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India: Cataract Blindness Control Project

Last Updated: Sept 2008
India: Cataract Blindness Control Project

Challenge

In the early 1990s, it was estimated that more than a third of the world’s total blind population of 35 million lived in India, reflecting both the country’s large population and the higher-than-average prevalence of cataract blindness (80 percent in India, compared to 50 percent worldwide). India also reported an earlier onset age of cataracts (younger than 60 years) and a high prevalence of cataracts among women due to low to healthcare. At the time, India's capacity to carry out cataract surgery was about 1.5 million operations annually, of which many were conducted in field hospitals with unsatisfactory results.

Approach

The Cataract Blindness Control Project supported by the World Bank became effective on January 31, 1995, and closed on June 30, 2002 after an extension of one year. Project objectives were to support India's efforts to upgrade the quality of cataract surgery; to expand the coverage of India's National Program for the Control of Blindness (NPCB) to underprivileged areas, with special attention to women, tribal, and isolated areas; and to assist in the reduction of cataract blindness in seven states that accounted for more than 70 percent of India’s cases of cataract blindness (Andhra Pradesh, Madhya Pradesh, Maharashtra, Orissa, Rajasthan, Tamil Nadu, and Uttar Pradesh). The project also sought to eliminate the backlog of cases by conducting an estimated 11 million surgeries. In addition to financing and providing technical assistance to strengthen infrastructure, the project aimed to increase awareness that cataracts were curable, thereby increasing demand for new surgery technology.

Results

A countrywide shift in surgical technology resulted in a total of 15.3 million cataract operations performed, without which the affected persons would have eventually gone blind.

Highlights:
- Women and tribal populations comprised more than 50 percent of operations.
- 842 ophthalmic surgeons were trained in performing the surgery using the new technology.
- The project led to qualitative improvements in surgical and post-surgical care, including a shift from camp surgeries (which were often responsible for poor outcomes) to surgeries in fixed facilities using new surgical technology.
- The project resulted in substantial strengthening of infrastructure, including the construction of 301 operation theatres and 273 eye wards. In addition, 45 medical colleges, 259 district hospitals, 254 district mobile units and 3281 primary health centers were provided with eye-care equipment, including 747 operating microscopes, 600 slit lamps, 821 A-Scans, 344 AVUs, 681 keratometers, and 178 Yag lasers.
- The project introduced new evaluation tools, which the National Program Management Cell used to facilitate implementation and focus on outcomes.
- Management of the cataract blindness control program was institutionalized at the central, state, and district levels. The project raised public awareness about cataracts being curable and the advantages of the new surgical technology.

Contribution

The total project cost was US$135.7 million of which IDA committed US$117.8 million. In January 2000, US$10 million of this total was cancelled due to a fall in prices of equipment and exchange rate savings. These funds were reallocated to the Gujarat Earthquake Rehabilitation Program. The project thus closed with a total disbursement of US$94.2 million. IDA was able to support the significant buildup in institutional capacity needed to undertake a program of such scale, including the establishment of a National Blindness Control Board with its own technical advisory board. IDA used its resources to improve the quality of cataract surgery, the technical skills of ophthalmic surgeons, and the availability of appropriate equipment.

Partners

Extensive participation of the NGO and private sectors assisted the Government in reducing the backlog of cataract blindness. This project supported a total of 30 NGOs with a one-time nonrecurring grant to provide services in remote and underserved areas. NGOs contributed substantially to service provision in peripheral areas by organizing eye screening camps, school eye-health programs, and village volunteer programs. These NGOs also helped provided curative, preventive, and rehabilitative care. A dramatic, albeit unforeseen outcome, was the expansion of manufacturing capacity for high-quality ophthalmic materials and suture material for surgery, which the country is now exporting.




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