National programme for control of blindness - E

Moderator : Prof. Mehendale
Presenter : Ranjana
 NPCB was launched in the year 1976 as a
100% Centrally Sponsored scheme with the
goal to reduce the prevalence of blindness to
0.3% by 2020.
 Rapid Survey on Avoidable Blindness
conducted under NPCB during 2006-07
showed reduction in the prevalence rate of
blindness from 1.1% (2001-02) to 1% (200607).
 Low vision – VA of less than 6/18 but equal to or better than
3/60, or a corresponding visual field loss to less than 20°, in
the better eye with the best possible correction. (10th revision
of the WHO International Statistical Classification of
Diseases, Injuries and Causes of Death)
Blindness - VA of less than 3/60, or a corresponding visual
field loss to less than 10°, in the better eye with the best
possible correction.
‘Visual impairment’ includes both low vision and blindness.
In 2009, the term ‘low vision’ was deleted from the 10th
revision of the ICD (ICD-10),
Moderate visual impairment -presenting visual acuity of
< 6/18 to 6/60 and
Severe visual impairment- VA< 6/60 to 3/60 from all causes.
Burden of disease
Globally about 314 million people are visually impaired,
45 million of them are blind.
 1990- ranged from 0.08% of children to 4.4% of
persons aged over 60 years, with an overall global
prevalence of 0.7%.
 7 million people become blind each year and that
the number of blind people worldwide was
increasing by 1–2 million per year.
In India
 2003-1.1% in the major States and 1.38% in the
north-eastern States
 2006-07 -1%.
Projected trends in Global Blindness
to demographic changes to 2020
45 to 76 million (73%
Major causes of blindness
Major causes of blindness in
Refractive error
Corneal blindness
Post. Capsular
Posterior segmant 4.7
Key facts
 About 314 million people are visually
impaired worldwide, 45 million of them are
Most people with visual impairment are
older, and females are more at risk at every
age, in every part of the world.
About 87% of the world's visually impaired
live in developing countries.
The number of people blinded by infectious
diseases has been greatly reduced, but agerelated impairment is increasing.
Cataract remains the leading cause of
blindness globally, except in the most
developed countries.
Correction of refractive errors could give
normal vision to more than 12 million
children (ages five to 15).
About 85% of all visual impairment is
avoidable globally.
 To reduce the backlog of blindness through
identification and treatment of the blind;
 To develop Comprehensive 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/Private Practitioners in eye Care.
 To enhance community awareness on eye care.
Four pronged strategy of the
 Strengthening service delivery,
 Developing human resources for eye care,
 Promoting outreach activities and public
awareness and
 Developing institutional capacity
Revised strategies
 To make NPCB more comprehensive-
corneal blindness, refractive error, post op
cataract, glaucoma.
 To shift eye camp approach to a fixed
facility surgical approach.
 To expand world bank project activities like
construction of dedicated eye operation
 To strengthen participation of voluntary
orgnization in programme.
 To enhance eye care services in tribal and
other under served areas.
Organizational structure
Administration(addl. Secretary/Joint secertary)
Opthalmology section
State opthalmic cell, directorate of
health services,state health societies
District blindness control society
Composition of state health
society (blindness division)
 The primary purpose-is to plan, implement and
monitor blindness control activities in all the districts
of the State as per the pattern of assistance
approved for National Programme for Control of
Blindness by the cabinet in Centre.
In the state level the State health Society is formed
with the following members
Chairman : State Mission Director/Secretary.
Vice Chairman : Director Health Services
Member Secretary : Joint/Dy. Director (from the
state cadre)
1. To coordinate and monitor with all the District Health
2. To conduct regular review meeting with districts in
coordination with Centre.
3. To procure equipment and drugs which required in GOI
4. To receive and monitor use of funds, equipments and
material from the Government and other agencies.
5. To involve voluntary organization and Private Practitioners
providing free/Subsidized eye care services in district.
6. To promote eye donation through various media and monitor
the districts for collection and utilization of eyes collected by
eye donation centres and eye banks
Composition of DBCS
 Maximum of 15 members:
 Chairman : District Collector/District Mission Director
 Vice-Chairman : Chief Medical & Health Officer/District
Health Officer
Member Secretary : Officer of the level of Deputy CMO
preferably an Ophthalmologist
Technical Advisor : Chief Ophthalmic Surgeon of District
hospital. Members : Medical Superintendent/ Civil
Surgeon of Distt. Hospital
District Education Officer
Representatives from NGOs engaged in eye care services
District Mass media/ IEC officer
Prominent practicing eye surgeons
 To assess the magnitude and spread of blindness in the
To organize screening camps for identifying those requiring
cataract surgery and other blinding disorders,;
To plan and organize training;
To procure drugs and consumables
To receive and monitor use of funds
To involve voluntary and private hospitals providing
free/subsidized eye care services
To organize screening of school children;
To promote eye donation through various media and monitor
collection and utilization of eyes collected by eye donation
centers and eye banks.
The PMOAs shall be doing the regular screening for and
other diseases in the out reach camps.
 Funds will be released by the GOI to
State Health Society (or State Health
& FW Society) based on Annual
Action Plan submitted to GOI.
a. Statement on performance and
b. Audited Statement of Accounts
c. Utilization Certificate
d. State Annual Action Plan for the
current financial year.
 GOI will release funds in two equal
instalments in a financial year; first
instalment will be equivalent to 50%
of the planned budget.
 Honorarium to Member
Secretary and other staff
 Procurement of goods
 Provision of spectacles
 Information Education and
 Grant-in-aid to voluntary
 Training activities within the
 Operational Expenditure
Record maintenance
 blind register,
 cataract surgery record,
 diabetic register,
 glaucoma register,
 squint register,
 keratoplasty,
 monthly and quarterly reporting format, cash
book, balance sheet, utilization certificate
 Random checks need to be carried out to
assess the validity of reported data, status
of follow-up, provision of glasses and
patient satisfaction.
 Standard Cataract Surgery Records
(Format II) should be filled up for each
operation performed.
 Periodic review should be undertaken by
the District Health Society to assess the
progress in each block and by each
provider unit.
 The District Health Society should be
concerned about the outcomes i.e.
number of persons whose eyesight is
restored rather than be satisfied with the
product i.e. no. of cataract operations
Training activities under NPCB
 1. (a). General Training in ECCE / IOL, SICS and Phaco
Emulsification(2months) - Keratometry, Biometry and Yag Laser
Capsulotomy along with surgery techniques.
 1. (b). SICS and simultaneously SICS trained surgeons only will be sent
for Phaco
 2. Pediatric Ophthalmology(3 mths) - management of Amblyopia and
squint, Cataract, Glaucoma and Retinopathy of pre-maturity (ROP).
 3. Medical Retina & Vitreo Retinal Surgery(3 mths) –indirect
Ophthalmoscope, fluorescence angiography
 4. Low Vision Services – 1 week Training.
 The trainees will be posted to Low Vision units of training institutions.
They should be taught handling of various instruments / L.V Aids and
Management of patients.
New initiatives
Construction of dedicated Eye Wards and Eye Operation theaters in Districts
Appointment of Ophthalmic Surgeons and Ophthalmic Assistants in new districts
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
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.
Role of international
 WHO- 40 intra country fellowship
in institute of Excellence under
specialities, corneal tr
surgery,laser in opthal, paed opth
Launch workshop on Vision 2020,
“the right to sight”initiative
World Sight day
Danish International Development
World Bank- assisted cataract
blindness control project, in which
Rs. 554 crore had spent.
 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
Special drive in NE States
 To make the drive a success, Eye Surgeons from reputed
institutions like Dr. R.P. Centre, New Delhi, Venue Eye
Hospital, New Delhi and Aravind Eye Hospital, Madurai
(TN) have been deputed in NE States for Cataract
 Against the target of 59,000 cataract surgeries for 200506, around 57141 cataract surgeries were performed in
these states during 2005-06. During the year 2006-07,
around 62,145 cataract surgeries have been reported by
NE states against the target of 59,000 cataract surgeries.
 This is the first time in recent years that NE states have
achieved more than their annual target for Cataract
Govt. of India. National Programme for Control of blindness:Guidelines for State
Health Society and District Health Society, Opthalmic/Health division, Nirman Bhavan
New Delhi, 2009
World health organization. Vision 2020 the right to sight, Global Initiat iative for the
elimination of avoidable blindness , Action plan 2006-2011
R. Serge et al. Global data on visual impairement in the year 2002. Bulletin of the
World Health Organization ,2004 november;82(11):844-849
B. Thylefors,' A.-D. Negrel,2 R. Pararajasegaram,2 & K.Y. Dadzie2.Global data on
blindness . Bulletin of the World Health Organization, 1995, 73 (1): 115-121
World health organization. Trachoma Control ,a guide for trachoma managers, 2006
World health organization. Magnitude and causes of visual impairment,2007
Dua A. National commission on macroeconomics and health, Govrnment of India
Background Papers·Burden of Disease in India
R . Jose. Present status of the national programme for control of blindness in India
.Community Eye Health J 2008;21(65): s103-s104