Visual impairment is a public health problem and majority of blindness is preventable, treatable and curable. Vision is the most dominant sense of the individual and vital at every stage of life. The existence of the world depends on one’s ability to see. A new born recognizes and establishes bond with the mother only through vision. Vision loss has devastating impact on individuals, households and community in many ways, mainly through enhancement of poverty, reduced quality of life as well as employment. Globally there is relative loss of 30.2% employments and annual productivity loss which is estimated to be as $408.5 billion ppp (Dollar purchasing power parity)[1]. Worldwide at least 2.2 billion people are suffering from impaired vision. In India particularly in Assam prevalence of blindness is higher despite concerted action during last 30 years by the Govt. of India as well as State Govt. World report on vision 2019 by the WHO seeks to stimulate action in countries to address these challenges by implementing integrated peoples centric eye care (IPCEC), particularly in country like in India and in Assam where eye care and health care inequality is significantly existing in terms of coverage, quality, prevention and rehabilitation services. Blindness is directly related to economic development and health spending of the state[2]. According to NITI Aayog’s report on ranking of the states on SDG performance, our state has been ranked 3rd from bottom so far good health and wellbeing are concerned. The score of Assam is also below the national average. SDG vision report Assam agenda 2030 distinctly carries aspiration to leap fogging in various developmental sectors of other Northeastern states on health and transforming Assam in economic interaction social promotion however with risk and vulnerability to disaster, nontraditional security threat and human aspiration[3]. Poor eye care uptake in the Northeast India and relatively higher incidence of blindness has been related to poverty and different barriers like non availability, poor accessibility, and poor health status of the people, faith, and apathy towards vision, lack of information, infrastructure, no escort and affordability issues. The scenario of childhood blindness is also grave in the Northeastern region. The fact has been reflected in a rapid assessment of avoidable blindness. This report showed that only 8.1% blindness in Assam is unavoidable and 91.9% are curable but due to the above facts the prevalence of blindness is highest in the country[4],[5],[6],[7]. All these facts warrant manifold increase of eye care coverage in our state.
Vision centre is a small self sustainable permanent facility setup in semi rural and rural community. Vision centre provides primary eye care services to the population under cover of the centre. Vision centre is operated by trained optometrist/ophthalmic assistant. The patient can also avail Tele-ophthalmology consultation and treatment from an ophthalmologist in the base hospital linked with the particular vision centre. The vision centre is the implementation and action of the aspiration expressed in the world health report on “Primary Health Care”. As per WHO, vision centre are to provide “services to a finite population with permanent commitment to the population with appropriate infrastructure and trained human resources from local community”. “Vision centre approach” of primary eye care is also approved by the Ministry of Health, Govt. of India, NPCBVI Govt. of India, International Council of Ophthalmology and WHO Vision 2020 “The right to sight..India”. Thus vision centre fulfill the SDG millennium developmental goal of UN.
SSDN is committed to community service and offering assistance to economically underprivileged patients. The community eye care services were inaugurated in 1994 by the then Governor of Assam L.N. Mishra in a free premises in a charitable dispensary of one of our trustee Mr. Ramesh Pasari. The Bonda centre is located at Chandrapur 11.5 Km away from Guwahati in a semi urban setting. Since then up to 2021 SSDN has offered 59,669 number of surgeries at free of cost not only that also arranged free mobilization, logistics, stay, food, medicine and post operative care costing us Rs.49,41,12,338 We also extend outreach activities in all the other Northeastern states, are working in collaboration with NPCBVI Govt. of India and other eye care NGOs and regularly conduct different survey works of the Govt. of India.
Fig 1:- Blindness free village declaration ceremony by His Excellency the Governor of Assam Prof. Jagdish Mukhi ji at Sonapur (100636 households and 452862 population covered under the project)
In this collaborative project SSDN Community Department work in collaboration with Operation Eyesight International, Canada through a strategic program, comprised of enumeration, survey, screening, validation, blindness registry, surgery, treatment, monitoring, surveillance and follow up services. Under this project SSDN has made 178 number of villages sustainably free from avoidable blindness and 13946 numbers beneficiaries. His Excellency the Governor of Assam publically declared the villages of Sonapur to be blindness free. This achievement was possible only because of implementation of vision center approach on blindness. 100636 households and 452862 population covered under the Sonapur project. This initial success led us to open 9 more vision centers in different districts of Assam.
Fig 2:- Different districts where our vision centres are working and upcoming vision centers
Commemorating the 75 years of Indian independence “Ajadi Ka Amrit Mohatsav” SSDN has undertaken the above project. At present vision centers are functioning in 8 districts namely Kamrup Metro, Kamrup Rural, Morigaon, Darrang, Nagaon, Bongaigaon, Goalpara and Udalguri under 10 vision centers (namely Sonapur VC, Bijoynagar VC, Hajo VC, Sualkuchi VC, Morigaon VC, Mangaldoi VC, Nagaon VC, Bongaigaon VC, Goalpara VC and Udalguri VC). 3 new vision centers (namely Bajali VC, Barpeta VC and Dhekiajuli VC) in Bajali, Barpeta and Sonitpur districts covering 100 villages under each vision centers will be started functioning by 15th of February 2022.
The standard facilities available in vision centre are:- i. Eye screening ii. Spectacles iii. Telemedicine iv. Follow up facilities v. Medication for simple eye condition vi. Coordination with base hospital vii. IEC activities The above facility will be available in Dhekiajuli vision centre also.
A vision centre has been proposed to start in Dhekiajuli, Sonitpur after renovating an old godown building. This premise has been donated to SSDN by Mr. Dipankar Chatterjee Vice President of our foundation. The house measures 2000 sq. ft. floor area. As the Assam type house is about 50 years old several repairs and renovation work had to be undertaken for making a safe place for the visiting patients complying vision centre norms and recommendations. Under this vision centre 100 villages will be adopted and sustainably these villages will also be made free from avoidable blindness through primary eye care approach and systematic medical and surgical treatment. The service will be free to all economically underprivileged patients.
Conclusion Vision centre is the functional unit of Sri Sankaradeva Nethralaya at the community grassroots level. Vision centre is nothing but the implementation and action unit to fulfill the aspiration expressed in the world health report on “Primary health care” to provide committed service to the community. To reduce the burden of blindness and achieve sustainable development goals (SDG3) of UN particularly SDG target 3.8 on universal health coverage, vision center approach is a WHO recommendation. This approach is also approved by the Govt. of India, Ministry of Health & Family Welfare and the National Program for Control of Blindness and Visual Impairment (NPCBVI). Vision centre is a feasible and cost effective solution for eye care promotion, prevention, treatment and rehabilitation under Universal Eye Health coverage. The Dhekiajuli Vision center is aim to fulfill all the objectives.
Reference: i. Global economic productivity loss from vision impairment and blindness. April 25, 2021. DOI: https://doi.org/10.1016/j.eclinm.2021.100852 . ii. WHO reference number ISBN 9789241516570. iii. Vision document Ministry of Development of Northeast. https://mdoner.gov.in>actvities>visiondocument. iv. Prem Kumar SG et. al. Factors limiting the Northeast Indian elderly population is seeking cataract surgical treatment. Evidence from Kolasib district, Mizoram, India. Indian Jr. of Ophthalmology 2018; 66:969-974. v. Bhattacharjee H et. al. Causes of childhood blindness in Northeast India. Indian Jr. Ophthalmology 2006; 56:495-499. vi. Bhattacharjee H et. al. Changing pattern of childhood blindness in eight North-Eastern states and review of the epidemiological data of childhood blindness of India. Indian Jr. Ophthalmology 2021; 70:214-222.
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