1. Innovative ideas to prevent & control Non-Communicable Diseases through Rural Eye Health Intervention Sarangadhar Samal Kalinga Eye Hospital (An unit of NYSASDRI) Odisha, India

2. Non Communicable Disease Noncommunicable diseases (NCDs), also known as chronic diseases, are not passed from person to person. They are of long duration and generally slow progression. The 4 main types of noncommunicable diseases are cardiovascular diseases (like heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructed pulmonary disease and asthma) diabetes and oral and eye diseases

3. NCDs are largely preventable by means of effective interventions that tackle shared risk factors NCDs are not only a health problem but a development challenge as well.

4. Who is at risk of such diseases? All age groups and all regions are affected by NCDs. NCDs are often associated with older age groups, but evidence shows that 16 million of all deaths attributed to noncommunicable diseases (NCDs) occur before the age of 70. Of these "premature" deaths, 82% occurred in low- and middle-income countries. Children, adults and the elderly are all vulnerable to the risk factors that contribute to noncommunicable diseases, whether from unhealthy diets, physical inactivity, exposure to tobacco smoke or the effects of the harmful use of alcohol. These diseases are driven by forces that include ageing, rapid unplanned urbanization, and the globalization of unhealthy lifestyles.

5. What are the socioeconomic impacts of NCDs? NCDs threaten progress towards the UN Millennium Development Goals and post-2015 development agenda. Poverty is closely linked with NCDs. The rapid rise in NCDs is predicted to impede poverty reduction initiatives in low-income countries, particularly by increasing household costs associated with health care. Vulnerable and socially disadvantaged people get sicker and die sooner than people of higher social positions, especially because they are at greater risk of being exposed to harmful products, such as tobacco or unhealthy food, and have limited access to health services.

6. Prevention and control of NCDs To lessen the impact of NCDs on individuals and society, a comprehensive approach is needed Promoting the interventions to prevent and control NCD Primary eye-care approach to strengthen early detection and timely treatment.

8. Map of India showing Odisha State

9. Why rural Eye health? 69% people reside in the rural areas (census 2011 India) 70% of the Eye Care Professional lives in Urban Areas Even major eye care institutions & service providers are located in urban area too. Thus Eye care delivery to the doorstep of the Rural areas remains a biggest challenge; result, rural eye health remains the most neglected area and rural population live and succumb to the blinding conditions

10. Odisha National Blindness Control Programme has significantly contributed to blindness control efforts in India. The state performance remains dismal compared to the national average. The prevalence of blindness in Odisha is at 1.4% as compared to the national average of 0.8% and there is estimated 0.514 million blind person in the state (Odisha report on NRHM).

11. Situation Analysis Odisha An estimated 10% of the public health delivery systems in Odisha have eye care service provisions (majority of them only provide primary eye care). There are only 37 Ophthalmologist in the Govt. system against the position of 97. Similarly the state has only 244 ophthalmic assistants in position who provide primary eye care against the position of 444. Within such a context, providing eye care to the rural populous has paused a severe challenge for the Public Health Delivery Systems in Odisha. The State has a Cataract Surgical Rate (CSR4) of 2630 (As per state blindness control report 2013-14) which is quite low compared to the national average of 5406. With this CSR of 2630 in the state it’s very much clear that there are many districts in the state where the performance of the surgeries is very low and in some districts where basic eye care is even not available.

12. The Factors This situation is influenced by number of factors ranging from – Human resources, – Infrastructure availability and its productivity – The local leadership around eye health etc. Change in the status quo and enhancement of eye care services in such underserved districts is unlikely to happen organically by itself unless a suitable strategy with state commitment is placed with proactive measures.

13. The HR matters In the selected districts there is one ophthalmologist in Govt. set up for 0.88 million people and there is only one Ophthalmic Assistant for 0.19 million people. WHO standard suggests that for every 200,000 population there should be one ophthalmologist and for every 50,000 population there should be one ophthalmic paramedic.

14. Component of Rural Eye Health  Primary Eye Care (PEC)  Disease Specific Interventions:  Cataract & Refractive Errors (including Low Vision),  Glaucoma and Diabetic Retinopathy,  Childhood Eye Health (other than refractive errors) and Retinopathy of Prematurity  Human Resource Development  Eye Health Advocacy

15. Planned Strategies Increased uptake of rural eye health services by communities Strengthened eye health systems deliver eye health services to rural communities Eye health prioritized and integrated in wider rural health system.

16. Addressing the Situation/ Issues/ Challenges Quality eye health service delivery From geographical coverage to universal coverage Engaging with eye health enhancing determinants Engaging with leadership and Governance for reforms

17. The Actions Empowering the Community Advocacy with the Government Involving the Community Making Eye Care Available, Accessible & Affordable Ensuring Quality eye health service delivery Post Action survey for exploring the opportunities of improvements.

18. Advocacy Meeting

19. Empowering the Community

20. Involving the Community

21. The Outcome

22. Post action Survey

23. Scaling up the programme After successful implementation of the programme in one district, it will be scaled up in another two districts of the state. The main scale up partner for those districts will be Govt. of Odisha through the National Programme for the Control of Blindness(NPCB). Besides that the programme will also target other INGOs working in eye health and general health issues, CSR initiatives and corporate foundations who have similar interest. In the scale up districts the implementing partners in the demonstration will take the lead role. However for local convenience some new partnerships can be formed in these scale up districts so that the planned activities are implemented effectively.

24. Map of Odisha Dhenkanal Angul Deogarh

25. Thank you