|Year : 1977 | Volume
| Issue : 4 | Page : 1-5
National programme for prevention of visual impairment and control of blindness
Dr. R.P. Centre. for Ophthalmic Sciences, A.I.I.M.S., Ansari Nagar, New Delhi, India
L P Agarwal
Dr. R.P. Centre. for Ophthalmic Sciences, A.I.I.M.S., Ansari Nagar, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Agarwal L P. National programme for prevention of visual impairment and control of blindness. Indian J Ophthalmol 1977;25:1-5
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Agarwal L P. National programme for prevention of visual impairment and control of blindness. Indian J Ophthalmol [serial online] 1977 [cited 2021 Mar 8];25:1-5. Available from: https://www.ijo.in/text.asp?1977/25/4/1/34605
The colossal problem of blindness is well known to the ophthalmologists, planners and administrators of this country. There are 9 million blind and 45 million visually impaired individuals. Of the 9 million 85% are curable and in 27% blindness could have been prevented if timely measures of promotion of ocular health, prevention of eye diseases and cure of many ocular pathologies had been taken at an early stage. This is equally true for reducing number of visually impaired. Such visual involvement, blindness and visual impairment place a huge economic and social burden on the nation. A new concept of community Ophthalmology has since been evolved and based on that concept, the Ministry of Health of Govt. of India has launched a National Programme for Prevention of Visual Impairment and Control of Blindness to be completed in a period of 20 years. It has recognised that:
"One of the basic human rights is the right to see. We have to ensure that no citizen goes blind needlessly, or being blind does not remain so, if by reasonable deployment of skill and resources his sight can be prevented from deteriorating or if already lost can be restored".
The Government of India has discarded the concept of a disease oriented programme in prevention of visual impairment and control of blindness. The plan of action formulated is problem oriented and will take care of visual impairment and blindness in an integrated manner through promotive, preventive, curative and rehabilitative efforts.
The following strategy has been evolved:
(1) Eye Health Education with a view to disseminate information about the problem of blindness and visual impairment, their causes and their prevention through all mass media of communication. Distinct from the dissemination of information is the education involving school children, teachers, and the people. This is the most important simple item in the strategy. The cooperation of medical social workers, sociologists, ophthalmic personnel, paramedical personnel, general health workers, teachers, students, leaders of the community, state and local Govts. and voluntary agencies is imperative if the Plan is to succeed. The educational, sociological, political and peoples welfare institutions and agencies will need to cooperate in this effort.
(2) Augmenting ophthalmic services in a manner that relief can be given to the people in the remotest corner of the country in the shortest possible time. This is being looked through a camp approach of community eye health distinct from mere cataract camps. To achieve this a cluster approach has been adopted by providing one mobile unit for five districts covering roughly a population of 7.5 million. Each district is to organise 6 eye camps in the primary health centres located in three districts. The functions and objectives of these mobile units have been enlarged to cover:
i) General survey for the prevalence of various eye diseases and blindness.
ii) Educate people in the methods of prevention of eye diseases and proper care of the eyes in order to ensure better and lasting eye-sight.
iii) Provide medical and surgical treatment for the prevention and control of eye diseases including cataract operations.
iv) Detect early visual defects and provide suitable glasses and low vision aids at cost price.
v) Help in the rehabilitation of the blind in their own surroundings by training the blind in the art of daily living and mobility and give proper and suitable vocational training. The mobile units are fully staffed and equipped.
It is proposed that district co-ordination committees will be formed, the membership of which will be constituted as under:
(i) District Magistrate -Chairman
(ii) Civil Surgeon -Vice-Chairman
(a) Representative of Lions Club (b) Representative of Rotary Club (c) Member of Parliament
(d) Local member of legislative assembly (e) Indian medical association
(f) Representative of National society of prevention of blindness
(g) Representative of Members from organisations managing eye hospitals and conducting eye camps.
(h) Any other social worker or individual the chairman desires.
These mobile units are not exclusively meant for Government use but are placed under their administrative charge for coordination.
(3) Simultaneously to creation of a permanent infrastructure of ophthalmic service for promotion of ocular health, prevention of eye diseases and care of curable eye illnesses, the programme will also provide for man power development of paramedical, general medical and ophthalmic specialists besides applied and fundamental research. In the programme the efforts will integrate the eye care programmes with the general health services as far as possible augmenting specialised needs wherever required.
In order to achieve the ends the service will be developed at peripheral, intermediate and central levels.
(a) PERIPHERAL LEVEL
The peripheral Level of services will be delivered through the general health services like the agency of village health worker, multipurpose health worker, and general practitioners including the primary health centre doctors. At the primary health centre itself, taking into consideration the requirement of specialised nature, a specially trained ophthalmic assistant (para-medical worker) will be posted.
In the training programme of the village health workers and multipurpose health workers perliminary knowledge about eye health care has been included with a view to detect visual defects at an early stage, to render first aid in ocular emergencies and also to give some medicines in minor eye ailments. If the patients require further attention, they will be directed to the primary health centres. The objectives of the primary health centres are:
i) To provide a base for health education in ophthalmic field.
ii) To integrate ophthalmic services to the community with the infrastructure of basic health services e.g. Nutrition and family Planning Programmes, and existing general medical health programmes.
iii) To screen the cases requiring specialised ophthalmic care.
iv) To render ophthalmic care for minor ailment.
v) To assess and correct the visual status of the population.
vi) To educate teachers and parents and social workers in early detection of visual defects by simple means.
(b) INTERMEDIATE LEVEL
The intermediate level of services are the first level where permanent specialised services will be available and where cases can be referred from the peripheral level. This will be delivered through the sub-divisional hospitals (30 beds each) and district hospitals (50 beds). These hospitals will deliver eye health care through the same integrated approach, of promotion, prevention, cure and rehabilitation. The objectives of these hospiatls will be to:
i) Impart health education to field workers;
ii) Screen and diagnose all ophthalmic patients;
iii) Participate in the work of mobile unit;
iv) Provide leadership to primary health centres and other small units;
v) Provide for common intraocular and extra-ocular surgical operations;
vi) Provide facilities for visual screening, test and prescribing;
vii) Chose proper referrals
viii) Arrange for the screening of the population with visual and ocular problems;
ix) Survey local industries with regard to visual status of the worker and advise safety measures.
The practitioners of opthalmology should be able to lend a helping hand to these hospitals and at the same time be able to refer their problems of general ophthalmic care to them.
(c) CENTRAL LEVEL OF SERVICE
The central level of services will be provided through the medical colleges, the regional institutes and the apex organisation (National Institute).
i) Medical College The departments of ophthalmology of these colleges will be converted into departments of community ophthalmology. These colleges will offer good ophthalmic care to the community, provide technical leadership and support to the district hospitals, taluqa hospitals, primary health centres and smaller units. They will be primarily responsible for manpower development of all types of workers, i.e. ophthalmic assistants and technicians, ophthalmic nurses, general practitioners trained in ophthalmology and specialists in general ophthalmology. These colleges will also conduct refresher courses in ophthalmology to update the knowledge of staff working at the district, Taluqa and primary health centres levels. Appropriate syllabi and courses for the same have been devised and will be kept under constant review.
ii) Regional Institutes The main purpose of strengthening the existing post-graduate ophthalmic Institutes is to provide technical support in the zone of their activity. Their main objectives will be:
a) To evolve and demonstrate the methods of rendering a highly competent ophthalmic service to the community through an integrated approach of promotive, preventive, curative and rehabilitative concept with the full background of socio-economic, environmental and other local factors.
b) To provide facilities for refresher courses to ophthalmologists with a view to keep them upto date.
c) To disseminate widely, in coordination with the National Institute, information with regard to recent advances in ophthalmology which have an applied bias.
d) To provide opportunities for training of health personnel in the field of community ophthalmology.
e) To provide facilities for the training of personnel for the rehabilitation of the blind.
f) To provide facilities for the training of ophthalmologists and ancilliary ophthalmic personnel like ophthalmic assistants.
g) To provide facilities for the training and demonstrate the organisation and research in Eye Bank procedures including implantation and grafts.
h) To stimulate and provide facilities in research in Ophthalmology at a high level of competence.
iii) The National Institute of Ophthalmology will function as an apex organisation to help in the development of manpower, and provide high grade research support both applied and fundamental, to the National Programme.
There are certain special programmes which are being conducted in other phases in the field of nutrition and child development. It is the purpose of this programme to fully integrate our activities with the maternity and child health schemes and the programme of intensive child development.
Two other aspects of the programme are to abolish the use of sub-standard glass and practice by unqualified personnel in dispensing and prescribing for refractive errors. With a view to do this a comprehensive legislation will be brought about under the title of Regulation of Trade of Ancilliary Ophthalmic Personnel and Ophthalmic Materials. Such a legilsation is beset with many difficulties particularly because full cooperation of the states is required but I am confident that they will be overcome as we go along.
Yet another aspect is the production of ophthalmic equipment in the country. Every effort is being made to develop such an industry and lay down standards for the same. No nation alone can become self-sufficient in producing all the equipment that it needs. In the first phase our attempt is to produce items of daily use needed by the hospitals and the ophthalmologists like trial cases, cryounits, diathermy, slit lamp, ophthalmometers, synoptophore and as expertise develops to produce more and more sophisticated instruments.
From these it would be evident that based on the concept that for permanent solution of the maladies the programme should not be disease oriented but problem oriented, a comprehensive plan has been drawn up to develop ophthalmic services in an integrated manner of promotive (eye health education) preventive (eye health education & have remedies for minor ailments) and curative services at the peripheral, intermediate and central levels besides give immediate relief to the suffering humanity through a mobile unit approach.
A basic weakness of the plan is the lack of rehabilitative component for which efforts are continuing with the Ministry of Social Welfare to establish at least one centre in each district and ultimately in each Taluqa and sub-division.
In twenty years the problem should have been taken care of in all its aspects.
I have given you a strategy and a programme and I propose to seek your unstinted cooperation, whether you are in service or in practice. The first and the most urgent task before you is to mobilise public opinion, enthuse them in your aims for their good and take the leadership in your hand. Get on the task of organising district coordination committees, utilise the mobile units, get revenue divisional coordination committees and finally the State implementation committees. Please do not hesitate to call us whenever you need our help.