National Programme for Control of Blindness and Visual Impairment (NPCB&VI)

1. Background and Launch

• 60:40 (Centre : State) for all states
• 90:10 for North-Eastern states (including Sikkim)

2. Goal

• Rapid National Survey 2006-07: prevalence = 1.0%
• National Survey on Blindness 2015-19: prevalence = 0.36% (down significantly, but target not yet fully met)

3. Causes of Blindness in India (2015-19 National Survey)

• Age: ~30% of the blind in India lose sight before age 20; senile cataract occurs a decade earlier in India compared to Europe/America
• Sex: Higher prevalence in females (higher trachoma, conjunctivitis, and cataract rates)
• Malnutrition: Vitamin A deficiency (keratomalacia) is a major preventable cause, especially in children aged 6 months to 3 years
• Occupation: Factory and cottage industry workers are at high risk for eye injuries
• Social class: Blindness is twice as prevalent among lower socioeconomic groups
• Retinopathy of Prematurity (ROP): An emerging cause in children, with increased survival of premature babies in NICUs

4. Objectives (12th Five Year Plan Period)

1. Three signature activities:

• 66 lakh cataract operations per year
• School eye screening + distribution of 9 lakh free spectacles/year to children with refractive errors
• Collection of 50,000 donated eyes/year for keratoplasty

1. Reduce the backlog of avoidable blindness through identification and treatment at primary, secondary, and tertiary levels
2. Develop "Eye Health for All" strategy - universal, comprehensive eye-care services
3. Strengthen and upgrade Regional Institutes of Ophthalmology (RIOs) as centres of excellence in ophthalmology sub-specialties
4. Strengthen infrastructure and human resources for high-quality eye care in all districts
5. Enhance community awareness on eye care and preventive measures
6. Expand research for prevention of blindness and visual impairment
7. Secure participation of voluntary organizations and private practitioners

5. Strategies / Salient Features

1. Continued free cataract surgery through the health system, NGO sector, and private practitioners
2. Comprehensive eye care beyond cataract: diabetic retinopathy, glaucoma, corneal transplantation, vitreo-retinal surgery, childhood blindness
3. Active population screening above 50 years, organizing eye camps and transporting operable cases to fixed facilities
4. Refractive error screening in children + free glasses for those below the poverty line
5. Coverage of underserved areas through public-private partnership
6. Capacity building of health personnel
7. IEC (Information, Education, Communication) activities for community awareness
8. Strengthening Regional Institutes of Ophthalmology and Medical Colleges
9. Upgrading district hospitals with infrastructure, equipment, and contractual manpower
10. Establishing Vision Centres at all PHCs with a Paramedical Ophthalmic Assistant (PMOA)
11. Multipurpose District Mobile Ophthalmic Units for better rural/remote coverage

6. Organizational / Administrative Structure

7. Service Delivery and Referral System

• 80 central mobile units attached to medical colleges
• 341 district mobile units providing eye care through mobile eye camps
• Intra-ocular lens (IOL) implantation facilities expanded to taluka level

8. Key Components

A. Cataract Surgery

• 2022-23: 8.73 lakh surgeries (112.5% of target)
• 2023-24: 9.45 lakh surgeries (101.5% of target)
• IOL implantation rate consistently ~99% of all cataract surgeries

B. School Eye Screening Programme

• 6-7% of children aged 10-14 have vision problems affecting learning
• Children first screened by trained teachers; those suspected of refractive error referred to ophthalmic assistants
• Free spectacles provided to children below the poverty line
• Achievement 2023-24: ~12 lakh free spectacles distributed

C. Eye Donation and Keratoplasty

• Target: 50,000 donated eyes/year
• 2018-19 achievement: 68,409 donated eyes collected
• Hospital retrieval programme is the primary strategy - motivating relatives of terminally ill patients and accident victims
• Eye Donation Fortnight: 25th August to 8th September each year
• Leading states: Gujarat, Tamil Nadu, Maharashtra, Andhra Pradesh
• Indigenous cornea storage media developed under NPCB&VI

D. Management of Other Eye Diseases

• Diabetic retinopathy (laser + medical treatment)
• Glaucoma (surgical + medical)
• Retinopathy of Prematurity (ROP) with laser treatment
• Retinoblastoma surgery
• Congenital ptosis surgery
• Intraocular trauma in children
• Vitreo-retinal surgery

9. Role of Primary Health Worker (MPW/ASHA) in NPCB

• Identifying and referring all cases of blindness, including suspected cataracts, to the MO at PHC

10. Special Provisions for NE States / Tribal Areas

• Construction of dedicated eye units in North-Eastern states and hilly states
• Appointment of contractual ophthalmic manpower (surgeons, assistants, eye donation counsellors)
• Multipurpose District Mobile Ophthalmic Units for remote/difficult areas
• In 2025, 3 new multipurpose district mobile ophthalmic units established

11. Vision 2020: The Right to Sight

12. Role of NGOs and Voluntary Organizations

• 2,038 NGOs and 748 private practitioners registered under NPCB&VI MIS dashboard
• Organizations like Lions International, Rotary International, and NSPB India actively organize eye camps
• Voluntary organizations provide: health education, preventive services, rehabilitative services, surgical services

13. WHO Assistance

• Intra-country fellowships in: corneal transplantation, vitreo-retinal surgery, lasers, paediatric ophthalmology
• Training in district programme management
• Study on eye care infrastructure and human resources
• High-quality workshops for medical college faculty
• Development of "Vision 2020" plan of action

14. Prevention of Blindness - Components for National Action

1. Initial Assessment - prevalence surveys to determine magnitude, geographic distribution, and causes
2. Methods of Intervention:

• Primary eye care - village health guides/MPWs treat acute conjunctivitis, trachoma, ophthalmia neonatorum, and refer difficult cases; Vitamin A prophylaxis
• Secondary care - PHCs and district hospitals for cataract, trichiasis, glaucoma, ocular trauma; mobile eye clinics
• Tertiary care - RIOs and medical colleges for advanced surgery and sub-specialty care

1. Rehabilitation - providing low-vision aids, training blind individuals for self-sufficiency
2. Community health education - IEC at all levels

15. National Achievements (Last 5 Years, per Parliament data)