1. TITLE CLUSTER BASED PLANNING FOR ELIMINATION OF AVOIDABLE BLINDNESS (Rajganj Block, Jalpaiguri district, West Bengal) Presenter :- Anup Zimba Siliguri Greater Lions Eye Hospital Siliguri, West Bengal, India

2. SILIGURI GREATER LIONS EYE HOSPITAL PARTNERS :- Comprehensive Ophthalmology Vitreo Retina Pediatric Ophthalmology & Squint Glaucoma / Oculoplasty Low Vision Clinic / Contact Lens Tele-ophthalmology B.Sc. Optometry Vision Technician Ophthalmic assistant Established :1981 Beds : 54 OPD : 888,817 Surgery : 85,437 Outreach Screening : 483,095 School Screening : 1,663,398

3. SILIGURI GREATER LIONS EYE HOSPITAL

4. Vision “SGLEH’s vision is to be Centre of Excellence to provide quality eye care services for all” Mission “SGLEH is a public trust committed to provide excellent, affordable eye care services through dedicated team work and making it accessible to all in Eastern part of India.”

5. SILIGURI GREATER LIONS EYE HOSPITAL

6. Objective To assess the role of cluster based community eye health planning in eliminating avoidable blinding causes with the help of a secondary level hospital.  To improve eye health seeking behavior of the target population  To strengthen primary health services  To integrate primary eye care services with primary health care services Improved utilization of eye care services leading to elimination of avoidable blindness

7. Majority of population is economically and socially vulnerable. Existence of a well established secondary eye care center which is a OE partner hospital Accessibility to hospital - distance to hospital does not exceed 80-100 kms from any of the villages located in the Block Potential to increase walk-in patients from the area to the partner hospital SILIGURI GREATER LIONS EYE HOSPITAL

8. Cluster formation o Division of clusters : - Each cluster has 20,000-22,000 population - Geographical area - Population distribution o Field staff trainees selection 2 trainees per cluster Priority to women candidates Previous experience Good communication skills Local people to given preference SILIGURI GREATER LIONS EYE HOSPITAL

9. Based on Number of blind persons identified through door to door survey Number of persons with cataract (bilateral & unilateral) Number of persons with other eye diseases Current levels of knowledge, attitude and practices among the cluster population Number of persons with other eye diseases Number of screening Programme required to be conducted Number of eye health/ general health education events Number of NGOs present in the cluster Number of ICDS/ PHC centers and staff SILIGURI GREATER LIONS EYE HOSPITAL

11. Project started in July 2010 14 candidates underwent 23 days training. Door to door survey covering 1,04,327 persons. 320 villages covered. Survey period 3 months (Sep ‘10-Nov ‘10). Eye care services provided by Field Staffs Screening Diagnosis, referral Treatment Follow up Health education Coordination with government agencies for Immunization ANC/ PNC Socio economic development Networking with other agencies

12.  Training : Curriculum developed by OE First module Identifying blind persons and person with eye diseases Survey methodology Second module training Curriculum developed by OE All the trainee workers attend PHC services Networking Implementation of eye health services Door to door survey Conducted over 3 months Covers the entire population of the selected area (all clusters) The survey focuses on identification of visually impaired persons with special emphasis on identification of persons with cataract and refractive errors Computerization of all collected data for further analysis SILIGURI GREATER LIONS EYE HOSPITAL

13. Community Eye Care: Screening programmes in each cluster Eye check up Treatment for minor ailments Referral for further management to the base hospital. Primary eye care centers (vision centers) Health promotion/education activities Training of self help groups in eye care SILIGURI GREATER LIONS EYE HOSPITAL

14. Primary Health Care and Community Development Maternal and child health care Immunization Vitamin A Micro-skill development Primary and non formal education Water and sanitation Referral for community based rehabilitation SILIGURI GREATER LIONS EYE HOSPITAL

15.  Daily wage workers  Seasonal fluctuation  Drop outs of health workers  Capacity building of new recruits  Weather

16. Eye care (Jan 2011-July 2012) Total Camp: 76 Total Screened: 9,398 Total Advised for Cataract Surgery: 1,456 Total cataract operated: 1,186 (81%) Total Specs Advised: 1,265 Total Specs uptake: 833 (66%) Total People educated for Health Education: 39,015 Total network with local NGO/Govt: 19 Surgery 70% Free 20% Subsidized 10% Paying/RSBY SILIGURI GREATER LIONS EYE HOSPITAL

17. Services1234567Total Identified patients Blind Uni. & Bil-cataract Others 60 775 71 93 343 81` 155 556 105 219 388 63 86 462 109 68 256 116 126 323 199 807 3103 663 Operated1402002011681601922471,308 Spectacles provided106103107109108104105833 Balance patients7061434602834111802752458 Eye health education6,1406,4866,0656,4215,8765,9666,69339,015 Immunization coverageTwo years back 69.7% * Now 80% Surgical conversion81% Spectacle conversion66% * Singapore Med J 2010; Socioeconomic impact on child immunization in the districts of West Bengal, India

18. Immunization Rally by Children on Eye care Sanitation demo Health Awareness Health camp Training ICDS workers Meeting with NGOs Public awareness

19. SILIGURI GREATER LIONS EYE HOSPITAL Cluster based planning brings:  Services right at the door steps of the needy  Ensures treatment of identified  Increases positive behavioural change

20. SILIGURI GREATER LIONS EYE HOSPITAL 1.Establish a Vision Center. 2.Expansion of project catchment area. 3.Implement similar program in other Blocks. 4.Identify potential donors for supporting the project in other blocks.

21. SILIGURI GREATER LIONS EYE HOSPITAL Cluster based planning is proving to be an effective approach to elimination of avoidable blindness. Brings permanent and positive change in eye health seeking behavior in Rajganj block before the end of the project(2014).