Dr Sandeep Mahatme, District Magistrate, Khowai, Tripura, Government of India

An innovative public healthcare initiative taken in a small challenging district led by its District Magistrate and Collector with the support from National Health Mission (NHM) Tripura is acknowledged by Government of India in a National Forum. Cataract Backlog Free District: North Tripura District Initiative under NHM & Rashtriya Swasthya Bima Yojna (RSBY) was presented as Good Practice in the 4th National Summit on Good and Replicable Practices and Innovations in Public Healthcare Systems held in Indore, Madhya Pradesh during July 6–8, 2017. Dr Shailesh K. Yadav, IAS, Mission Director, NHM Tripura has presented the Good Practice in Indore National Summit on July 7, 2017.

Cataract Backlog Free District is an innovative approach undertaken by north district administration for providing eye care services to people in the district in a systematic and planned way for making a cataract backlog free zone with the support from District Health & Family Welfare Society, NHM, North Tripura.

National Program for Control of Blindness (NPCB) is one prime activity, which is targeted toward achieving the goal of reducing the prevalence of blindness. Since 2012–2013, Eight North Eastern States on an average could do only 32 percent of targeted cataract surgeries. Total estimated backlog as per data from NBCP for North Eastern states is 10, 12, and 868. As per Vision 2020, the target of WHO and NBCP is to reduce prevalence of blindness to less than 0.3 percent. By using all resources in a planned manner with focus on high backlog areas above targets can be achieved.The major problem in North District was that there was no dedicated district blindness control program (DBCP) unit and people were moving to either Unokoti District or Silchar (Assam) for eye care services where there were long queues for cataract surgery. The project began its journey with the baseline survey undertaken by L.V. Prasad Eye Institute in August, 2016. The total estimated population suffering from blindness was identified as 1281 as per the study.  The district eye OT was repaired and three OT tables were made functional by District Rogi Kalyan Samity. Partnership was made with two reputed NGOs: Help Me See and P.C. Chatterjee Eye Hospital (NGOs) for both screening and operation.

In North Tripura each habitation is having one ASHA covering on average a population of 300 and they have been assigned for house-to-house visit to identify the suspected cataract patients and patients with other eye diseases. On the day of evaluation of PHC/CHC, an evaluation team headed by the district eye surgeon, MO I/C, an ophthalmic assistant, and supportive teams carried out thorough evaluation of patients along with diagnostic equipment. The spectacle suppliers provided spectacles within 10 days to the PHC/CHC. Thereafter the spectacles had been distributed to the concerned patient by ASHAs.

A total number of 80,000 household visits were undertaken by 907 trained ASHAs and 2286 patients were evaluated at the health facility level. A total of 648 cataract cases were identified within one year from 121 villages and 83 percent of operations (538) were done successfully in a single OT at North District Hospital. Around 1500 refractive errors were corrected by distribution of spectacles, 1200 of which were given through tele-ophthalmology and 300 were provided through health camps. The intervention has created a positive response and demand generation among the community as the services have been provided to the patients within a very short time frame. The services have been made cashless for the RSBY smart card holders and also to the beneficiaries for non-RSBY smart card holders under NPCB.

The patients benefited in the intervention have also come forward to mobilize the beneficiaries in their local villages, which has led to a very good public demand and community participation in this project.

 

To provide better eye care services to the people free of cost as well as to prevent blindness in the entire district, this mammoth  intervention is undertaken as a joint mission of district administration and DPCB, North District with active support from PRI. North Tripura District has become an inspiration to other districts in the state to make the entire state a cataract backlog free district. The intervention of universal eye care services in North Tripura District may be replicated in other states, subject to local context.


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