Achieving a goal of universal health coverage is a complicated aspiration with many moving parts. The rate of cataract surgeries among the marginalised population of India has significantly increased, thanks to government-run health insurance programmes (Rashtriya Swasthya Bima Yojna and the recently launched Ayushman Bharat), and an increase in government allocation of financial assistance to NGO partners. While the availability of this funding is a very positive development, there are still many people in need of eye health intervention who have no idea this kind of support is available to them.
And cataracts are not the only cause of vision impairment among this population. According to the World Health Organization’s World Report on Vision, at least one billion people worldwide have vision impairment that could have been prevented or has yet to be addressed, and 123.7 million of these people suffer from unaddressed refractive error. In fact, recent studies have found that visual impairment and blindness caused by uncorrected refractive errors are expected to rise by about 10% and 8% respectively. With a lack of coverage for prescription glasses through insurance programs, the implementation of self-reliant vision centres is a viable solution to bridge this gap.
Operation Eyesight, with support from Seeing is Believing, has established four vision centres in 2018 across two states of India. Our relentless efforts and meticulous planning have helped us to achieve the sustainability of the vision centres within a few months of their establishment (see Table 1). We focused on six key principles to achieve this.
Know the place: Using a standardized process and manual, we follow a rigorous procedure to select the appropriate location for a new vision centre using a checklist. We take into account availability of other eye care services, distance from the base hospital and the surrounding population. We have implemented our Participatory Approach to Community Eye Health to ensure the vision centre will adequately meet the needs of the end beneficiaries.
Appearance is important: We invest in maximizing the aesthetic appeal of vision centres and spectacles, knowing appearance can the increase the rate of walk-ins, referrals and spectacle compliance.
Patient-centric approach: The vision technicians/optometrists and dispensing opticians in our vision centres are trained in soft skills to improve the compliance of prescribed treatments. Whenever possible, our vision centres offer same-day delivery of spectacles to increase patient satisfaction, knowing this satisfaction leads to a more successful vision centre.
Community-centric approach: In addition to supplyingservices through the establishment of a vision centre, we also work to create demandfor those services within a target area. Our Vision Centre-Based Community Eye Health Programme sends community health workers (CHWs) directly into the surrounding community to identify patients through door-to-door surveys and refer them to the nearest vision centre for a comprehensive eye examination. CHWs also empower communities through education and counselling, leading them to take responsibility for their own eye care needs. With increased demand for the vision centre’s services, revenue increases as well.
Monitoring and Audit: This step maximizes confidence in the success of vision centres. A CCTV camera is installed in each of the vision centres, allowing us to monitor day-to-day operations and the maintenance of quality and discipline within the vision centre. This system, along with periodical monitoring visits and a clinical and financial audit, has helped us to identify any gaps at an early stage and take corrective actions accordingly.
Closing-the-loop-approach: We have established follow-up procedures to determine the compliance of treatment and referrals with the help of CHW visits at the village level.
The long-term sustainability of our vision centres can be attributed in large part to a focus on involving the community from the planning stage of the project, and to the fact that we ensure demand is in place for the vision centre’s services to ensure a flow of revenue. Through the establishment of vision centres that act as an interface between the target communities and our partner hospitals, we have been able to empower underserved and marginalized communities to access quality, affordable eye care on a permanent and sustainable basis that will lead to the elimination of avoidable blindness.