|LETTER TO THE EDITOR
|Year : 2011 | Volume
| Issue : 4 | Page : 331
Financing eye care in India - Community-assisted and financed eye care project (CAFE)
Giridhar Pyda1, Bindiganavale R Shamanna1, Ramesh Murthy2, Rohit C Khanna1
1 International Center for the Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, India
2 Departments of Pediatric Ophthalmology, Strabismus, Oculoplasty, and Ocular Oncology, L V Prasad Eye Institute, Hyderabad, India
|Date of Web Publication||11-Jun-2011|
Departments of Pediatric Ophthalmology, Strabismus, Oculoplasty, and Ocular Oncology, L. V. Prasad Eye Institute, L. V. Prasad Marg, Banjara Hills, Hyderabad
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Pyda G, Shamanna BR, Murthy R, Khanna RC. Financing eye care in India - Community-assisted and financed eye care project (CAFE). Indian J Ophthalmol 2011;59:331
|How to cite this URL:|
Pyda G, Shamanna BR, Murthy R, Khanna RC. Financing eye care in India - Community-assisted and financed eye care project (CAFE). Indian J Ophthalmol [serial online] 2011 [cited 2020 Feb 28];59:331. Available from: http://www.ijo.in/text.asp?2011/59/4/331/82014
Blindness remains a challenging public health problem in India.  While 80% of blindness is either preventable or treatable, attempts to reduce this have been constrained by various factors, especially cost. , In an attempt to design a universal, affordable, continuous, self-sustaining model of eye care delivery to all members of the community, irrespective of their economic status, a novel initiative, the 'Community-assisted and financed eye care' project was initiated in 16 villages of West Godavari district, in Andhra Pradesh, between October 2001 and February 2006. The idea was to create a community fund for eye care on the basis of the participation of all members of a captive community, irrespective of any determinants. It was implemented through a field team that collected a payment of one rupee per person per month on a yearly basis for the entire family. An identity card, ensuring accountability, costing five rupees was also issued for each person, with a photograph that was taken by the field workers. This fund collected from the members of the community covered a complete eye examination at a secondary level eye care center, including cataract surgery with intraocular lens (IOL) implantation when needed and minor surgeries in the economy category (costing the equivalent of USD 25). Re-surgeries on the same eye done elsewhere and follow-ups not for the routine surgery, better comforts, medicines, and spectacles were not covered under the scheme. The eye hospital was reimbursed through the grant money. The grant was predominantly used to set up the project system, and hence covered the administrative cost. Renewal of the registration was regularly started from the eleventh month. Credibility was maintained by audits conducted annually. More than 70% of the population of these villages registered, the approximate population included was 50,000. Over a period of four years, 65% of the families utilized the hospital services, with 23,637 outpatients and 1805 children examined, and 1859 cataract surgeries with IOL performed. A noticeable increase in access to eye care was observed. Barriers to registration and availing services included prolonged waiting at the hospital, thus losing the wages for the day, unnecessary visits without any eye problem, preference for free camps with food and transportation, and reluctance to pay the identity card charge of rupees five. Drop outs included those who could not sustain registration after utilizing the services.
About one-third of the population was below 16 years and strongly felt they did not require eye care. Evaluation at the end of the third year of the project revealed that 34% of the registered participants had migrated out of the villages for work or following marriage. In the absence of provision for free eye care, this is an affordable, continuous, and self-sustaining eye care model. With the help of village heads, social workers, health personnel, and teachers, awareness should be spread in the community with regard to the need for eye care and regular checkups. In addition, such schemes can provide employment. It is also important that these schemes be brought under the umbrella of a universal insurance / health financing scheme, to be sustainable. The project can become self-sustainable for service delivery costs, provided there is a high degree of registration and renewals. Based on our experience we recommend that such projects and schemes can reach their full potential only if they are envisaged on a larger scale, for the entire state or country. 
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