Eye Care in North India

1. 24th September, 2010 Eye Care in North India Arun K. Arora Chief Executive Officer Dr Shroff’s Charity Eye Hospital, New Delhi

2. 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.

3. Indian Scenario: The Magnitude • Numbers • 12 million - Blind, 27- 30 million - low Vision • 3.8 million new cases added every year • Will reach 18 million by 2020 • Distribution • Blindness: 90% in rural underserved areas • Services & trained manpower concentrated to urban communities • 75 – 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

4. Eye-care services: India Government 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 Care • Prominent 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

5. 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.

6. Dr. Shroff’s Charity Eye Hospital Institutional Background • Established in 1914 • Only dedicated eye care hospital from Lahore (now Pakistan) to Kanpur. Founder: Dr Sorabji P Shroff , FRCS, awarded the PadmaShriby the government of India for his humanitarian efforts. A distinguished governing board • Mr. VikramLal (EICHER group) • Dr. NM Shroff (PadamShri) • Mr. NareshGujral • Mr. LalitNirula • Dr. ArvindTaneja

7. Dr. Shroff’s Charity Eye Hospital • Member of VISION 2020 India. • DSIR Recognized (Ministry of Science & Technology, Govt. of India) • Member of Credibility Alliance

8. 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

9. Our Approach

10. 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.

11. Expanding Geographical Reach …. SCEH Network SCEH (Base Hospital) • 1 Tertiary Hospital • 3 Secondary Hospitals • 1 Satellite clinic • 10 Functional rural VC • 3 Urban VC Alwar, Raj (Sec Hospital) Saharanpur, UP (Sec Hospital) Lakhimpur Khedi, UP (Sec Hospital) Meerut, UP (Sec Hospital)

12. 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 )

13. Primary Care Cataract Screening & referral Basic Refraction Training Sub specialty screening Community Research Health Awareness & Community Mobilization CBR

14. Secondary Care Basic Cataract Surgery Refraction & Dispensing Training Monitoring Sub specialty opinion & follow up Health Awareness

15. Tertiary Care Advanced Refraction & CL Advanced Cataract Training Monitoring Research Rehabilitation Sub specialty Referral & surgery Awareness

16. 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

17. Our Vision : Quality with Excellence “To make a lasting impact on the eradication of blindness and deafness in India by providing quality care to all sections of the society.”

18. 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

19. Infrastructure improvement THEN NOW

20. Infrastructure improvement

21. Adopting Best Practices NOW THEN

22. 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

23. 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

24. 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

25. Health Systems Approach

26. 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: 65,065 • Free: 35,968 • Children Seen: 1,54,200 • Operated: 4,515

27. 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.

28. 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.

29. A case study1 • Context • 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, Rajasthan • Holding camps in the rural areas in collaboration with local NGO’s • Setting up vision centers for primary eye screening and referral service • Outcome • Screening of Cataracts • Quality cataract surgeries • Referral of Pediatric /other sub specialties.

30. 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 Rehabilitation • Door to door survey to identify persons with disabilities • Setting up of the Community based rehabilitation centre • House services provided through field workers • Outcome • Counseling • Aids & appliances • Inclusive education

31. 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)

32. 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

33. 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.

34. Future Plans • Comprehensivecare: 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”

35. Seeking Partnerships • Infrastructure • IT systems • Power • Equipment • Residential Training academy • Vision centre operations • Community Research • Service delivery: Support free surgeries

36. Together we Can make a Difference… to many more lives Thank You