NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS (NPCB) Blindness is a major public health problem in most developing countries where

eye care facilities are still limited. Cataract is the leading cause accounting for 50% to 70 % of total blindness.80% of the blindness is avoidable.

India is the first country in the world to launch blindness prevention related programme as early as 1968 i.e. National programme for trachoma control. After few changes in the names, this programme was redesignated, since 1976 as "National programme for Control of Blindness" (NPCB) .

National Programme for Control of Blindness (NPCB) was launched in the year 1976 as a 100% Centrally Sponsored scheme with the goal to reduce the prevalence of blindness from1.4% to 0.3% . 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% (2006-07). OBJECTIVES:

Reducing the backlog of blindness by identifying and providing services to the affected population

To develop eye care facilities in every district To develop human resources for providing eye care services Improve quality of service delivery To secure participation of voluntary organizations in eye care To enhance community awareness on eye care

ACTIVITIES: Following activities are being covered:

Cataract Surgery & Support Services School Eye Screening Programme & Refraction Services Strengthening eye health education activities by IEC Activities Control of Corneal blindness including Establishment of Eye Banks Developing of infrastructures for IOL facilities

ORGANIZATION STRUCTURE: Administration: CENTRAL STATE DISTRICT Opthalmology section, DGHS, Ministry of Health& Family Welfare State ophthalmic cell, Directorate of Health Services, State health societies District blindness control society

Service delivery and referral system: TERITIARY LEVEL : Regional institutes of opthalmology and centres of excellence in eye care medical colleges SECONDARY LEVEL : District hospital and NGO eye hospital TERITIARY LEVEL: sub district level hospitals/ CHCs, mobile ophthalmic units, upgraded PHCs, link workers, panchayats. PROGRAM COMPONENTS: Cataract surgery : Purpose is to restore vision of affected persons,so that they can return to normal life. Eye screening in schools : Children are first screened by trained teachers for refractory errors. Those children suspected of refractive errors are examined by ophthalmic assistants and corrective spectacles are advised. Eye donation : Donation of eyes are motivated (voluntary and among relatives of terminally ill patients, fatal accident victims)

Voluntary organization: The organizations such as rotary international, Lions international, Blind relief association of India are active in conducting eye camps and in providing eye health education. Vitamin A prophylaxis : Vitamin A supplement and MMR vaccination are supplied through district blindness control society. Training programs : Training programs are provided to ophthalmic surgeons in IOL implantation. The faculty members of the medical colleges are trained as trainers. The other training programs include training of eye surgeons,nurses, ophthalmic assistants etc. IEC activities : Special campaigns are under taken during Eye donation Fortnight and on world sight day on second Thursday of October, every year.

STRATEGY OF NATIONAL BLINDNESS CONTROL PROGRAMME Decentralized implementation of the scheme through District Blindness Control Society. Reduction in the backlog of the blind person by active screening of population above 50 years, organizing screening eye camp and transporting operable cases to eye care facilities. Involvement of voluntary organization in various eye care activities. Participations of community and Panchayat Raj institutions in organizing services in rural areas. Development of eye care services and improvement in quality of eye care by training of personnel, supply of high tech equipments, strengthening follow up services and monitoring of services. Screening of school going children for identification and treatment of Refractive Errors, with special attention in under served areas. Public awareness about prevention and timely treatment of eye ailments.

 Special focus on illiterate women in rural areas. For this purpose, there should be convergence with various ongoing schemes for development of women & children. To make eye care comprehensive, besides cataract surgeries other Intra Ocular Surgical operations for treatment of Glaucoma, Diabetic Retinopathy etc. may also be provided free of cost to the poor patients through governments as well as qualified non government organizations.

NEW INITIATIVES UNDER THE PROGRAMME

Keeping in view of the measures and to avoid duplicity of work, State Ophthalmic unit has been merged with State Blindness Control Society. Due to formation of National Rural Health Mission (NRHM), State Blindness Control Society (SBCS) under NPCB has been further merged with State Health society under NRHM. District Blindness control society (DBCs) under NPCB has also been merged with District Health Society under NRHM.

Increase in assistance for commodity to various facilities to increase their capacity for treatment of all types of eye ailments;

Facility for India-ocular Lens (IOL) implantation expanded up to Taluka level; Marginal increase in grant-in-aid to Eye Banks, Eye Donation Centres and NGOs due to escalation of costs and to improve quality of services;

In addition to cataract, assistance would also be provided for other eye diseases like glaucoma, diabetic retinopathy, management of laser techniques, corneal transplantation, Vitreo-retinal surgery, treatment of childhood blindness etc.

Assistance for involvement of Ophthalmic equipments supplied under the programme; Development of Mobile Ophthalmic Units with Teleophthalmology Network and some fixed tele-models to cover difficult hilly terrains and difficult areas;

Strengthening of Management Information System Intensification of IEC activities. Construction of dedicated Eye Wards & Eye OTs in District Hospitals in North-Eastern States, Bihar, Jharkhand, J&K, Himachal Pradesh, Uttarakhand and few other States where dedicated Operation Theaters are not available as per demand.

Appointment of Ophthalmic manpower (Ophthalmic Surgeons, Ophthalmic Assistants and Eye Donation Counsellors on contractual basis).

Grant-in-and to NGOs for management of other Eye diseases other than Cataract like Diabetic Retinopathy, Glaucoma Management, Laser Techniques, Corneal

Transplantation, Vitreo-retinal 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.

Development of Mobile Ophthalmic Units in NE States, Hilly States & difficult Terrains for diagnosis and medical management of eye diseases.

Involvement of Private Practitioners in Sub District, Blocks and village Level. Maintenance of Ophthalmic Equipments supplied to Regional Institutes of

Ophthalmology, Medical Colleges, District/Sub-District Hospitals, PHC/Vision Centres.

Vitamin A supplement and MMR vaccination through DBCS (District blindness control society) to prevent childhood blindness.

VISION 2020 RIGHT TO SIGHT :

It is a global initiative to reduce avoidable blindness by 2020.The plan of action in India to achieve vision 2020 are developed with following features: Target diseases are cataract, refractive errors, childhood blindness, corneal blindness, glaucoma, diabetic retinopathy. Human resource development as well as infrastructure and technology development at various levels of health system. There is a proposed 4 tier system which includes : Centres of excellence(20) Training centres(200) Service sentres(2000) Vision centres (20000)