Describe the National Programme for Control of Blindness and VISION 2020.

The National Programme

• The national programme for control OF blindness was launched in 1976, and was the first national programme IN the world with the stated goal of eliminating avoidable blindness. It is 100% centrally sponsored
• It was renamed the national programme for control OF blindness and visual impairment (NPCBVI) in 2017, and the change of name reflected a real change of scope: from blindness alone to visual impairment, and from cataract alone to the whole range of eye disease
• Its original target was to reduce the prevalence of blindness from 1.4% to 0.3%, and the most recent survey indicates this has broadly been achieved in the surveyed age group

Vision 2020 and Global Strategy

• Vision 2020: the right TO sight was launched in 1999 as a joint initiative of the WHO and the international agency for the prevention OF blindness (IAPB), with the goal of eliminating avoidable blindness by the year 2020
• Its five priority conditions were chosen because each is common and avoidable and has a cost-effective intervention: cataract; refractive error and low vision; childhood blindness; trachoma; and onchocerciasis (not relevant to India). Glaucoma and diabetic retinopathy were added later as the epidemiology shifted
• Its three pillars — disease control; human resource development; and infrastructure and appropriate technology

Indicators and Applied Aspects

• Cataract surgical rate (CSR) — the number of cataract operations per million population per year. It measures service volume, and India’s has risen to among the highest in the world. Its weakness is that it says nothing about who was operated or how well they see
• Cataract surgical coverage (CSC) — the proportion of people with operable cataract who have had surgery. This is a far better measure because it relates the service to the need, and it exposes inequity: coverage is consistently lower in women, the rural, the poor and the illiterate
• Effective cataract surgical coverage (eCSC) — the same, but counting only those achieving a good postoperative outcome. This is now the headline indicator
• Outcome standard — the WHO target is that at least 80% achieve 6/18 or better with best correction, and fewer than 5% are left with a poor outcome (worse than 6/60)
• The residual causes of a poor outcome are, in order: uncorrected refractive error.
• Measure and publish outcomes, not only numbers; this is the shift that sustains community confidence, and a bad result deters the next ten patients in that village
• India ran the first national blindness programme in the world, launched in 1976 and fully centrally sponsored
• The rename to NPCBVI in 2017 widened the scope from blindness to visual impairment and from cataract to all eye disease
• The eye camp era generated distrust through poor outcomes, and that distrust took years of better results to undo
• Camps now screen and transport rather than operate, which was the single most important safety reform in the programme
• Aphakic spectacles were the weak point of camp surgery; they were lost, broken or never worn, and gave poor vision even when worn