December 20, 2017
As per Indian Government’s initiative (as on 2017), there will be a promising healthcare assistance to every citizen and reduction in the healthcare expenses with the help of state governments. In the recent announcement by our Honourable Prime Minister Narendra Modi, six major steps have been taken by the government to provide better healthcare system in India. One of the primary requirements is the “Door-to-Door Screening for Chronic Diseases” and more attention to be considered on the healthcare initiatives for the urban poor. From eye healthcare perspective, there is always a constant need to build strong eye healthcare models and systems in India as eye disorders causing impaired vision or blindness are emerging into an epidemic and have been listed as one of the major public health problems encountered worldwide.
Thinking in this direction, eye healthcare statistics were considered -- along with Nayonika Eye Care Charitable Trust (NECT), Bangalore, I propose 6A’s eye healthcare reforms that can be implemented to improve eye healthcare system in India.
The statistics are based on the authentic sources such as World Health Organisation (WHO), The International Agency for the Prevention of Blindness (IAPB), and healthcare journals.
A significant majority (around 90%) of the visually impaired individuals and blind individuals reside in Africa and Asia. Among the Asian countries, India has estimated 54 million visually impaired individuals and 8 million blind individuals, who contributes towards 20% of the global blind population. The population of blind is expected to reach 15 million by 2020 in India. The main reason for blindness/visual impairment in India is cataract (62.6%) followed by refractive error (19.7%) and glaucoma (5.8%) and around 80% of the blind population in India are above the age of 50. Likewise, India has around 320,000 children who are blind, one of the highest globally. The national prevalence of childhood blindness or low vision is 0.80/1000 in India. The common cause of childhood blindness/visual impairment in India is uncorrected refractive error and vitamin deficiency between the age group of 5 to 15 years.
Most individuals affected with visual impairment and blindness suffer inequalities throughout their lives, as most of them have poor health and also meet obstacles in their social lives. Most eye disorders causing visual impairment/blindness are preventable and treatable. Detection of eye disorders at appropriate time can prevent the loss of visual acuity and providing adequate treatment for the eye ailment can reduce complete blindness and visual impairment by 80% which will enable these individuals to lead a better quality life. However in developing countries the utilization of the eye care services is low. In India, the utilization of eye care services is poor among the rural households, women and the widowed even after the government of India launched eye care programs to cater to the needs of the people. Other factors such as low socio-economic background, low literacy level, ageism, difficulty in healthcare access and less awareness among people inhibit them from utilizing the primary care services effectively.
By identifying relevant sources such as World Health Organisation (WHO), The International Agency for the Prevention of Blindness (IAPB), and healthcare journals, Nayonika Eye Care Charitable Trust (NECT) and I propose 6A’s eye healthcare reforms that can be implemented to improve eye healthcare system in India. The points are discussed below:
1)Affordability: The eye care bodies providing services to rural population should lay emphasis on providing affordable treatment by comprehending the requirements of people in the community as it is pivotal to address peoples’ need. Secondly, direct cost (treatment cost) and indirect expenses (food, transport, medicines) imposed on people to seek treatment stands as a barrier. This can be reduced by organizing free eye care screening camps regularly in villages, providing financial and moral support to the affected, providing subsidized user fee, providing follow-up care and creating awareness among people to use eye care services before their eye ailments become worse which will prevent them spending out of their pockets.
2)Accessibility: It is essential for an eye care service to effective; it must be made accessible to the community. Mobile eye care services/eye care services linked with M-Health should be promoted for better outreach of eye care services. Training of field workers should be promoted to screen for eye diseases at the community level as field workers act as first contact between the people and healthcare. In addition, conducting monthly screening eye care camps targeting a particular eye ailment should be encouraged.
3)Availability: Eye care services should be made available to all age groups from paediatrics to geriatrics at a good frequency. Affordability and accessibility are two essential components to promote the availability of eye care services. Promotions regarding the eye care camps timings and details of other eye related services should be encouraged to disseminate awareness and better utilization of the available eye care services.
4)Acceptability: This is an important factor in provision of any healthcare services. In term of eye care services, it is essential for healthcare workers/doctors to make one (patient) understand the state of the eye ailment in a language comprehended by them and provide details regarding the necessity of further treatment. This will aid in better acceptability of eye care services by the community and will also enhance patients’ health literacy level. In addition, the recent years witnessed the introduction of mobile technology to screen eye diseases. Such technologies can be accepted and implanted in rural areas only when the importance of mobile technology in screening eye diseases has been explained to the community in a simplified manner.
5)Authenticity: The eye care services provided must be authentic i.e. it needs to reliable and of good quality. The services should be provided by a qualified ophthalmologist and trained health workers. The instruments used in eye surgeries should be of good quality to provided effective eye care services. This in turn will improve people’s acceptability of the received treatment. The medicines provided to treat eye ailment should be of good quality and should be supplied by a reliable source to ensure the safety of patients.
6)Associability: This is an important factor, to establish effective eye care services and better community outreach. It is essential that government eye organization should associate with various NGOs or private organizations to provide better eye care facilities to the people. This will also promote wider awareness and promote better utilization of eye care facilities among the community members. Government partnership with NGOs or private organizations in provision of eye care services will also enhance the standards of eye care services and will aid in providing eye care services free/at subsidized rate to the community.
To build a successful and a strong eye healthcare innovation engine in India, adopting eye healthcare reforms along with understanding the challenges/problems is a critical part to improve the quality of the healthcare. Stimulating discussions must be conducted with Government and Private doctors, practitioners and NGOs to improve the quality of the healthcare system in India. Various eye care trusts must conduct community outreach programs to provide increased eye awareness, self efficacy, coverage and quality of services.
Currently, Nayonika Eye Care Charitable Trust (NECT) in Bangalore is conducting various eye related projects in collaboration with Government of Karnataka to provide affordable and accessible eye care services to all individuals by considering the above proposed model.