Community Participation in Eye Care - A Model for Developing Countries
R.Priya & S.Saravanan, Faculty Members, LAICO.

This article gives an overview of how community resources can be utilised for organising effective outreach programmes to provide the essential eye care to the needy in the community. The effectiveness of the outreach programme is enhanced by sharing many of the major responsibilities, and involving the community in decision making activities. The eye hospitals have to identify suitable persons who are inclined to serve the community, at the same time can influence the community, they may belong to different categories but their role has to be clearly specified. The hospitals have to devise means to ensure better coordination for working in harmonious manner with them in order to provide eye care services to the community.

Outreach programme for eye care organised by many institution aims at reaching the unreached. Many healthcare institutions organise outreach programme to create awareness in the community, to educate the community on health and to provide possible medical intervention. In India, healthcare facilities are distributed in such a way that 80% of facilities are available in urban area and 20% in rural whereas the population distribution is vice versa 20% in urban and 80% rural. India has an estimate of about 28 million cataract blind. There is a need to extend the healthcare facility to rural masses which covers the vast majority of the population. This can be effectively done by organising outreach programmes in rural areas and following a base hospital approach, the quality of care provided can be better and if good quality of services are extended to the community, then there will be better readiness among the community and there will be more awareness among the people about cataract surgery.

The eye hospitals depending upon their size and the extent of population they are serving in the region might have one or more camp organisers. Each camp organiser can be assigned a separate territory and he is responsible for the same. He should have knowledge about the eye disease - cataract, number of cataract patients in a given population of a specific region, the publicity that should be arranged for camps and selection of the sponsor.

The eye hospitals can effectively mobilise the cataract patients with the active involvement of the local community. The hospitals should have camp organisers responsible for identifying sponsors who are capable of influencing the community, and will share the financial burden of the camps to some extent. The need to identify such persons in the community is that if they are given certain responsibility and authority to take certain decisions, they feel that they have been given importance and will be more committed to serve the community. Such identified sponsors can be religious groups, voluntary agencies, Institutions, Village Heads, Individuals etc., who have to be thoroughly convinced about need to extend the eye care services to the community. If they have been convinced and are committed to serve the community then, it will further facilitate the process of patient mobilisation.

Guidelines for selecting a sponsor:
The camp organiser has to find suitable local sponsor in that specific region who are interested in providing service. The role of the organiser while selecting the sponsor will be:

  1. Gauge the commitment of the sponsor: The sponsor/sponsoring organisation should have good rapport and respect with the local community. There should be real involvement and commitment from the sponsor. This can be found using a simple evaluation form designed that could provide information regarding the extent of commitment of the sponsor which will help the organiser to gauge the commitment of sponsor in providing service. The camp organiser can emphasise to the sponsor about the extent of benefits rendered to the society.
  2. Financial strength of the sponsor: The sponsor should be fmancially sound for meeting certain expenses incurred in the outreach programme. In some exceptional cases, if the sponsor is really committed and enthusiastic to render service to the community, though they may not be fmancially very good but is ready to extend all possible support and cooperation" for the camp, then they will have to be given a chance. The sponsor who is financially sound but has no commitment or involvement will not be a suitable person, so at any stage and at every stage decisions have to be taken by the organiser. So the camp organiser has to be very careful by paying keen attention to the above issues while selecting a sponsor.
Role of the Sponsor:
The eye hospitals depending upon their financial strength can divide the responsibilities between them and the sponsor. Usually, it is preferred that the hospitals follow and encourage a common protocoVpolicy for all sponsors, so that it eliminates any discrepancy in the way camps are organised There are some sponsors who have the capacity to bear the expenses of free medicine, IOLs and spectacles. Such sponsors are few in number and may not sustain for a longer period The capacity of sponsors might vary depending upon their fmancial strength. The hospitals have to continue and sustain organising camps. So it is preferred that hospitals set some common guidelines for the sponsors for sponsoring camps. The responsibilities of the sponsor ideally can be to provide campsite, bear the transportation cost of patients and the publicity costs for the camp. For all camps, there should a standard set of information from the hospital that has to be advertised. There are a variety of publicity tools like handbills, posters, mike publicity, etc., that can be used. The camp organiser has to work collaboratively with the sponsor and guide him initially while organising camps.

Types of Sponsors:
There are wide range of sponsors available in different areas. The sponsors can be Institutions, Individuals, voluntary agencies, religious organisations or some hospitals interested in extending eye care to the community. The Institutions can be prominent some factories/industries located in the region, Colleges through their NSS programmes, Co-operative Societies, Banks etc., are to name a few examples. There are a variety of clubs like Lions, Rotary, Jaycees; Friends club, Recreational clubs and others like Filmstar Fans Clubs, etc., In voluntary agencies, organisations like the merchants association, farmers associations, organistions run by certain trusts etc. are some of them. In some cases, two agencies will join hands to organise the camp wherein they share their responsibilities like one can provide the financial support and the other manpower support. The local municipalities, political parties/Heads, corporation offices, village panchayats can form another source of sponsors. The religious groups like Saibaba Samities, Jain Samities or other famous Sabhas in the region are some of them to be considered as sponsors. The rich and the famous in the community might be interested to offer services on a specific day like a birthday/Wedding day/Death Aniversary in their family. Some of the voluntary hospitals in the region which does not have eye care facility. might be interested in extending the services, so these are some sponsors whose services can availed for organising outreach by the.eye hospitals. The table - 1 below, provides an insight about the organisations that sponsors camps.

Statistics of Aravind Eye Hospital Camps organised by various Organisations in 1996
Organisations Number of Camps Organised Number of Outpatients Screened Number of Cataract Surgeries Other Cases Total
Lions Club 404 1,20,839 18,141 457 18,598
Rotary Clubs 24 10,129 1,822 25 1,847
Vivekananda Kendra 59 10,059 1,068 66 1,134
Bhagavan Sathya Sai Seva Orgn. 59 14,421 2,419 96 2,515
Religious Organisation 50 14,144 1,975 49 2,024
Jaycees 5 793 119 3 122
Banks 18 3,992 398 8 406
Mills and Factories 28 11,825 2,064 80 2,140
ASSEFA 6 628 61 16 62
Schools and Colleges 20 2,323 188 69 194
Hospitals 92 11,75,77,728 1,321 27 1,390
Trusts 19 4,173 1,480 24 1,505
Youth and Fans Association 28 14,181 464 34 488
Other Voluntary Service Organisations 70 - 2,307 - 2,340
Others 45 13,008 1,527 47 1,574
Total 927 2,40,000 35,354 992 36,340

Hospital Assistance to the sponsor:
The camp organiser from the hospital has to contact the sponsor and should give a clear picture about the outreach programme. The responsibilities of the sponsor must be clearly communicated to him by.the organiser. There should be standard .~formation for publicity. The sponsor should be informed about the infrastructure needed for screeniIig the patients. The different stations like the place for registration of patients, place for doctor's examination, refraction area - the exact requirement of space for the specified areas and other specifications needed must be informed to the sponsor well in advance. One of the ways to clearly communicate to the sponsor is using display sheets that contain literature with photographs which narrates clearly all the details regarding different stages in organising the outreach programme.

Motivating and Guiding a sponsor:
The eye hospital while explaining to the sponsor the requirements expected from him, the organisers from the hospital must guide the sponsors for organising the camps:
  1. Communication to the sponsor: Communication plays an important role in every field. The camp organiser has to give a clear picture to the sponsor describing the catchment area & map of the area i.e. the neighboring villages, the population, prevalence & incidence of blindness and estimation of demand for the eye care services in that region. This will enable the sponsor not only to know about extent of blindness problem, but also to realise the importance of the pr~)Vidingeye care services.
  2. Guidance to the sponsor: The camp organiser has EOguide the sponsor if he is organising for the first time initially at each and every step. In case of publicity for the camp, the organiser should instruct the sponsor the content for publicity, the way it should be publicised, type of media that has to be used for publicity, the time, place, type of publicity that has to be given, when and how publicity should be arranged.
The hospitals should encourage the sponsors to continue their work in a productive manner. In order to sustain the sponsor's interest in organising camps and to boost their morale, the hospitals have to motivate them. This can be done by organising a function for them at the hospital and then honouring and felicitating them for their good work.

The success of the camp depends both on the organiser and the sponsor. The level of commitment and involvement shown by the sponsor plays a crucial role nevertheless the extent of motivation provided by the camp organiser shapes the whole issue. Any camp whether it is a success or failure the real reasons responsible for it has to be probed in and properly documented. Every experience in the camps paves the way for learning and improving certain aspects in outreach work further. All the eye hospitals as they know that there is huge backlog of cataract to be operated, they must understand that community participation is very essential, and try their best to tap this potential for serving the community.