Is Community Development necessary for Eye Care? Dr Gopa Kothari Director Community Programs Operation Eyesight Universal 22 nd Nov 2008, Delhi, India

National Vitamin A prophylaxis program Launched in 1970… 2

National Blindness control Program

*India shoulders the world’s largest burden of blindness million people are blind, 52 million are visually impaired 320,000 children under the age of 16, constituting one fifth of the world’s blind children 4 *Orbis International 2007

Vertical approach >>Failure 5

6 75% of blindness is avoidable

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Community “Com – together, munis – to have charge of” It is defined *as a group of interacting people living in a common location, organized around common values and social cohesion within a shared geographical location, generally in social units larger than a Household and are exposed to similar risks. * Standing Conference for Community Development, 2004Standing Conference for Community Development 8

Also, “Community* is a group of people who occupy a well defined territorial area, have common interests and needs and have common pattern of socio economic relationship, derives a common bond of solidarity from the conditions of its abode, has a constellation of social institutions and is subject to some degree of group control” *Young P.V

Community is in the grip of the “Vicious cycle” Poverty Traditional beliefs Ignorance Poor health seeking behavior Diseases Poor Health and Eye Health 10

Major Challenge HEALTH NOT A PRIORITY EYE HEALTH NEVER A PRIORITY! 11

Solution…..Create Awareness!! Awareness General Health + Eye Health NutritionEducation Socio economic sector Environmental sanitation 12

Tool to bring about an Awareness…. 13

Community Development…. ………brings about the ability of people to act together to influence the social, economic, political and environmental issues which affect them. 14

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Process OutlineImportant aspectsMatters to consider I – Community Dialogue Entry of project team into a community Community ParticipationIdentification of felt needs of the community II – Community Diagnosis Situational analysis Sample survey and door to door survey Identification of grass root staff Work by a group of members – volunteers and Community Health Workers (CHWs) Sharing results with the community -Formulating action plan with consent of the community III- Implementation Project team with help from CHWs and Community volunteers To make the community understand the impact of nutrition, education, Socio economic sector and environmental sanitation on health and eye conditions Networking with concerned departments -Improve Health seeking behavior -Make health and eye health as a priority -Create a Demand for eye care 16

Process OutlineImportant aspectsMatters to consider IV – Transfer of responsibility Community volunteers and CHWs under guidance from project team Challenges faced Group becomes more structured – Committee Tasks assigned to a group headed by a team leader Accountability Reorientation and Capacity building of groups in Eye Care Governance Monitor and review Effective utilization of exiting infrastructure of eye care V- Community Ownership Program implemented by Community, project team act as mentors Monitoring and review process Leadership skill building Ongoing refreshers training- Evidence based practices in providing eye care which leads to demand for eye care. VI – Achievement “Our work is done”Evaluation, Effective utilization of existing infrastructure & Permanent referral system for eye care Sustainability of eye care services Self reliant Community 17

To make Eye Health a demand by the Community.. HealthNutritionEducation Socio economic sector Environmental sanitation Eye Health PromotivePreventiveCurative Rehabilitation Supportive Integrate  Implement  18

Promotive Activities Causes and effects of blindness What Community, Schools Rural health centres Urban health posts, Urban dispensaries Where Volunteers, community leaders, health workers, school teachers traditional healers, traditional birth attendants (TBAs) Who 19

Preventive Activities Antenatal & Postnatal care Immunization, Nutrition, Eye care & healthcare Vitamin A prophylaxis, Water and sanitation What Rural health centres Urban health posts and dispensaries Where Health workers – Medical officers, Public health nurse, ANMs, TBAs Traditional healers Para professionals Community leaders, Volunteers Who 20

Curative Activities Management of eye injuries Diagnosis and treatment of common eye diseases Referral of complicated cases What Community, Schools Rural health centres Urban health posts and dispensaries Where Community health workers Medical officers, Nurses, Ophthalmic para-medicals School teachers Who 21

Rehabilitation Activities Referral of low vision and incurably blind Other disabled What District Hospital Tertiary care center Where Community health workers Medical officers, Nurses Ophthalmic para-medicals School teachers Who 22

Primary eye care becomes an integral component of Primary Healthcare 23

Supportive Services Improve: EducationEmpowermentEmploymentEconomic independenceEnvironmental sanitation Leading to Community development 24

Improve maternal health Combat HIV/AIDS, Malaria and other diseases Ensure Environmental Sustainability Global partnership for development Millennium Development Goals Eradicate Extreme Poverty Achieve Universal Primary Education Promote Gender Equity and empower women Reduce Child Mortality 25

How do we ensure sustainability? 26

Networking with………… GovernmentNon governmental organizationsOther stakeholders 27

Capacity building through training… 28

Effectively Utilizing the existing resources… 29

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Path is Challenging…………… If Goals and Objectives are clear.. We will succeed in controlling avoidable blindness! 31

Success achieved through Community Development …can be summarized as follows’ Go in search of your people Understand their needs, Learn from them Serve them Begin with what they know Build on what they have Control Avoidable Blindness through Community Development which makes the community understand the need for Quality Eye Care…and echoes out loud, 32

“Our Priority is Quality Eye Care ” Thank you! 33

Overall objective LogicIndicatorsMeans of verification Assumptions Specific objectives To control of avoidable blindness To improve eye health awareness To bring down mortality and morbidity rates.. To develop inter sectoral coordination for sustainable community development programmes. Number of people trained Number people identified and treated Number of agencies involved in collaboration (networking) Course registers Baseline survey registers, Outreach registers, OT registers Records with concerned agencies People will realize the need of health care and inter related services aimed at community development. Development of referral system in health and related sectors. Continuity of trained Human resources. Outputs / desired results Decline in avoidable blindness Improvement in socio economic status. Decline Rural urban migration Decline in cataract, Refractive error, Nutritional blindness and other eye ailments Improved attendance in school 2-3 crops per year Records and Registers Continuation of services and programmes initiated by the project. Improved quality of life Improved farming Activities HR Recruitment and training Situational analysis Intervention Monitoring Evaluation Number of HR trained Number of screening camps, Number of beneficiaries trained Records and registration Improved awareness and utilization of existing infrastructure. Improved socio economic condition Inputs Planning Cost of training, service delivery, Monitoring and evaluation. Detailed project plan, Increase in community participation, Increase in demand for services, willingness to pay for services Action plan, Review reports, audit reports, periodical reports. Affordable, accessible, available, acceptable of services by the community Pre condition Availability of funds to implement the program. Logical frame work Matrix 34

Overall objective LogicIndicatorsMeans of verification Assumptions Specific objectives To control of avoidable blindness To improve eye health awareness To bring down mortality and morbidity rates.. To develop inter sectoral coordination for sustainable community development programmes. Number of people trained Number people identified and treated Number of agencies involved in collaboration (networking) Course registers Baseline survey registers, Outreach registers, OT registers Records with concerned agencies People will realize the need of health care and inter related services aimed at community development. Development of referral system in health and related sectors. Continuity of trained Human resources. Outputs / desired results Decline in avoidable blindness Improvement in socio economic status. Decline Rural urban migration Decline in cataract, Refractive error, Nutritional blindness and other eye ailments Improved attendance in school 2-3 crops per year Records and Registers Continuation of services and programmes initiated by the project. Improved quality of life Improved farming Activities HR Recruitment and training Situational analysis Intervention Monitoring Evaluation Number of HR trained Number of screening camps, Number of beneficiaries trained Records and registration Improved awareness and utilization of existing infrastructure. Improved socio economic condition Inputs Planning Cost of training, service delivery, Monitoring and evaluation. Detailed project plan, Increase in community participation, Increase in demand for services, willingness to pay for services Action plan, Review reports, audit reports, periodical reports. Affordable, accessible, available, acceptable of services by the community Logical frame work Matrix 35

Action plan for your area Action plan“SMART” Aim: Objectives: Goals Short term: Long term: Who will you contact to seek permission for implementation of the program? Who will you orient at your center? 36

Prepare an action plan (time bound) Activities to be completed in : 1 week: 1 month: 6 months: 1 year: 37

Review How will you monitor your progress/delay? Indicators developed? Plan B 38

Key features of Community Development The Need?...So that, Community DialogueTo understand felt needs of the community Active Community participationCommunity members can meaningfully influence decisions that affect their lives. Engage community members in problem diagnosis Those affected may adequately understand the causes of their situations Help community leaders understand the impact of various factors on health and eye conditions They understand impact of Nutrition, education, socio economic sector and environmental sanitation on health - with alternative solutions to the problem Formulate action plan with the community members They are able to solve agreed-upon problems by emphasizing shared leadership Increase leadership capacity Skills, confidence, and aspirations of community members increase. 39