Presidential Address by Dr Taraprasad Das at the VISION 2020 INDIA’s 15th annual conference inaugural on 8 June 2019 at Aravind Eye Hospital, Chennai
Sophie, a young Ophthalmic Nursing Assistant from Changlang district, Arunachal Pradesh participated in one of the VISION 2020 India hands-on workshops. She spent additional month training at the host institute. Returning to her district, she was confident enough to help increase annual cataract surgery from 40 to 500 with minimal complications. The Government of India declared this 11- village cluster in Arunachal Pradesh free of cataract blindness in 2017. Isn’t this very powerful?
Kajol, a young Ophthalmic Technician from Mastichak, Bihar polished her patient interaction skills including the nuances of refraction in another VISION 2020 India hands-on workshop. Because of her enhanced ability, the ophthalmologist in the eye centre could spend additional quality time in treating people. Do you see a value in it?
These are the success stories of VISION 2020 India workshops. There are many similar ones spread over the less reached India.
Shri Purohit, the honorable Governor of Tamil Nadu, Professor Namperumalswamy, honorable Chairman emeritus, Professor Ravindran, honorable Chairman, and Dr Haripriya Aravind, the Organizing Secretary, all from the Aravind Eye Care System, my fellow Executives, honorable Members, and Friends of VISION 2020 India.
Greetings to all of you..
Global VISION 2020 is a 2-decade old organization and the VISION 2020 India-a 182- member strong eye care advocacy organization- is a decade and half old. We are the public health arm of ophthalmology- the bridge between the science and the society, a bridge between the Government and non-Government eye care providers.
Health transitions dictate our health policies. The health transition evolves in response to demographic, socio-economic, technological, political, cultural, and biological changes. Two important health transitions are: (1) Demographic and (2) Epidemiological. The demographic health transition depicts the changes from high fertility- high mortality, a reality in less developed countries to the low fertility- low mortality, a fact in more developed countries. The epidemiologic health transition depicts the changes from infectious to chronic diseases. Three major mechanisms in health transition are – the decline in fertility, the changes in disease risk factors, and the improvement in health care technology. A decline in fertility impacts the distribution of people in the society. The changes in risk factors impact the incidence and pattern of diseases. Improvement in health care technology impacts the fatality rates.
India stands in the middle of this transition. We, and many countries of similar economy are engaged in a dual fight of containing a developing country’s disease pattern and delaying a developed country’s health disorders. Having said that, the eye care in general has performed reasonably well globally. The Vision Loss Expert Group reported a decline in global blindness from 0.75% in 1990 to 0.48% in 2015, and a decline in global the visual impairment from 3.8% in 1990 to 2.9% in 2015. But this did not translate into reduction of absolute numbers of affected people. In fact, the number of blind people in the world has increased from 30.6 million in 1990 to 36 million in 2015; the number of visually impaired people has increased from 160 million in 1990 to 216 million in 2015. While we attribute this phenomenon to population rise and aging, we must also admit that our efforts have not matched the demand. What is worse, with the current trend, it could increase to 237 million visually impaired and 38.5 million blind people by year 2020. This is ironical because by year 2020 we were expected to be 20/20 good.
So what should we do?
Actually this was kind of anticipated a decade before VISION 2020 was formed. Attended by 137 countries and 67 international organizations the WHO convened meeting at Alma- Ata 1978 was a major advance in this direction. The Alma-Ata declaration identified primary health care, PHC, as the key to attainment of the goal, Health for All. This is the meeting where the health was defined as a state of complete physical, mental and social wellbeing and not mere absence of disease. Forty years later, in 2018, the WHO reconvened the meeting to reemphasize the benefit of Primary Health Care. The PHC has all 3 main elements of good health care: (1) integrated services, (2) multi-sectorial policymaking, and (3) empowering people and communities.
PHC in eye care begins at the Vision Centers, at the bottom of the Eye Health Pyramid that serves a population of 50,000 people in a cluster of villages. Fifty percent of eye care is delivered right here. Started in 2002 by the L V Prasad Eye Institute at Chagaullu, a village in West Godavari, Andhra Pradesh, then with a population of approximately 20,000 people, the concept of Vision Center has since captured the imagination of eye care policy makers all over the world. Today, we have hundreds of Vision Centers; incidentally most of them are built and managed by the non-Government eye care organizations. I work with the Government of Odisha in the Universal Eye Health Program. I am happy that the Government of Odisha has established 60 Vision Centers in several districts of the state with standard equipment, trained manpower and sound resource allocation.
The world is committed to attain the 17 Sustainable Development Goals, the SDG, by year 2030. In order to do so, we need several transformations of the existing health care strategies. I suggest 3 transformational steps: Step One, at least double the health financing from the current 1.2% of GDP; Step Two, ensure that the scarce available resource reach everyone everywhere; and Step Three, provide appropriate and affordable care backed by adequate referral system. We take pride that we are the first country to recognize blindness and visual impairment as a health priority in 1976. But our cataract centric focus now must expand to the universal eye health coverage, UHC.
A comprehensive eye care is the basic tenet of UHC. Probably, we are getting there, but not reached yet. We need to accelerate our pace and all of our actions must also direct to improve people’s health seeking behavior. In my personal opinion, one-off mass screening and/or surgery particularly in villages accessible by reasonably good transportation system today only dampen the health-seeking behavior of people. A fixed facility manned by technical personnel trained for this purpose is the solution. This requires a change in administrative policy change and behavior change of care providers.
Government alone cannot do every thing. We need a Public Private Partnership for a Purpose. The purpose is both reducing blindness and same time empowering people. The VISION 2020 is building this bridge. Name VISION 2020 would change after year 2020; but not the mission. The WHO would soon disseminate the new World Report on Vision. This report would help redesigning country specific strategic to reach the sustainable development goals by year 2030.
Welcome the possibilities.
Thanks everyone for joining us in this journey.
Taraprasad Das
President, VISION 2020 INDIA