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Present status of the national programme for control of blindness in India

The National Programme for Control of Blindness (NPCB) was launched in 1976 as a 100% centrally sponsored scheme with the goal of reducing the prevalence of blindness from 1.4% to 0.3%. According to a survey in 2001-02, the prevalence of blindness was estimated at 1.1%. The target for the 10th Plan was to reduce this to 0.8% by 2007. A survey done in 2006-07 estimated the prevalence of blindness at 1%.

The main causes of blindness in India are as follows: - Cataract (62.60%) Refractive Error (19.70%) Corneal Blindness (0.90%), Glaucoma (5.80%), Surgical Complications (1.20%) Posterior Capsular Opacification (0.90%) Posterior Segment Disorder (4.70%) and Others (4.19%). The estimated national prevalence of childhood blindness /low vision is 0.80 per thousand.

The objectives of the NPCB are:-

• To reduce the backlog of blindness through identification and treatment of blind;

• To develop eye care facilities in every district,

• To develop human resources for providing eye care services;

• To improve quality of service delivery;

• To secure participation of voluntary organizations in eye care.

The allocation of funds and the expenditure is as follows:-

Year	Budget Allocated	(FE) Expenditure (Rs. in crore)
2002-03	85.00	84.62
2003-04	86.00	85.62
2004-05	88.00	87.20
2005-06	93.32	92.84
2006-07	111.87	111.53
2007-08**	165.20	164.95

** Provisional (Surrender Rs.6.67 crore in 2007-08)

Achievements of NPCB

A) Performance of Cataract Surgery: has been steadily increasing as indicated below:

Year	Target	Achievement	% Surgery with IOL
2002-03	4000000	3857133	77
2003-04	4000000	4200138	83
2004-05	4200000	4513667	88
2005-06	4513000	4905619	90
2006-07	4500000	5040089	93
2007-08**	5000000	4068027	92

** Provisional

B) School Eye Screening Programme:

Year	Teachers trained	Schoolchildren screened	Children detected with refractive errors	Children provided free glasses
2002-03	35267	9736805	506663	98697
2003-04	88317	19260984	552963	184305
2004-05	97310	26862932	572691	283070
2005-06	126163	29737168	771901	385403
2006-07	203221	35429289	963168	456634
2007-08**	136686	20138871	836292	298928

** Provisional

C) Donated Eyes Collected

Year	Total No. of Eyes Collected
2003-04	23741
2004-05	23553
2005-06	28007
2006-07	30007
2007-08**	31998*

** Provisional

D) Training of Ophthalmic Surgeons:

Year	Nos.
2002-03	176
2003-04	229
2004-05	350
2005-06	250
2006-07	250
2007-08**	300

** Provisional

Collection and Utilization of donated eyes: Currently, nearly 20,000 donated eyes are collected each year in India. Hospital retrieval programmes are the main strategy for collection of donated eyes. This involves motivating the relatives of terminally ill patients, accident victims and others with grave diseases to donate eyes. Eye donation fortnight is organized from 25th August to 8th September every year to promote eye donation/eye banking. Gujarat, Tamil Nadu, Maharashtra, Delhi, Chandigarh, Andhra Pradesh, Kerala and Karnataka are are at the forefront of this activity.

E) IEC Activities: Information, Education and Communication (IEC) activities are undertaken at all levels through the Central, State and District Blindness Control Societies (DBCS). Special campaigns for mass awareness were undertaken during Eye Donation Fortnight (25th August to 8th September) and World Sight Day (2nd Thursday of October). At the Central level, prototype IEC material is produced and disseminated to the States. Guidelines and training manuals are also prepared centrally and disseminated. A quarterly newsletter has been started since July 2002.

F) Support to Voluntary Organizations (VOs): VOs play an important role in implementing various activities under the programme. District Blindness Control Societies (DBCS) have been established throughout the country under the Chairmanship of District Collector/Deputy Commissioner. So far, 604 DBCSs have been established. The Blindness Societies have been merged with Health Societies both at State and District level. Under the scheme a non-recurring grant for a maximum of Rs.25.00 lakhs is granted for expansion/ upgradation of Eye Care Units in tribal and backward rural areas. Also Rs. 10 lakh is granted for upgradation of Eye Banks for non-recurring assistance and Rs. 1000 is provided per pair of eyes as recurring assistance. So far, 74 NGOs have been assisted under this scheme ,in 2006-07 and 45 eye banks in the voluntary sector were assisted in promoting collection of donated eyes.

Special drive for cataract and other comprehensive eye care activities in the Northeastern States

With the launch of the National Rural Health Mission on 8.11.2005 at Guwahati (Assam), special drives to improve the Cataract Surgery rate and School Eye Screening Programme and other comprehensive eye care activities have been initiated in the NE States under NPCB. To make the drive a success, Eye Surgeons from reputed institutions like Dr. R.P. Centre, New Delhi, Venu Eye Hospital, New Delhi and Aravind Eye Hospital, Madurai (TN) have been deputed in the Northeast to meet the need for cataract surgery. As a result, against the target of 59,000 cataract surgeries for 2005-06, around 57141 cataract surgeries were performed in these states during 2005-06. During the year 2006-07, around 62,145 cataract surgeries were reported by these states against the target of 59,000 cataract surgeries. This is the first time in recent years that the NE states have achieved more than their annual target for cataract surgery.

Achievements

• 307 Dedicated eye operation theatres and eye wards built in District level hospitals;

• Supply of Ophthalmic equipment for diagnosis and treatment of common eye disorders

• More than 2000 Eye Surgeons trained in IOL surgery and other super specialties.

• During the year 2006-07, a total 50,40,336 Cataract Surgeries were performed against the target of 45,00,000, out of which 94% Surgeries were with IOL Implantation.

• The volume of cataract surgery has steadily increased since 1993. Currently, Cataract Surgery Rate is 4500 per million populations. There has been a significant increase in proportion of cataract surgeries with IOL implantation from <9 % in 1994 to 93% in 2006-07.

• Recent surveys have confirmed higher success rates following cataract surgery with Intra Ocular Lens implantation as compared to conventional surgery. Follow up of operated cases was an important factor in those cases who had poor visual outcome following cataract surgery

Looking ahead

Under the programme, the following new initiatives are proposed:

• Construction of dedicated Eye Wards and Eye Operation theaters in Districts and Sub Districts Hospitals in North- Eastern States, Bihar, Jharkhand, J&K, Himachal Pradesh, Uttaranchal and few other States as per demand.

• Appointment of Ophthalmic Surgeons and Ophthalmic Assistants in new districts in District Hospitals and Sub District Hospitals.

• Appointment of Ophthalmic Assistants in PHCs/ Vision Centers where there are none (at present ophthalmic assistants are available in block level PHCs only)

• Appointment of Eye Donation Counselors on contract basis in Eye Banks under Government Sector and NGO Sector.

• Grant-in-aid for NGOs for management of other Eye diseases other than Cataract like Diabetic, Retinopathy, Glaucoma Management, Laser Techniques, Corneal Transplantation, Vitreoretinal Surgery, Treatment of childhood blindness etc of Rs. 750 per case for Cataract/IOL Implantation Surgery and Rs.1000 per case of other major Eye Diseases as described above. For North-Eastern States, Hilly and Desert Areas Rs. 850 for Cataract and Rs.1100 for other major Eye Care Management is proposed.

• Special attention to clear Cataract Backlog and take care of other Eye Health Care Centers from NE States.

• Telemedicine in Ophthalmology {Eye Care Management Information and Communication Network}

• Involvement of Private Practitioners.

• A provision of Rs.1550 crore has been proposed for implementation of NPCB during 11th Five Year Plan.