1. 24th September, 2010
Eye Care in North India
Arun K. Arora
Chief Executive Officer
Dr Shroff’s Charity Eye Hospital, New Delhi

2. Avoidable Blindness
 Globally: 314 million- visually impaired ; 45 million of
them are Blind.
Most people with visual impairment are older, and
females are more at risk at every age, in every part of
the world.
2

3. Indian Scenario: The Magnitude
 Numbers
12 million - Blind, 27- 30 million - low Vision
3.8 million new cases added every year
Will reach 18 million by 2020
 Distribution
Blindness: 90% in rural underserved areas
Services & trained manpower concentrated to urban
communities
75 – 80% preventable/ curable (Cataract and
Uncorrected Refractive errors)
 Economic burden (1997)
 $US 4.4 Billion (annual)
Cumulative loss over the lifetime of the blind $77.4 Billion
3

4. Eye-care services: India
Government Commitment:
First to launch National program for prevention of blindness
(NPCB), 1976
 Signatory to “VISION 2020- The Right to Sight”
Status Of NGOs In Eye Care
Prominent NGO presence: 69% of Manpower
(ophthalmologists) and 71.5% dedicated infrastructure present
in NGO and Private sector.
Till recently, approach has been mainly camp based and
Cataract focused
4

5. SCEH: The Genesis…
At the time of inception (1914) there was no dedicated eye care
provider in entire North India.
Mission:
To make a lasting impact on the eradication of blindness and
deafness in India by providing quality care to all sections of the
society.
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6. Dr. Shroff’s Charity Eye Hospital
Institutional Background
– Established in 1914
– Only dedicated eye care hospital from Lahore (now Pakistan) to
Kanpur.
Founder: Dr Sorabji P Shroff , FRCS, awarded the Padma Shri by the
government of India for his humanitarian efforts.
A distinguished governing board
– Mr. Vikram Lal (EICHER group)
– Dr. NM Shroff (Padam Shri)
– Mr. Naresh Gujral
– Mr. Lalit Nirula
– Dr. Arvind Taneja
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7. Dr. Shroff’s Charity Eye Hospital
 Member of VISION 2020 India.
 DSIR Recognized (Ministry of Science & Technology, Govt. of
India)
 Member of Credibility Alliance
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8. Target Beneficiaries
Reaching the unreached communities
Three North Indian States (Rajasthan, Uttar
Pradesh, Haryana)
Underserved areas of Delhi (Urban Slums)
Priority Groups:
Elderly (50 years and above)
Women & Children
Rural underserved
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9. Our Approach Commitment to
Serving the
community
Sound Governance & Expanding
Systematic approach Geographical Reach
Affordability with
sustainability Comprehensive eye care
Excellence & Quality
9

10. SCEH : Commitment to Serving the community
 Strategic Approach: To control and reduce “Avoidable
Blindness” in North India by Creating sustainable eye
care delivery models Helping build capacity of like
minded organization
 Minimum 50% of all surgeries and procedures
performed are free of cost to the patient.
10

11. Expanding Geographical Reach
…. SCEH Network
SCEH
(Base Hospital)
1 Tertiary Hospital
Alwar, Raj
3 Secondary Hospitals
(Sec Hospital) 1 Satellite clinic
10 Functional rural VC
3 Urban VC
Saharanpur, UP
(Sec Hospital)
Lakhimpur Khedi,
UP (Sec Hospital)
Meerut, UP (Sec Hospital)
11

12. Comprehensive Eye care delivery
 VISION Centre:
• Basic services at the doorsteps
• Community participation & Ownership
 Secondary Hospital (Service centre)
• Quality surgical care for cataract, in a cost effective manner
• Referral unit for the Vision centres
• Identification and referral of sub specialty cases to tertiary center
 Tertiary Hospital (Training Center):
• High end equipments ensuring international standards of care
• Research and Training (National & International)
• Management of rare eye diseases (Cancers )
12

13. Primary Care
Cataract
Basic
Screening &
Refraction
referral
Training
Community Sub specialty
Research screening
Health Awareness &
CBR Community Mobilization
13

14. Secondary Care
Basic
Refraction &
Cataract
Dispensing
Surgery
Training
Monitoring
Health Sub specialty opinion
Awareness & follow up
14

15. Tertiary Care
Advanced Advanced
Refraction & CL Cataract
Training
Monitoring
Research
Rehabilitation
Awareness Sub specialty Referral &
surgery
15

16. Global Partners
 Project Prakash- Collaborative study with MIT (USA)
 ORBIS – Controlling Refractive Errors
 ORBIS- Eye Banking
 ORBIS – Quality Assurance in eye care
 World Diabetic Foundation: Diabetic Retinopathy
screening in Alwar (Raj)
 CBM- Community based Rehabilitation
 Rotary- Cataract Surgery
 CBF- Community Outreach, Saharanpur (UP)
 ADOBE Systems: “UJAGAR” IT resource center for the VI &
LV
16

17. Our Vision : Quality with Excellence
“To make a lasting impact on the eradication of
blindness and deafness in India by providing
quality care to all sections of the society.”
17

18. Strive Towards Excellence & Quality
 Tertiary Hospital
– Continuous up gradation & modernization- Center of Excellence
– Quality Assurance
 Secondary Hospital:
– Affordable Cataract Surgery (60% of avoidable blindness)
– Awareness building in community- prevention and uptake of eye
care
 VISION Centre:
– Essential eye care (primary) at Grassroots level
– Community participation
– Local NGO involvement
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19. Infrastructure improvement
THEN NOW
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20. Infrastructure improvement
20

21. Adopting Best Practices
THEN NOW
21

22. Outreach: Evolution
Eye Camp Approach
 Cataract focused
 One Off camps
Vision Center Approach
 Poor follow up
 Poor Quality control  Comprehensive
 Untrained Manpower  Continuous
 Limited role in community  Regular follow up
 Outcome Monitoring
 Trained Vision technician
 Broad perspective (CBR,
Research, Awareness) 22

23. Interventions & Intents:
“Towards cost-effective & Quality eye care for all”
Expansion of geographic reach to the rural hinterlands of
Rajasthan, Uttar Pradesh and Haryana.
Shift to comprehensive eye care
Community Based Rehabilitation of visual & hearing
impairment.
Active social marketing to increase uptake of services
23

24. Affordability & Sustainability
 Cross subsidization to ensure services for all socioeconomic
sections while maintaining optimal internal revenue generation
 Partnership with like Minded organizations (Such as ORBIS
international, World Diabetes Foundation, CBM ) and donors.
 Utilize local resources to bring down costs, create ownership
and generate employment opportunities
24

25. Health Systems Approach
Comprehensive Affordable Accessible Effective
25

26. Achievements & Impact
…… (Over the last Decade)
 Touching Lives of people of all sections of the society
spread over three states in North India (Delhi NCR,
Haryana, Rajasthan & Western UP.
Patients Seen: 9,09,520
Operated: 65,065
Free: 35,968
Children Seen: 1,54,200
Operated: 4,515
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27. Achievements & Impact
…… (Over the last Decade)
 Sustainability: Achieving 85 – 90% operational cost recovery
 Up gradation of Secondary hospital (Alwar) to Advanced
secondary.
 Pioneering in setting up “Paediatric Ophthalmology” unit
 Fastest growing Eye bank in India.
 Operationalized three secondary hospitals, 13 Vision centres in
Rural areas of North India.
 International NGO collaborations.
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28. Achievements & Impact
…… (Over the last Decade)
 Training :
• Ophthalmologist : 235 (Long and short term training), 25
International trainees.
• Optometrists: over 100 (Fellowship & Internship)
• Training programs for Vision Technician & Ophthalmic
Nursing assistants also running.
 Research & Publications:
• Running clinical trials with reputed firms (e.g. Bausch &
Laumb)
• Numerous publications in national & International peer review
Journals.
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29. A case study1
Context
Reduction of the burden of Preventable blindness
caused by Cataract and Refractive error for Alwar
district in Rajasthan (Population 11 Lacs)
 Solution
Setting up secondary hospital at Alwar, Rajasthan
Holding camps in the rural areas in collaboration
with local NGO’s
Setting up vision centers for primary eye screening
and referral service
Outcome
Screening of Cataracts
Quality cataract surgeries
Referral of Pediatric /other sub specialties.
29

30. A case study2
 Context
Rehabilitation and inclusion of the Visually/Hearing impaired
and low vision persons of Malakhera in Alwar district in the
mainstream.
 Solution: Community Based Rehabilitation
Door to door survey to identify persons with disabilities
Setting up of the Community based rehabilitation centre
House services provided through field workers
 Outcome
 Counseling
 Aids & appliances
Inclusive education
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31. Featured in…
‘Nature’ Magazine
‘Time’ magazine 2007
Rated by Outlook Magazine as one of the best
places for eye care in Delhi (Outlook, 1st July,2002)
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32. Learning from Challenges
 Health Awareness (or lack there of) and early self
reporting of eye diseases.
 Overcoming Geographic & Cultural variations (social,
gender, transportation)
 Need for comprehensive approach
 Building community partner for improving credibility
and output performance
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33. Future Plans
 Increase operations capacity: Double the number of
surgeries performed annually by 2013.
 Geographic expansion: Reaching out to remote
underserved regions and establishing 30 Vision centres, 4
secondary hospitals, 4 clinics in North India by 2013.
 Enhance Sustainability: work towards increased cost
recovery and long term sustainability.
Cont.
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34. Future Plans
 Comprehensive care: To add diagnostic & basic sub-
specialty (Glaucoma & Retina) services at secondary
hospitals.
 Replicating community based rehabilitation & eye
banking in other areas.
 Establishing a community based eye-care training &
resource centre for North India.
 Spread scope of operations to incorporate initiatives like
“Sound Hearing 2030”
34

35. Seeking Partnerships
Infrastructure
• IT systems
• Power
• Equipment
• Residential Training academy
Vision centre operations
Community Research
Service delivery: Support free surgeries
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36. Together we Can make a Difference…
to many more lives
Thank You