National Program for Control of Blindness

1. National Program for Control of Blindness Ministry of Health & Family WelfareGovernment of IndiaNirman Bhawan, New Delhi

2. National Programme for Control of Blindness was Launched in 1976 as a 100% Centrally Sponsored Programme to reduce prevalence of blindness from 1.4% to 0.3% 2

3. Estimated Prevalance of Blindness in India (2001-02)

4. Estimated Prevalance of Blindness in India (2001-02)

5. Cataract Operation

6. Performance of Cataract Surgery: 1985-2008(in lakhs) Nos. in Lakhs 6

7. Percentage of Cataract Performance with IOL Implantation:2001-2010

8. Causes of Blindness 8

9. Focus areas for 11TH five year plan Cataract Childhood Blindness Refractive Error & Low Vision Corneal Blindness Glaucoma Diabetic Retinopathy Trachoma(Focal) 9

10. Recurring Grant-in-Aid for NGOs for management of other Eye diseases other than Cataract • Diabetic Retinopathy, • Glaucoma Management • Laser Techniques • Corneal Transplantation • Vitreoretinal Surgery • Treatment of Childhood blindness etc. (Rs. 750 for Cataract Surgery with Intra Ocular Lens Implantation and Rs.1000 for other intervention) 10

11. New Initiatives- DR, Glaucoma, Corneal Blindness, Childhood Blindness • Training to Ophthalmic Surgeons and PMOAs • Last year PIPs of the states have included these new diseases but no progress reports have been received yet. • More close monitoring is recommended by the State Mission Director/ State Health Secretary.

12. New Initiatives cont… • Construction of dedicated Eye Wards and Eye Operation theaters in • NE States • Bihar • Jharkhand • J&K • Himachal Pradesh • Uttrakhand and few other States as per demand. 12

13. Status of Eye wings/wards • States in which Eye wings /wards not built in spite of releases in last and this financial year. • States in which the Eye wards though built in the 9th FYP but still not usable • Himachal Pradesh • Orissa • States in which the Eye wards though built in the 9th FYP usable but no manpower has been deployed.

14. New initiatives • Appointment of Ophthalmic Surgeons @ Rs 25,000/- and Ophthalmic Assistants Rs 8,000/- in new district Hospitals and in PHCs/ Vision Centers where there are none. • Appointment of Eye Donation Counselors @Rs 10,000/- on contract basis in Eye Banks under Government /NGO Sector. 14

15. New Initiatives –cont… • Involvement of Private Practitioners in sub- district, block and village levels • Maintenance Of Ophthalmic Equipments supplied to RIOs, Medical Colleges, district hospitals, PHCs/Vision centre's etc. • Development of Mobile Ophthalmic Units With Tele Ophthalmology Network in NE/Hilly states/Difficult terrains/underserved states and few fixed models in other states 15

16. PIP, Allocation& Release

17. PIP, Allocation& Release

18. PIP, Allocation& Release

19. PIP, Allocation& Release

20. Collection of Donated Eyes 20

21. States with One or no Eye Banks • Himachal Pradesh • Arunachal Pradesh • Sikkim • Manipur • Mizoram • Meghalaya • Haryana-(16 Eye Bank registered- 2 functional) In many States, the collection is negligible

22. Distribution of Free Spectacles to School Children 22

23. Issues under NRHM: Manpower : • The Ophthalmic surgeons have not been posted uniformly in all the Districts. • The Manpower is in excess in some of the Districts whereas in remote areas there is still a shortage of Eye Surgeons

24. Issues under NRHM: Manpower • Ophthalmic surgeons are utilized for other programmes or even casualty and post-mortem duties • Non operating surgeons need to be identified and motivated by imparting training • The surgeon-wise surgeries need to be monitored at the district level.

25. Training of Ophthalmic Surgeons Issues under NRHM: Manpower : 25

26. Issues under NRHM: Manpower : Training Of Paramedical Ophthalmic Assistants (PMOA) • RIOs and Medical colleges initially trained PMOAs • More training centers need to be identified • Trainings/refresher courses of PMOAs need to be regularly organized by the State • There are states like Orissa, Rajasthan where these earlier trained PMOAs are rendered jobless at the end of ninth plan

27. Issues under NRHM • The newly sanctioned contractual manpower under the 11th Plan since October 2008 have not been recruited by the States despite release of funds • In States like Orissa & TN where posts were created in the 9th five year has been discontinued in the tenth and 11th plan but steps have not been taken by the states to convert them to non plan posts.

28. Issues under NRHM • The DPM’s/ DPO’s identified at the District level have multiple responsibilities in addition to Blindness hence do not find time to Blindness work. It is suggested that the SPOs and the DPMs/DPOs are Ophthalmic surgeons • The contractual staff employed at the state Health Society have a variation in wages with that of the contractual employed in the Mission hence either they or not fill and even if filled they leave the job.

29. Issues under NRHM • The Procurement of Ophthalmic equipment still remains a sore point in spite of many relaxed procedural guidelines given by GOI. • The State Mission Director, District Mission Director and the District Collector should monitor the programme on the quarterly basis and ensure that the reports are sent to the centre in time. • The PIPs should show the targets proposed and achieved and based on the gap analysis the PIPs shall be approved.

30. Issues under NRHM • The release of payments from the State Health Society to Districts and Districts further to NGOs and agencies should be expedited as there lot of complains regarding delayed payments. • The delegation of financial powers approved in the NRHM guidelines should be followed in which it has been clearly stated that the Director Health Services be given the power to sanction the proposal up to the amount mentioned in the guidelines.

31. Issues under NRHM • The proposals are subjected to re-approvals and re- examinations at state level thereby delay in implementation. • The proposals made by the Blindness Division which are in accordance to the approved PIPs of the States, once submitted to the State Mission Director of the State take a circuitous route at this level and thereby the delay.

32. Issues which need to be addressed • The new activities approved as proposed in last years State PIPs like : • Recruitment of contractual appointments, • Tele-ophthalmic networks • Construction of Eye ward & Eye OT have not taken off by the state even after fund allocations have been done. • Diabetic Retinopathy, Glaucoma, Corneal Blindness, Childhood Blindness. • The audited UCs are delayed . • There are huge unspent balances released in various heads. • State Mission Directors& DC’s may ensure the same. 32

33. Thank you 33