Eye Care in North India

Arun K. AroraChief Executive Officer

Dr Shroff’s Charity Eye Hospital, New Delhi

24th September, 2010

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Avoidable Blindness

Globally: 314 million- visually impaired ; 45 million of them are Blind.

Most people with visual impairment are older, and females are more at risk at every age, in every part of the world.

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Indian Scenario: The Magnitude

Numbers12 million - Blind, 27- 30 million - low Vision3.8 million new cases added every yearWill reach 18 million by 2020

DistributionBlindness: 90% in rural underserved areasServices & trained manpower concentrated to urban

communities75 – 80% preventable/ curable (Cataract and Uncorrected

Refractive errors)

Economic burden (1997) $US 4.4 Billion (annual)Cumulative loss over the lifetime of the blind $77.4 Billion

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Eye-care services: IndiaGovernment Commitment: First to launch National program for prevention of blindness

(NPCB), 1976 Signatory to “VISION 2020- The Right to Sight”

Status Of NGOs In Eye CareProminent NGO presence: 69% of Manpower

(ophthalmologists) and 71.5% dedicated infrastructure present in NGO and Private sector.

Till recently, approach has been mainly camp based and Cataract focused

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SCEH: The Genesis…

At the time of inception (1914) there was no dedicated eye care provider in entire North India.

Mission: To make a lasting impact on the eradication of blindness and

deafness in India by providing quality care to all sections of the society.

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Dr. Shroff’s Charity Eye HospitalInstitutional Background

– Established in 1914

– Only dedicated eye care hospital from Lahore (now Pakistan) to Kanpur.

Founder: Dr Sorabji P Shroff , FRCS, awarded the Padma Shri by the government of India for his humanitarian efforts.

A distinguished governing board

– Mr. Vikram Lal (EICHER group)

– Dr. NM Shroff (Padam Shri)

– Mr. Naresh Gujral

– Mr. Lalit Nirula

– Dr. Arvind Taneja

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Dr. Shroff’s Charity Eye Hospital

Member of VISION 2020 India.

DSIR Recognized (Ministry of Science & Technology,

Govt. of India)

Member of Credibility Alliance

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Target Beneficiaries

Reaching the unreached communities

Three North Indian States (Rajasthan, Uttar

Pradesh, Haryana)

Underserved areas of Delhi (Urban Slums)

Priority Groups:

Elderly (50 years and above)

Women & Children

Rural underserved

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Our Approach Commitment to Serving the community

Expanding Geographical Reach

Comprehensive eye care

Excellence & Quality

Affordability with sustainability

Sound Governance & Systematic approach

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SCEH : Commitment to Serving the community

Strategic Approach: To control and reduce “Avoidable Blindness” in North India by Creating sustainable eye care delivery models Helping build capacity of like minded organization

Minimum 50% of all surgeries and procedures performed are free of cost to the patient.

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Expanding Geographical Reach …. SCEH Network

1 Tertiary Hospital3 Secondary Hospitals1 Satellite clinic10 Functional rural VC3 Urban VC

SCEH (Base Hospital)

Alwar, Raj (Sec Hospital)

Saharanpur, UP (Sec Hospital)

Lakhimpur Khedi, UP (Sec Hospital)

Meerut, UP (Sec Hospital)

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Comprehensive Eye care delivery VISION Centre:

• Basic services at the doorsteps

• Community participation & Ownership

Secondary Hospital (Service centre)

• Quality surgical care for cataract, in a cost effective manner

• Referral unit for the Vision centres

• Identification and referral of sub specialty cases to tertiary center

Tertiary Hospital (Training Center):

• High end equipments ensuring international standards of care

• Research and Training (National & International)

• Management of rare eye diseases (Cancers )

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Primary Care

Basic Refraction

Cataract Screening &

referral

Sub specialty screening

TrainingCommunity Research

CBRHealth Awareness &

Community Mobilization

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Secondary Care

Refraction & Dispensing

Basic Cataract Surgery

Sub specialty opinion & follow up

Training

Monitoring

Health Awareness

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Tertiary Care

Advanced Cataract

Advanced Refraction & CL

Sub specialty Referral & surgery

Rehabilitation

Training

Monitoring

Research

Awareness

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Global Partners

Project Prakash- Collaborative study with MIT (USA) ORBIS – Controlling Refractive Errors ORBIS- Eye Banking ORBIS – Quality Assurance in eye care World Diabetic Foundation: Diabetic Retinopathy

screening in Alwar (Raj) CBM- Community based Rehabilitation Rotary- Cataract Surgery CBF- Community Outreach, Saharanpur (UP) ADOBE Systems: “UJAGAR” IT resource center for the VI &

LV

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Our Vision : Quality with Excellence

Excellence Equity

“To make a lasting impact on the eradication of blindness and deafness in India by providing

quality care to all sections of the society.”

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Strive Towards Excellence & Quality Tertiary Hospital

– Continuous up gradation & modernization- Center of Excellence

– Quality Assurance

Secondary Hospital:– Affordable Cataract Surgery (60% of avoidable blindness)

– Awareness building in community- prevention and uptake of eye care

VISION Centre: – Essential eye care (primary) at Grassroots level

– Community participation

– Local NGO involvement

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Infrastructure improvement

THEN NOW

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Infrastructure improvement

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Adopting Best Practices

THEN NOW

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Outreach: Evolution

Cataract focused

One Off camps

Poor follow up

Poor Quality control

Untrained Manpower

Limited role in community

Comprehensive

Continuous

Regular follow up

Outcome Monitoring

Trained Vision technician

Broad perspective (CBR, Research, Awareness)

Eye Camp Approach

Vision Center Approach

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Interventions & Intents: “Towards cost-effective & Quality eye care for all”

Expansion of geographic reach to the rural hinterlands of

Rajasthan, Uttar Pradesh and Haryana.

Shift to comprehensive eye care

Community Based Rehabilitation of visual & hearing

impairment.

Active social marketing to increase uptake of services

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Affordability & Sustainability

Cross subsidization to ensure services for all socioeconomic sections while maintaining optimal internal revenue generation

Partnership with like Minded organizations (Such as ORBIS international, World Diabetes Foundation, CBM ) and donors.

Utilize local resources to bring down costs, create ownership and generate employment opportunities

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SCEH Community

Eye Care

Leadership (Vision & Strategy)

Workforce(Training)

SustainabilityQuality Control

(monitoring)

Technology

Community Participation

Comprehensive Affordable Accessible Effective

Health Systems Approach

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Achievements & Impact …… (Over the last Decade)

Touching Lives of people of all sections of the society spread over three states in North India (Delhi NCR, Haryana, Rajasthan & Western UP.

Patients Seen: 9,09,520

Operated: 65,065Free: 35,968

Children Seen: 1,54,200

Operated: 4,515

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Achievements & Impact …… (Over the last Decade)

Sustainability: Achieving 85 – 90% operational cost recovery

Up gradation of Secondary hospital (Alwar) to Advanced secondary.

Pioneering in setting up “Paediatric Ophthalmology” unit

Fastest growing Eye bank in India.

Operationalized three secondary hospitals, 13 Vision centres in Rural areas of North India.

International NGO collaborations.

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Achievements & Impact …… (Over the last Decade)

Training :

• Ophthalmologist : 235 (Long and short term training), 25 International trainees.

• Optometrists: over 100 (Fellowship & Internship)

• Training programs for Vision Technician & Ophthalmic Nursing assistants also running.

Research & Publications:

• Running clinical trials with reputed firms (e.g. Bausch & Laumb)

• Numerous publications in national & International peer review Journals.

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A case study1Context

Reduction of the burden of Preventable blindness caused by Cataract and Refractive error for Alwar district in Rajasthan (Population 11 Lacs)

Solution Setting up secondary hospital at Alwar,

RajasthanHolding camps in the rural areas in

collaboration with local NGO’sSetting up vision centers for primary eye

screening and referral service

Outcome Screening of CataractsQuality cataract surgeriesReferral of Pediatric /other sub specialties.

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A case study2 Context Rehabilitation and inclusion of the Visually/Hearing impaired and low vision persons of Malakhera in Alwar district in the mainstream.

Solution: Community Based RehabilitationDoor to door survey to identify persons with disabilitiesSetting up of the Community based rehabilitation centreHouse services provided through field workers

Outcome Counseling Aids & appliancesInclusive education

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Featured in…

‘Nature’ Magazine

‘Time’ magazine 2007

Rated by Outlook Magazine as one of the best

places for eye care in Delhi (Outlook, 1st July,2002)

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Learning from Challenges

Health Awareness (or lack there of) and early self reporting of eye diseases.

Overcoming Geographic & Cultural variations (social, gender, transportation)

Need for comprehensive approach Building community partner for improving

credibility and output performance

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Future Plans

Increase operations capacity: Double the number of surgeries performed annually by 2013.

Geographic expansion: Reaching out to remote

underserved regions and establishing 30 Vision centres, 4

secondary hospitals, 4 clinics in North India by 2013.

Enhance Sustainability: work towards increased cost recovery and long term sustainability.

Cont.

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Future Plans

Comprehensive care: To add diagnostic & basic sub-specialty (Glaucoma & Retina) services at secondary hospitals.

Replicating community based rehabilitation & eye banking in other areas.

Establishing a community based eye-care training & resource centre for North India.

Spread scope of operations to incorporate initiatives like “Sound Hearing 2030”

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Seeking Partnerships

Infrastructure

• IT systems

• Power

• Equipment

• Residential Training academy

Vision centre operations

Community Research

Service delivery: Support free surgeries

Thank You

Together we Can make a Difference… to many more lives