National programme for the control of blindness

Introduction: In 1976, National programme for control of blindness (NPCB) was formally launched and included in Prime Ministers 20 point Development programme and incorporates the earliest trachoma control programme started in 1968. The ultimate goal of the national programme is to reduce blindness in the country from 1.4% to 0.3% by 2000 AD, and to provide comprehensive eye care through Promary Health Care.

Major landmarks in the history of blindness control activities in India in chronological order can be briefly National Trachoma control programme was launched in 1963 to prevent and control blinding trachoma. A survey was under-taken by ICMR in 1971-1974 to identify main cause of blindness. A comprehensive National Programme for control of blindness was launched in 1976 with the goal of reducing prevalence of blindness to 0.3% by 2000 AD. DANIDA agreed to assist NPCB since 1978 (phase-I) DANIDA phase III project was launched in 1997-98 Mid-term evaluation of worked bank project in 1997-98 indicated marginal ( 10-15%) fail in prevalence and lack of follow up services.

Epidemiological features of Blindness in India

The main causes of blindness are already stated will include: -Cataract -Refractive errors -Exophthalmia and childhood blindness Other emerging causes include: -Glaucoma -Anterior segment infections -Age related diabetic retinopathy -Injuries macular degeneration

Cataract: -Cataract is a major problem in India and occurs much earlier than in the developed countries. -Cataract is the commonest cause of blindness in the country. -It is curable through a simple surgical operation which restores vision of the patient.
Refractive errors and Low Vision: Blindness due to refractive errors suggests that eye care services in general are inadequate.

Xerophthalmia ant childhood blindness: - All families consider children as their most precious asset. A blind child is a major tragedy for families and communities. - A child whose blindness would have been prevented or cured is an even greater loss and tragedy. Trachoma and Corneal Blindness: - Trachoma is one of the oldest recorded disease of mankind. - Corneal disease resulting in corneal scarring is also a common cause of blindness.

Factors causing Blindness: While blindness can afflict anyone, these are some who are affected more than others. The major contributing factors are: Age Gender Poverty Social Inequality Ageing and blindness: Age specific prevalence of blindness and visual impairment in the over 60 years age group is 68,000 blind per million population in developing countries as compared to 750 blind per million in children.

Gender and blindness: - Women bear approximately two-third of the burden of blindness in the world. - Trachoma is more common in women, since women and older girls are primary childcare providers and acquire active trachoma from young children. - In many societies women live longer than men and therefore suffer more frequently from age related eye diseases or blindness.

Objectives: - Thus, WHO has concluded that blindness prevention programmes are an investment with a high rate of return. - WHO has set 2020 as the target year of achieve Global Elimination of Trachoma India, Myanmar and Nepal in the South East Asian region have been identified as areas of programme activity. - Presently, the goal set to be achieved under the National programme for control of blindness is to reduce the prevalence of blindness from 1.49% to 0.3%.

Objectives fixed to be attained under the National Programme for control of Blindness are as follows: 1. Develop eye care infrastructure through out the country. Increase institutional capacity for eye care. 2. Expand coverage to underserved areas. 3. Decentralisation to district level. 4. Human resource development for eye care at all levels. 5. Improvement in quality of eye care for better visual outcome. 6. Secure participation of non-government and private sector.

Organizational Structure of the Programme.

At the national level, a national programme management cell has been established in the directorate General of health Services(DGHS), Department of Health in the Ministry of Health and family welfare. NPCB At the State level At the district level National Bodies for NPCB: National Blindness control Board National programme co-ordination committee. National Technical Advisory Committee. At State Level: The programme is being implemented at the state level through the state governments. A state programme cell is already in place for which five posts including that of a Joint Director(NPCB) are in existence.

At District level: The scheme of setting up a District Blindness Control Society in each district of the country was launched in the year 1994-95. Composition of DBCS: Members: -Medical superintendent / Civil surgeon of district hospital -District Education officers. -Project Director DRDA/ ITDA -Ophthalmic surgeon of mobile eye Unit -District Mass Media / IEC officer At the sub district level: At the block level and ophthalmic assistant is posted to work under the overall supervision of the medical officerIn-charge. This is the last level where a designed worker for eye care has been provided in the health system.