Transcript Long Range Strategy Plan ORBIS – INDIA

Long Range Strategy Plan
ORBIS INTERNATIONAL–
INDIA
Highlights of the Situational Analysis Document
Keerti Bhusan Pradhan,
B R Shamanna,
P K Nirmalan
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
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
GLOBAL BLINDNESS
Millions
45
50
38
28
1975
? 30
1980
31
1984
1990
1995
2000
Prevalence of Blindness (Visual Acuity
<6/60) as per the National Survey (86-89)
Category
Prevalence
(%)
Less then 1
Low
Prevalence
States & regions of the
country
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
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
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
Causes of Blindness in India
15%
Others
7%
Cornea
4%
Glaucoma
Cataract
55%
Ref.error
19%
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.
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
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
Disease Control Status
• Cataract
–Issues:
• Major cause for blindness
• Changing demographics =
Increasing prevalence and incidence
• Only 60% IOL
• Quality of surgery
Disease Control Status
• Cataract
–Issues:
• Geographic coverage
• Socioeconomic issues
• Gender issues
Disease Control Status
• Cornea
– Issues:
• Infectious disease
• Nutritional causes
• Trauma
• Awareness, treatment strategies and
access
• Determining the national need for corneas
• Cornea
Disease Control Status
– 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)
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
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
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
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
Disease Control Status
• Emerging problems
– Diabetic Retinopathy
– Glaucoma
– Age –Related Macular Degeneration
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
Human resources
• 80 institutions currently training
MLOP’s in India
• 1300 persons each year
• Fellowship programs
• Optometry, Ophthalmic techniques,
Instrument maintenance, opticians,
management courses
Human Resources status
and needs in India
Category
Ophthalmologists
Mid Level
Personnel
Eye Care Managers
Community Eye
Health Specialists
Current
2005
2010
2015
2020
11,000
15,000
18,000
21,000
25,000
24,000
40,000
51,000
62,000
73,000
200
500
1,000
1,500
2,000
20
50
100
150
200
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
•
•
•
•
•
•
•
•
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
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
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
Role of Stakeholders in Eye Care in
India
• Multilateral & Bilateral agencies
– WHO
– World Bank
– UNICEF
– DANIDA (DANPCB)
– DFID
– USAID
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
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
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.
Strategic Opportunities
• Goals
– Disease Control
– Developing Human Resources
– Strengthening Service Delivery
– Promoting outreach activities and
public awareness - advocacy
– Develop institutional capacity,
partnerships and Networking
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
Disease Control
Cataract
–Understand risk factors better,
gender and socioeconomic
factors
–Alternate service delivery
models
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
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
Disease Control
• Refractive errors
– Develop service delivery models
– Promote refraction training centres
– Promote optical ‘dispensing’
training centres (grinding, fitting)
Disease Control
• Diabetic retinopathy
– Strengthen tertiary care centres
– Training in management of diabetic
retinopathy
– Awareness
– Service delivery models
Disease Control
• Glaucoma
– Tertiary care centres
– Training in management of glaucoma
Low Vision
– Tertiary care centres
– Training in management
Human Resource Development
• MLOP
– Develop curriculum
– Training materials in regional
languages
– Body for accreditation
– Develop Management Competence
– Standardized Ophthalmologist
training, CME
Service delivery models
• Need to develop working models
of primary eye care
• Strengthen tertiary care models
• Develop regionally appropriate
IEC materials
Advocacy
Develop partner institutes to COE
Improve networking between
stakeholders
Low Vision devices production
Technologies
• Telemedicine
• GIS