NATIONAL PROGRAMME

FOR CONTROL OF
BLINDNESS (NPCB)
D VISHNU VARDHAN REDDY
MBBS FINAL PART 1
ROLL NO 36
• India was the first country in the world to launch the ‘National Programme for Control of
Blindness (NPCB)’ in the year 1976 as 100 percent centrally sponsored programme which
incorporated the earlier trachoma control programme started in the year 1963 and vitamin
A prophylaxis programme launched in 1970.

OBJECTIVES :
In 1976, the NPCB was launched with following goals:
1)To provide comprehensive eye care facilities for primary, secondary and tertiary levels of
eye health care.
2) To reduce the prevalence of blindness in population from 1.38% (ICMR 971-74) to 0.31 by
2000 AD
Recently, government of India has adopted ‘Vision 2020: Right to Sight’ under
National Programme for Control of Blindness. The initiative ‘Vision 2020’ has been launched
with the objective to eliminate avoidable blindness by the year 2020.
 • Extension of eye care
services
PLAN OF ACTION AND Basic
programme
• Establishment of permanent
components
ACTIVITIES concepts • Intensification of eye health
education

PLAN OF
• Central level
ACTION AND Programme • State level
ACTIVITIES organization • District level

• Strengthening advocacy
• Reduction of disease burden
Strategic
• Human resource
plan for
development
vision 2020 • Eye care infrastructure
development
BASIC PROGRAMME COMPONENTS:
• A) Extension of eye care services:
It is being done through the state and district mobile units by adopting an ‘eye camp approach’ and by enlisting the
participation of voluntary organisations. The following facilities are being provided in remote areas:
1. Medical and surgical treatment for the prevention and control of common eye diseases. Eye camp approach is of
great help in reducing the back- log of cataract by mass surgeries. Recent emphasis is on reach-in-approach.
2. Detection and correction of refractive errors.
3. Thorough ocular examination including vision of school children for early detection of eye diseases and promoting
ocular health.
4. Rehabilitation training of visually handicapped.
5. General survey for prevalence of various eye diseases.
• B) ESTABLISHMENT OF PERMANENT INFRASTRUCTURE:

The ultimate goal of NPCB is to establish permanent infrastructure to provide eye care
services. It is being done in three-tier system i.e., peripheral, intermediate and central level.
1.ESTABLISHMENT OF PERIPHERAL SECTOR FOR PRIMARY EYE CARE:
Peripheral sector for primary eye care at PHC and subcentre levels is being strengthened by:
Providing necessary equipment,
Posting a paramedical ophthalmic assistant, and
Organising refresher courses for doctors and other staff of PHC on prevention of blindness.
By the year 2002, 5033 PHCs had been strengthened.
Community ophthalmology practice at primary
level
• 2. ESTABLISHMENT OF INTERMEDIATE SECTOR FOR ‘SECONDARY EYE CARE’:
Secondary eye care involves definitive management of common blinding
conditions such as cataract, glaucoma, trichiasis, entropion and ocular trauma.
The intermediate sector for secondary eye care is being strengthened by
development of diagnostic and treatment facilities at district and subdivisional levels
under the charge of an eye specialist.
• 3. ESTABLISHMENT OF CENTRAL LEVEL FOR ‘TERTIARY EYE CARE’:
Tertiary eye care services include the sophisticated eye care such as retinal
detachment surgery, laser treatment for various retinal and other ocular disorders,
corneal grafting and other complex forms of management not available in secondary
eye care centres. The central level for tertiary eye care services and development of
manpower is being strengthened byupgradation of eye departments of state medical
colleges and by establishment of regional institutes of ophthalmology (RIO).
• 4) ESTABLISHMENT OF APEX NATIONAL INSTITUTE OF OPHTHALMOLOGY:
An apex National Institute of Ophthalmology has been established at Dr.
Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi. This institute has been
converted into a centre of excellence to provide overall leadership, supervision and
guidance in technical matters to all services and technical institutions under the
programme.
C. INTENSIFICATION OF EYE HEALTH EDUCATION:
Intensification of eye health education is being done through mass
communication media (television talks, radio talks, films, seminars and books), school
teachers, social workers, community leaders, mobile ophthalmic units, and existing
medical and paramedical staff. Main stress is laid on care and hygiene of eyes and
prevention of avoidable diseases.
Health education about hygiene of vision in schoolchildren is being imparted with
regard to good reading posture, proper lighting, avoidance of glare, and a proper distance.
 • Various programme activities implemented at central, state
and district levels are as follows
1. Central level:
At the central level, programme organization is the
responsibility of the ‘National Programme Management Cell’
located in the office of Director General Health Services (DGHS),
Department of Health, Government of India (GOI). To oversee
the implementation of the programme three national bodies
PROGRAMME have been constituted as below:
ORGANIZATIO • National Blindness Control Board, chaired by Secretary
Health to GOI.
N • National Programme Co-ordination Committee, chaired by
Additional Secretary to GOI
• National Technical Advisor Committee, headed by Director
General Health Services, GOI
• 2. State level:
The NPCB is implemented through the State
Government. A ‘State Programme Cell’ is already in place for
which five posts including that of a Joint Director (NPCB) have
Central level activities include: State-level activities include:
L. Procurement of goods L. Execution of civil works for new units.
2. Non-recurring grant-in-aid to NGOs. 2. Repairs and renovation of existing units/
equipments.
3. Organizing central level training courses.
3. State level training and IEC activities.
4. Information, education and communication
(IEC) activities 4. Management of State Project Cell.
• 5. Salaries for additional staff.
5. Development of MIS, monitoring and
evaluation.
6. Procurement of services and consultancy.
• 7. Salaries of additional staff at the central
level.
• 3.District level:
To organize the programme at district level, ‘District Blindness Control
Societies’ have been established.
DISTRICT BLINDNESS CONTROL SOCIETY
The concept of ‘District Blindness Control Society (DBCS)’ has been
introduced, with the primary purpose to plan, implement and monitor the blindness
control activities comprehensively at the district level under overall control and guidance
of the ‘National Programme for Control of Blindness’. This concept has been implemented
after pioneering work by DANIDA in five pilot districts in India. Objective of DBCS
establishment is to achieve the maximum reduction in avoidable blindness in the district
through optimal utilisation of available resources in the district.
Need for establishment of DBCS
was considered because of the following factors:
1. To make control of blindness a part of the Government’s policy of designating the districtas the unit for
implementing various development programmes.
2. To simplify administrative and financial procedures.
3. To enhance participation of the community and the private sector.
Revised strategies adopted for implementation of programme at district level are:
1. Annual district action plan is to be submitted by DBCS. Funding will be in two instalments through
GOI/SBCS.
2. NGO participation made accountable; allotted area of operation.
3. Revised guidelines for DBCS — capping of expenditure; phasing out contract managers.
4. Emphasis on utilization of existing governmentfacilities.
5. Gradual shift from camp surgery to institutiona surgery.
6. Development of infrastructure and manpower forIOL surgery.
STRATEGIC PLAN FOR VISION 2020:

The Government of India has adopted ‘Vision 2020: Right to Sight’ under ‘National Programme for Control
of Blindness’ at a meeting held in Goa on October 10-13, 2001 and constituted a working group. The draft
plan of action submitted by the ‘Working Group’ to the Ministry of Health and Family Welfare Govt. Of
India in August, 2002 includes following strategies
A. Strengthening advocacy
B. Reduction of disease burden
• C. Human resource development, and
• D. Eye care infrastructure development
A. Strengthening advocacy B. Reduction of disease
burden (disease-specific
Public awareness and information about eye approach)
care and prevention of blindness.
Introduction of topics on eye care in school Cataract,
curricula. • Childhood blindness,
• Refractive errors and low vision,
Involvement of professional organizations
such as All India Ophthalmological Society • Corneal blindness,
(AIOS), Eye Bank Association of India (EBAI) • Diabetic retinopathy,
and Indian medical Association (IMA) in the
National Programme for Control of Blindness. • Glaucoma, and
• To strengthen the functioning of District • Trachoma (focal)
Blindness Control Society (DBCS).
CHILDHOOD BLINDNESS:
• To eliminate avoidable causes of childhood
Common causes of childhood blindness by year 2020
blindness are :: vitaminA deficiency, AIM
measles, conjunctivitis, ophthalmia
neonatorum, injuries, congenital
cataract, retinopathy of prematurity • Detection of eye disorders
(ROP), and childhood glaucoma • Prevention of xeropthalmia, trachoma
STRA • Proper and prior treatment of childhood glaucoma
TEGI and refractive errors
Extent :: Prevalence of childhood ES
blindness in India has been projected
to be 0.8/1000 children by using the
correlation between under five • Establishment of paediatric Ophthalmology units
mortality rate and prevalence. TAR • Establishment of refraction services and low vision
Currently, there are an estimated centers
GET
270,000 blind children in India. S
CATARACT:
Cataract continues to be the single largest cause of blindness. According to latest
National Survey in India (1999-2001), 62.6% of blindness in 50 + population of India
was found to be cataract related.
Objective: To improve the quantity and quality of cataract surgery. Targets and
strategies include:
• To increase the cataract surgery rate to 4500 per million per year by 2005, 5000
by 2010, 5500 by 2015 and 6000 by 2020.
• To improve the visual outcome of surgery to conform to standards set by WHO
(i.e., 80% to have visual outcome 6/18 or >6/18 after surgery).
REFRACTORY ERRORS AND LOW VISION:
Targets::To combat refractive error and low vision following targets have been set in India:
Refraction services to be available in all primary health centres by 2010. Availability of low-
cost,good quality spectacles for children to be insured.

GLAUCOMA:
As per the ‘National Survey on Blindness’ (1999-2001, Govt. Of India Report 2002) glaucoma is
responsible for 5.8% cases of blindness in 50+ population. Effective intervention for prevention of
glaucoma resultant blindness is quite difficult.
Following measures are recommended for opportunistic glaucoma screening (case detection) by
tonometry and fundus examination:
Opportunisitic screening at eye care institutions should be done in all persons above the age of 35 years,
those with diabetes mellitus, and those with family history of glaucoma.
• Community based referral by multi-purpose workers of all persons with dimunition of vision,
coloured haloes, rapid change of glasses, ocular pain and family history of glaucoma.
CORNEAL BLINDNESS:
A significant number of cases of visual impairment and gross degree of loss of vision occur due to
diseases of the cornea. There are about 1 million corneal blinds in India. Majority of these persons are
affected in the first and second decade of life. The major causes of this blindness are corneal ulcers due
to infections, trachoma, ocular injuries and keratomalacia caused by nutritional deficiencies.
Objectives regarding corneal blindness under ‘Vision 2020’ in India are:
• To reduce prevalence of preventable and curable corneal blindness.
• To identify the infants at risk in cooperation with RCH programme.
Strategies for control of corneal blindness:
1) Early treatment of eye infections
2) Prevention of trachoma blindness
3) Prevention of xeropthalmia
4) A total ban should be placed on the ophthalmic practice by quacks
C. Human resource development
Mid-Level Ophthalmic Personnel (MLOP). The term MLOP has been introduced to include all
categories of paramedics who work full time in eye care. Broadly two streams of such personnels are
envisaged:
• 1. Hospital-based MLOP. These include ophthalmic nurses, ophthalmic technicians, optometrists,
and orthoptists etc.
• 2. Community-based MLOP include those with out reach/field functions such as primary eye care
workers and ophthalmic assistants.
 D. EYE CARE
INFRASTRUCT
URE
DEVELOPMEN
T:
THANK YOU