Goal: Elimination of avoidable blindness on a sustainable basis

Objectives:

• Enabling Changlang/Namsai district of Arunachal Pradesh to deliver comprehensive quality eye care services through competent and empowered health care providers through the HWC service delivery framework in the next 6 months
• Bringing quality eye care services closer to the communities by operationalizing teleophthalmology and mobile vision center services in one block of Changlang/Namsai district of Arunachal Pradesh in 6 months
• Designing and implementing an integrated sustainable and scalable eye health model within CPHC service delivery through HWCs using a continuum of care approach.
• Empowering communities to take care of their eye health needs through health education.

Strategy:

 Operation Eyesight in close association with partner and state/district health departments will support the expansion of the service delivery package for eye care at the Health and Wellness Centers. It will adopt a systems approach to operationalize the eye care service delivery components using the prescribed operational guidelines by the Government of India and work closely with state and district officials to ensure all the critical elements necessary for optimal eye health are appropriately addressed using a continuum of care approach. The following strategies are proposed to strengthen the eye care services delivery; Strengthening primary eyecare services through;

• Establishing Vision Points and Sub-Center HWCs and Vision Centers (VCs) at the Primary Health Center (PHC) level and Vision Points at a few selected Sub Center – HWCs after conducting a facility audit
• Establish linkage of Vision Centers with District Hospital through piloting teleophthalmology
• Building capacity of existing eye health staff on key components of Primary Eye Care (PEC) after training needs assessment
• Increasing outreach of PEC services through mobile VCs
• Building capacity of frontline health workers on early diagnosis and timely referral of all suspected cases with eye conditions
• Establishing functional linkages for the provision of free/affordable spectacles
• Launching mobile Vision Center
• Conducting health education sessions by engaging community members to increase community awareness and demand generation for eye care services
• Integrate the learnings in the district PIP
• Strengthening secondary eye care services through;
• Conducting facility audit to identify the gaps in the delivery of eye care services and developing an action plan to bridge the gaps
• Building capacity of existing eye health personnel on eye care services through training needs assessment
• Establishing functional linkages for the provision of free/affordable spectacles and quality surgical services
• Piloting teleophthalmology for bringing quality eye care (secondary and tertiary) closer to the community and data-driven decision making
• Establishing functional Intra/interstate referral and feedback linkages with premier/tertiary eye care institutes
• Meaningful inclusion of the private sector by leveraging the available PMJAY impaneled facilities network for the provision of quality assured eye care services
• Establishing a robust monitoring and reporting framework to support data-driven decision making
• Promote declaration of Avoidable Blindness Free Villages (ABFVs)
• Technical support to state and district for scale-up of successful interventions.

COMMUNITY EMPOWERMENT AND DEMAND GENERATION:One of the key activities of the project is to empower the target communities to take ownership of their eye health. This will be achieved by conducting periodical eye health education sessions by trained frontline workers (ANM, ASHA, Anganwadi Workers) to raise awareness and promote eye health-seeking behavior among target communities by using appropriate Behavior Change Communication (BCC) materials developed in mutual consultation.

COMMUNITY SCREENING OF EYE CONDITIONS:The project, through the frontline health workers, will develop a mechanism for community screening for eye conditions. The project will explore the possibilities of incorporating relevant elements into the existing Community Based Assessment Checklist (CBAC). The project will also explore the possibility of incentivizing the frontline workers for undertaking door to door surveys.

CAPACITY BUILDING:The project will undertake capacity-building activities for the various cadre of staff on key elements of comprehensive primary eye care in line with the GoI prescribed operational and CPCH guidelines. The proposed capacity-building areas for the key health care providers are listed below.

ESTABLISHMENT OF VISION POINTS, VISION CENTERS, AND MOBILE VISION CENTERS:To streamline and strengthen the eye care service delivery, the project will establish dedicated eye care delivery structures leveraging and supporting the available frameworks. The project proposes to establish;

• Establish Vision Points at HWCs-SC to provide screening services such as visual acuity measurement, provide primary eye care services for eye conditions like dispensing of prescribed medicines and ointments, ointments for conjunctivitis, dry eye, and Trachoma, health education, Identification of common eye diseases such as cataract, Presbyopia, Trachoma and Corneal disease including Vitamin A deficiency and referral linkages with Vision Center.
• Establish Vision Centers at HWCs-PHCs and CHC to provide comprehensive eye examination services, diagnosis and treatment of refractive errors and foreign body removal, identification of cataract and other eye diseases, consultation with a specialist using teleophthalmology, referral and follow-up of operated cases.
• Launch Mobile Vision Center in difficult geographies to provide primary eye examination at the community level, identification of refractive errors, linkage for spectacles, Identification of common eye diseases such as cataracts, dispense medicines for common eye infections and dry eyes, health education, and referral to the appropriate center.

STRENGTHENING SURGICAL EYE CARE SERVICES THROUGH UPGRADED COMMUNITY HEALTH CENTER AND DISTRICT HOSPITAL:The project will leverage the already upgraded OPD and Operation Theater (OT) at Bordumsa Community Health Center to deliver quality eye care services. The project will also support the district and state to conduct a gap analysis and action plan to streamline and strengthen eye care service delivery. The project will also facilitate the training needs assessment for the various cadre of staff across the spectrum and work closely with the state and partners for putting in place the mechanisms for continued capacity building.

STRENGTHENING REFERRAL AND FOLLOW-UP MECHANISM TO ENSURE CONTINUUM OF CARE:One of the key activities Under the project will be to develop and establish robust referral feedback linkages to provide free/affordable quality eye services throughout the continuum of care. The project will work closely with the state and partners to strengthen the referral feedback mechanism through;

• Defining and strengthening patient flow, care provision, and follow-up processes and mechanisms
• Establishing functional referral linkages with TRIHMS for complicated case management/tertiary level of care
• Exploring possibilities for leveraging the available network of PMJAY impaneled private sector facilities within the state after conducting thorough quality assessments
• Exploring possibilities of establishing functional interstate referral linkages with premier eye care institutes such as Sri Sankaradeva Netralaya in Guwahati, Assam.
• Promoting the use of Tele-ophthalmology to provide specialist care near the community
• Establishing mechanisms for tracking back referrals and follow up at the community level

DECLARATION OF AVOIDABLE BLINDNESS FREE VILLAGES (ABFV):One of the success indicators of the project will be to declare villages as avoidable blindness free. The project will work with the state and partners to promote the declaration of ABFV in the villages where no patient has visual acuity less than 6/60 in the better eye due to avoidable or treatable conditions. The definition of the ABFV has been validated by L V Prasad Eye Institute, Hyderabad – a WHO collaborating center. The declaration would be celebrated and leveraged to ensure sustainability and provide motivation to the health workers and the communities.