Universal Eye care : Is "Vision First" a reality in the state of Jharkhand.

World sight day was celebrated this year on 10th October. The fraternity working around eye sight and other stake holders conducted nationwide awareness drives with sole agenda "Vision First". Amidst the drives and concerns of sight and challenges, there were two reports which were making the scenario  worrisome. One was World report on Vision by WHO, While the other was National blindness and visual impairment survey of India 2015-19, conducted by Dr. Rajendra Prasad centre for Ophthalmic sciences, AIIMS.

There have been concerted efforts for last 30 years in eye care, still significant challenges galore. Needless to say, without vision every life function is a struggle. The world vision report by WHO reports that "Globally, at least 2.2 billion people have a vision impairment or blindness, of whom at least 1 billion have a vision impairment that could have been prevented or has yet to be addressed". The distribution of eye care related challenges are not evenly distributed across major economies of the world. The burden tends to be greater in low- and middle-income countries and underserved populations, such as women, migrants, indigenous peoples, persons with certain kinds of disability, and in rural communities. Population growth and ageing, along with behavioural and lifestyle changes, and urbanization, will dramatically increase the number of people with eye conditions, vision impairment and blindness in the coming decades. WHO proposes an Integrated people-centred eye care (IPCEC), as an approach to health system strengthening and for achieving Universal Health coverage and SDG 3: Ensure healthy lives and promote well being for all at all ages.

National blindness and visual impairment survey of India 2015-19 was conducted in order to collect evidence about the prevalent status of blindness and visual impairment in India. This survey was conducted in 31 districts of 24 states/ Union territories of India during sept 2015 to June 2018. The data was collected through house to house survey in selected districts. In Jharkhand, East Singhbhum was selected and the sample size was 3000.

The survey found a prevalence of 0.36% of blindness in all age groups. Whereas the prevalence of blindness in population more than 50 years of age was 1.99%. Major causes of blindness in population aged more than 50 years were - cataract (66.2%), Corneal opacity (7.4%), Cataract surgical complications (7.2%), Posterior segment disease (5.9%) and Glaucoma (5.5%). Whereas the major causes of visual impairment in population more than 50 years of age were - Cataract (71.2%), Refractive error (13.4%), Cataract surgical complications (5.9%).

In the population less than 50 years of age, the major causes of blindness were - Corneal opacity (37.5%), All globe/CNS abnormality (25.0%), Phthisis (12.5%), Other (25.0%). The major causes of visual impairment in this population range were - Refractive error (29.6%), Cataract (25.4%), Al globe/CNS abnormality (15.5%), Corneal opacity (14.1%).

Jharkhand's sample district East Singhbhum has reported a higher percentage of blindness and visual impairment than average. While the national average of districts regarding prevalence of blindness in population aged more than 50 years remained at 1.99%, the figure stood at 2.13% in East Singhbhum. While looking at the data collected regarding status of visual impairment in population more than 50 years of age across districts, we observe a national average of 13.76% and East Singhbhum figures standing at 16.26%.

The above average figures of East Singhbhum are alarming. It reflects that a higher percentage of population more than 50 years of age suffers from blindness or visual impairment in the district. What makes these figures more worrisome is the status of Jharkhand's lacking health infrastructure in terms of inclusion of eye care as part of universal health care. While WHO proposes an Integrated people-centred eye care (IPCEC), the State's health centres are struggling to get requisite infrastructure and Human resources. The recommended International standard for Doctor-population ratio is 1:9000, Jharkhand's public health system struggles with only 40 doctors to cater a population of more than 30 million people. Out of these 40 doctors, only 20 can do surgery. Thus the entire concept of universalization of Eye care falls in the ambit of non - govt players in the state.

This paucity of trained Eye health professionals is not going to be solved soon. At present the post graduate studies are available in only one medical college in the state. This medical college produces only 8 ophthalmologists (MS) in an year. Though the Government is taking strong steps towards capacity building of its medical colleges to produce more ophthalmologists in coming years, But till then it does not look like "Vision First" in the state of Jharkhand.