1. Barriers in accessing eye care
Lions Aravind Institute of Community Ophthalmology

2. Review Article - 1
People Who Don't Use Eye Services: 'Making the Invisible Visible‘ - Martine Donoghue BSc MSc , Research Fellow Department of Epidemiology & Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
Community Eye Health Vol.12 No p36-38

3. Reasons for the Poor Use of Eye Services
Fear
- damage /'spoil' eyes
- miscellaneous fears.
Cannot leave family/work responsibilities.
Post-operative recommendations put them off.
Treatment cost.
Can manage - treatment not necessary.
Too old.
Fatalistic - 'God's will'.
No escort.
Lack of transport.
Distance.
Conclusion: We need to raise awareness about the low use of cataract services, and adopt strategies which promote equality in eye service delivery, access and use.

4. Article - 2
Reasons for Low Uptake of Eye Care Services Among Tribal and Non-Tribal People in Mysore District: An Anthropological Study - C. K. Kantharaju* and H.K. Bhat** Department of Studies in Anthropology, University of Mysore, Mysore , Karnataka, India
Anthropologist, 8(2): (2006)

5. List of barriers identified among non-tribal people for low uptake of eye care services
Types of responses
Male
Female
Total
No money 72 68
140
Lack of information on eye care services 43 24 67
Fear of surgery or treatment 23 32 55
Lack of time 30 17 47
Presence of other illness like asthma, Blood pressure, cardiovascular diseases and diabetes etc 18 21 39
Nobody to accompany 16 13 29

6. List of barriers identified among non-tribal people for low uptake of eye care services
Types of responses
Male
Female
Total
No faith in the treatment 9 10 19
Shyness among women to wearing spectacle 2 16 18
Lack of family members who are willing to accompany the blinds to get treatment 8 7 15
Lack of interest to undergo operation in old age 6 14
Believe in there is no proper treatment 13

7. List of barriers identified among members of Scheduled Tribes for low uptake of eye care services
Types of responses
Male
Female
Total
No money 65 17
137
Lack of information on eye care services 25 36 61
Fear of surgery or treatment 43 39 79
Lack of family members those who willing to blinds to get treatment 20 31 51
Lack of interest to undergo operation in old age 13 30
No faith in the treatment 10 9 19
Presence of other illness: like Asthma, Blood Pressure, Cardiovascular diseases, Diabetes etc. 3 5 8
Shyness among women to wearing spectacle

8. Article - 3
Low Uptake of Eye Services in Rural India – A challenge for programs of blindness prevention – Astrid E. Fletcher, PhD., Martine Donoghue, Msc., John Devaram, Msc., R.D.Thulasiraj,MBA.,Susana Scott,Msc., Moha Abdalla, PhD., C.A.K. Shanmugam,MD, P. Balamuruagn,BA.
Arch ophthalmol, 1999;117;

9. Reason for Non use of Eye Care Services
Responses
Person with eye problem
N = 743
Key informants
N = 565
Fear
Spoiling eyes
163 (21.9)
78 (13.8)
Miscellaneous
85 (11.4)
70 (12.4)
Can manage
207 (27.9)
126 (22.3)
Can not leave family or work responsibilities
194 (26.1)
82 (14.5)
Treatment cost
180 (24.2)
97 (17.2)
Post operative recommendations
128 (17.2)
48 (8.5)
“God’s will
103 (13.9)
80 (14.2)
Too old
95 (12.8)
63 (11.2)
No point, blind already
2 (0.3)
1 (0.2)
Miscellaneous reasons
118 (15.9)
133 (23.5)
Made no comment
47 (6.3)
69 (12.2)

10. conclusion
A salient message from this study is that providing services and promoting the knowledge of them is not sufficient to ensure the use of eye care.

11. Review Article - 4
Recognising and Reducing Barriers to Cataract Surgery- Susan Lewallen MD, Paul Courtright Dr PH
British Columbia Centre for Epidemiologic & International Ophthalmology- St Paul’s Hospital, Vancouver, BC
Community Eye Health Vol 13 No

12. Cultural and Social Barriers
There is an increasing amount of data demonstrating that women are significantly less likely to receive cataract surgery than men, in spite of the fact that cataract surgical rates in women are slightly higher than those in men.

13. Knowledge of Services
Community based education about cataract has not been undertaken in most areas; when it is, the demand for surgery will increase.
Not only must patients be made aware of the existence of the service, but they need to know what to expect:
• how long surgery will take?
• what will it cost?
• will it be painful?

14. Role of community
Health care workers at the village level must be made aware of existing services.
Lack of knowledge of services as a barrier may be reduced by:
Using health workers (including community based rehabilitation workers) and/or traditional healers to find, screen and educate patients about cataract surgery
Using successfully operated patients as educators and motivators
Educational campaigns using available media resources.

15. Low vision

16. Article - 5
Perceived Barriers to the Provision of Low Vision Services among Ophthalmologists in India - Sarfaraz A Khan, MD; Shamanna BR, MD; Rishita Nuthethi, MSc
Indian J Opthalmol 2005;53:69-75Vol. 53 No. 1

17. Major barrier/constraint expressed in providing low vision care
Responses No %
Q1 Lack of training / knowledge in low vision care 65
82.3
Q2 Lack of awareness about low vision services 59
74.7
Q3 Non availability of Low Vision Devises 57
72.2
Q4 Lack of motivation 43
54.4
Q5 Low Vision Care is time consuming 37
46.8
Q6 Busy in providing general ophthalmology services 35
44.3
Q7 Low Vision Care is not lucrative 14
17.7
Q8 Low Vision Services are not effective in helping patients 10
12.7

18. Refractive error

19. Article - 6
Barriers to seeking care following school vision screening in Rochester, Minnesota. Yawn BP, Kurland M, Butterfield L, Johnson B. Dept. of Research, Olmsted Medical Center, Rochester, MN 55904, USA.
This project used community focus groups in Rochester, Minn., to identify barriers that may delay seeking professional care following school vision screening.

20. Barriers
Major barriers identified included lack of community awareness about the frequency and potential effect of refractive errors in children
A parental perception of inadequate communication between schools and the parents and community,
High cost of corrective lenses
Limited availability of convenient eye care appointments
Adolescents reluctance to wear glasses.
Program planners developed a community action plan to address the perceived barriers.

21. The Health Belief Model

22. Receiver Provider Barriers Acceptable Accessible Affordable
Appropriate
Provider
Manpower
Materials
Management
Money

23. Providers Resource barriers Geographical barriers
Healthcare Strategies barriers
Socio-Cultural Barriers

24. Barriers – Individual General Physical Economic No aware/knowledge
Lack of information
Distance
My vision is ok/normal
No camp
No service provider/No access
Lack of information on eye care
Old age
Other disability/handicapped
Unable to walk
Asthma, hypertension, Diabetic, cardiovascular diseases
Sick
No money for transport,
No money surgery cost
Postoperative care/work

25. Barriers – Individual Psychological Social and family
Fear/ fear of surgery
It is not treatable
God’s will
My own sin
Wrong perception
Fear of death
Superstitious belief/ misconception about operation
Mental stress/strain/beliefs
Operation is Painful
No one to accompany/no attendee
Other work priority
Family problems
Being alone
Family culture – women
No help from family members
Depend on family
Festival/marriage
Lack of family support
Spiritual/ traditional healers
Previous bad experience

26. Breaking the barriers Happy patients after surgery Counseling
Zero cost patient policy
Training of volunteers and translators
Target oriented education
Criteria for referral
Giving transportation to the patients
Written information

27. Use of existing network of Health Promoters in the communities
Contact the Health Promoter of the communities or network
Training of the health Promoter
Outreach activity with the Health Promoter in there community.
Follow up

28. Thank you