

Vision Centre Model

Vijay kumar Swetha MBA
Fellow in Eye hospital management
Aravind Eye Care System

Vision Centre:

The main objective of vision centre is to create permanent access communities and to increase the uptake of eye care services in the rural communities. This centre offers primary eye care services with the help of trained ophthalmic technician at an affordable cost.

The role of vision centre is to provide comprehensive primary eye care, referral services and also create adequate awareness creation in the community. The present approach in the National Action Plan of India, gives more emphasis to setting up vision centers under Comprehensive Eye Care Model in rural areas. The Vision Centres are the first contact place where people can come and interact with the eye care professional and seek treatment as well as the advice for their problem.

Many eye care institutions are running vision centres within their existing Comprehensive Eye Care Model across the Country. This article focuses on examining the different ways of vision centres are operationalised across India. This is done through the case study of five hospitals.

R.R.Lions Eye Hospital :

It is located at Palakol in A.P with the hospital being established in the year of 1990.They have a vision centre in Marchala .It was started in the year June 2005.The distance covered from the base hospital to vision centre is 350 km and the radius is covered by the vision centre is 50 km.
The vision centre is open 6 days in a week with the working time is 9 A.M to 1 P.M and 3 P.M to 5 P.M.

Infrastructure and Resources:

The equipment they have in the vision centre is slit lamp, streak retinoscopy, direct ophthalmoscope, B.P apparatus, glucometer, trial sets, schiotz tonometer, flash autoclave, vision testing drum (remote), furniture, minor surgical kit, eye charts, binocular loop, torch light.

The trained paramedical staff will be placed in the vision centre and the OPD procedures in the vision centre are a qualified ophthalmic assistant is posted and is assisted by a junior ophthalmic assistant. He will register, vision testing, slit lamp exam. He will do refractions and prescribe glasses. For minors like conjunctivitis, corneal ulcers and F.B. he will treat and do miscellanies tests for cataract, glaucoma and others. Ophthalmologist visits the centre twice in a month, stays 2 days, examine selected cases, post operative cases and refer for surgery, and diabetic retinopathy cases are also screened.

Performance of vision centre from 19th June 2005 to 30th November 2005

Vivekananda Mission Ashram:

It is situated in Chaitanyapur, West Bengal which was established in the year 1962. This ashram has its vision centre in Nandigram, established in February 2003 and the distance from vision centre to the base hospital is 50 km. The radius and the population covered by the vision centre is 20 km and 1.5 lacs people respectively. A similar vision centre was established in Bajkul in August 2005 which serves a population of 1.5 lacs people. The distance of the vision centre from the base hospital is 60 km and the radius is 20km. Khejuri vision centre was established in March 2003 and the distance of the vision centre from the base hospital is 70 km and the radius is 20 km and it serves the population of 1.5 lacs people. Pratapdighi vision centre was established in December 2005. The distance from the vision centre to the base hospital is 90 km and the radius is 30 km. This vision centre serves a population of 2 lacs people, a slightly larger group than the other vision centres.

The vision centre is opened for 2 days in a week with the working time of 9.00 a.m to 4.00 p.m.

Infrastructure and the Resources:

The equipment in the vision centre are slit lamp, streak retinoscopy, direct ophthalmoscope, B.P. apparatus, trial sets, and schiotz tonometer. There are well trained paramedic staff, community worker, and administrative staff in the vision centre.

The OPD procedures followed in the vision centre are:

Ophthalmic Assistant mainly performs refraction and detects other eye disorders.
Ophthalmic Assistant are instructed to prescribe only for common disorders.
They also do counselling for referral cases.
Post operative refraction is also performed and if any complication is suspected patients are referred to the base hospital.
Glasses are prescribed to the patient from the base hospital and delivered to the patient within a week.

And once in a month the ophthalmologist will be visiting the vision centres. The number of patients treated for the refractive error from March to October 2005 is 4746.

Sadguru Netra Chikitsalaya:

The Sadguru Netra Chikitsalaya is situated in Chitrakoot, Satna District established in the year 1968. They have two Vision centre one in Manikpur established in October 2003. The distance from the vision centre to the base hospital is 40 km and the radius is 20 km. It serves the population of 45,000 people. Another vision centre is in Attarah established in December 2004. The distance from the vision centre to the base hospital is 50 km. The radius is 20-25 km. It serves the population of 60,000 people.

The vision centre is opened for 6 days in a week with the working time of 9:00 a.m to 1:00 p.m and 2:00 p.m to 6:00p.m

Infrastructure and Resources:

The equipments present in the vision centre are slit lamp, streak retinoscopy, direct ophthalmoscope, B.P. apparatus, trial sets, schiotz tonometer, grinding, edging kit and machine, lensometer, and paediatric trial frame.

There are well trained paramedic staff, field workers, and administrative staff in the vision centre. Various OPD procedures in the vision centre are registration, vision testing, refraction, slit lamp examination and other procedures according to the patient condition.

Performance of vision centre:

Sewa Rural Hospital:

The Sewa Rural Hospital is situated in Jhagadia; Bharuch (Gujarat). It was established in the year 1980.They have four vision centres. One of the vision centres is in Khamar. The distance of vision centre from base hospital is 35 km and the population covered by the Vision centre is 30,000.

Another vision centre is in K.Colony which is 66km from the base hospital and the population covered by the vision centre is 25,000.

In Mangrol the distance covered by the vision centre is 55 Km and the population covered by the vision centre 40,000 and in Gunetha the distance covered by the vision centre from the base hospital is 100 Km and the population covered by the vision centre is 45,000.

The working days of the vision centre is half a day in a week and the working time in the vision centre are as follows:

Khamar- 10 a.m to 1 p.m
K.Colony-3 p.m to 5 p.m
Mangrol -10 a.m to 1 p.m
Gunetha- 3 p.m to 5 p.m
Infrastructure and Resources:

The equipment present in the vision centre are slit lamp, streak retinoscopy, direct ophthalmoscope, B.P. apparatus, glucometer, trial sets, schiotz tonometer, A- scan, keratoplaster, medicine and sac syringe set.

There well trained paramedic staff, community worker and field workers in the vision centre.

Performance of vision centre:

Aravind Eye Hospital, Theni:

Aravind Eye Hospital, Theni was established in the year 1985, the service area and population covered is 1,087,058.They have three Vision centres. Ambasamuthiram vision centre was established in April 2004. The distance of the vision centre from the base hospital is 10 km and the population covered by the vision centre is 35,000.

Andipatti vision centre is established in December 2004. The distance of the vision centre from the base hospital is 14 km and the population covered by the vision centre is 50,000. Bodinayakkanur vision centre is established in the September 2005. The distance of the vision centre from the base hospital is 15km and the population covered by the vision centre is 75,000.

The vision centre is opened for 6 days in a week with the working time of 9 a.m. to 5 p.m.

Infrastructure and Resources:

The equipment present in the vision centre are slit lamp, trial sets, streak retinoscopy, schiotz tonometer, direct ophthalmoscope, B.P.apparatus, glucometer, flash auto clave grinding, edging kit and machine computer & printer, and fundus camera.

There well trained paramedic staff, field workers, community worker, and administrative staff in the vision centre. The OPD procedures followed in the vision centre are registration, checking up the height & weight,B.P, and refraction. If the patient's age is above 40 yrs tension & duct examination will be done. After that examination, the medical officer in Theni does the consultation through Tele-communication. Ophthalmologist visits the vision centre once a month.

Performance of Vision centre:

Conclusion:

The paramedical staff and community worker plays a vital role in the entire vision centre. In most of the hospitals the distance between the vision centre and the base hospital is within 100 km. Almost all the hospitals have more than one vision centres. The success of one vision centre model will also replicate to start another vision centre.
Methodology of the Data collection:

The materials have been collected through e-mail by sending the structured questionnaire to various eye hospitals. The structured questionnaire was sent to fifteen hospitals and five hospitals responded back for the questionnaire.