Only 60% IOL • Quality of surgery

  13. Disease Control Status • Cataract • Issues: • Geographic coverage • Socioeconomic issues • Gender issues

  14. Disease Control Status • Cornea • Issues: • Infectious disease • Nutritional causes • Trauma • Awareness, treatment strategies and access • Determining the national need for corneas

  15. 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)

  16. Disease Control Status Childhood 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

  17. 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

  18. 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

  19. 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

  20. Disease Control Status • Emerging problems • Diabetic Retinopathy • Glaucoma • Age –Related Macular Degeneration

  21. 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

  22. Human resources • 80 institutions currently training MLOP’s in India • 1300 persons each year • Fellowship programs • Optometry, Ophthalmic techniques, Instrument maintenance, opticians, management courses

  23. 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 Human Resources status and needs in India

  24. 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

  25. 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

  26. 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

  27. 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

  28. Role of Stakeholders in Eye Care in India • Multilateral & Bilateral agencies • WHO • World Bank • UNICEF • DANIDA (DANPCB) • DFID • USAID

  29. 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

  30. 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

  31. 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.

  32. Strategic Opportunities • Goals • Disease Control • Developing Human Resources • Strengthening Service Delivery • Promoting outreach activities and public awareness - advocacy • Develop institutional capacity, partnerships and Networking

  33. 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

  34. Disease Control Cataract • Understand risk factors better, gender and socioeconomic factors • Alternate service delivery models

  35. 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

  36. 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

  37. Disease Control • Refractive errors • Develop service delivery models • Promote refraction training centres • Promote optical ‘dispensing’ training centres (grinding, fitting)

  38. Disease Control • Diabetic retinopathy • Strengthen tertiary care centres • Training in management of diabetic retinopathy • Awareness • Service delivery models

  39. Disease Control • Glaucoma • Tertiary care centres • Training in management of glaucoma Low Vision • Tertiary care centres • Training in management

  40. Human Resource Development • MLOP • Develop curriculum • Training materials in regional languages • Body for accreditation • Develop Management Competence • Standardized Ophthalmologist training, CME

  41. Service delivery models • Need to develop working models of primary eye care • Strengthen tertiary care models • Develop regionally appropriate IEC materials

  42. Advocacy Develop partner institutes to COE Improve networking between stakeholders Low Vision devices production

  43. Technologies • Telemedicine • GIS

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