सीधे मुख्य सामग्री पर जाएं

Understanding inclusivity in eye care: for poor, marginalized, affordability is a concern

By Simi Mehta, Anshula Mehta, Arjun Kumar, Kuldeep Singh

Vision is not just critical to an individual’s growth and development but has direct implications for national and global development. It holds the potential to boost the global economy in a fair and equitable manner. It enables everyone to live their lives to the fullest, releasing their potential to learn, to work, and to lead fulfilled and productive lives.
Blindness and Visual Impairment was defined as presenting Visual acuity (VA) <3/60and <6/18 in the better eye, respectively. However, on closely observing the situation in India, prevalence of blindness remains a major health and social issue in a vast country like India which has a population of over 1.4 billion and where access to health care, education and decent livelihood for all remains a pipeline dream.
The population coverage and treatment resources are disproportionately distributed. Additionally, social, economic, and demographic factors can reduce an intervention’s success. A large proportion of the “neglected population” (Rao, 2015) constituting people from urban slums or tribal areas, illiterates from socially and economically backward groups, women and children, people with disabilities, migrants, and refugees, are at the receiving end of relatively poor health care. Inequity in healthcare can take place at the level of availability, accessibility, and affordability.

Prevalence of Blindness in India

According to the National Blindness and Visual Impairment Survey of 2015-19, the Rural-urban wise prevalence of blindness in the Indian population above 50 years is given below. The prevalence of blindness is higher in the rural population as compared to the urban population. It can be attributed to poor access to health care services in rural areas, exacerbated further by poor road conditions, higher levels of poverty, higher dependence on public transport that are often overcrowded and or untimely.
The age-wise prevalence of blindness (%) in the population above 50 years in India is given below. As we move from the lower to higher categories of age, the prevalence of blindness increases exponentially.
Social determinants based on scheduled castes, scheduled tribes, women and children, religious minorities, and the queer community determine the accessibility patterns of healthcare in India. These social inequities are unfair and unjust and reveal the societal make-up of a country. Apart from social determinants, statist interventions also play a significant role in ensuring accessibility of healthcare services. For example, Information, Education, and Communication (IEC) services and their prevalence in a society determine the ease with which citizens can approach and access healthcare services.
Women bear a disproportionate burden of health inequity anywhere around the world, and the case is no different for visual impairment. 609 million out of the 1.1 billion people around the world with vision loss are women, which is about 55% (Vision Loss Expert Group/Global Burden of Disease (VLEG/GBD) 2020 Model). The gender disparity widens further where eye care is concerned. In a 2020 study, women were found to have 35% higher odds of being blind and 69% higher odds of being cataract blind, but with 27% lower odds of getting cataract surgery (Prasad et al., 2020).
In India as well, the trends and disparities between men and women in terms of the prevalence of blindness in the population above 50 years can be identified by the graph below:
Researchers have seldom driven their work towards the geography of the parts of the population who grapple with disabilities. To alleviate specific future research challenges, funding for specific R&D departments is needed. Approaching these communities with promotive actions to prevent future eye-based disabilities would be an important state intervention. This should be done with the purpose of preventing: future economic losses, isolation of the disabled from society and economic burden of the caregiver.
According to the study on ‘Bridging the gap: Tapping the agriculture potential for optimum nutrition’ jointly by ASSOCHAM and EY, India houses the world's highest number of malnourished children (Shenoy 2017). The Government of India will need to focus on improving nutritional security in the country. Considering that Vitamin-A deficiency is associated with childhood blindness, this becomes all the more urgent.
The literacy-wise prevalence of blindness in the population above 50 years is given below. Evidently, blindness is substantially higher among illiterates as compared to other categories. The estimates for 5th to 9th class pass and 10th class pass and above are roughly comparable, while the prevalence for 4th class pass is marginally higher than the former.

Affordability of Healthcare Services:

Income levels are crucial determinants of affording quality healthcare services. With a rising share of private healthcare, service provisioning amid the declining public healthcare system is a barrier to the affordability of healthcare. According to the Economic Survey of 2020-21, 60% of expenditure on healthcare services is out-of-pocket (OOP) expenditure. To effectively reduce this expenditure to 30%, the survey has suggested raising the ratio of healthcare expenditure/GDP to 2.5% from the present 1%. For the poor and marginalized, affordability remains a concern towards availing eye care. Affordable spectacles and treatment options must assume paramount importance for an inclusive eye care system.

Conclusions:

Thus, the above description clearly points through official data of the National Blindness and Visual Impairment Survey of 2015-19 that universal eye care in India is far from reality. Thus, the Leaving No One Behind motto of the Sustainable Development Goals of the United Nations is put at risk. Further, there are several converging goals that are impacted, for example: SDG 1- No Poverty, SDG 2 - Zero Hunger, SDG 3 - Good Health and Well-Being, SDG 4 - Quality Education, SDG 5 - Gender Equality, SDG 8 - Decent Work and Economic Growth, SDG 10 - Reduced Inequalities, SDG 11 - Sustainable Cities and Communities, which are indispensable if we have to ensure the Right to Sight for all in the country.
Hence, it is of utmost importance that such inequities are fully and urgently addressed. Continued collection of information on low vision and blindness will help improve understanding of the problem and assist in developing newer strategies.

Future Directions of Research:

Access to reliable data on the prevalence of visual impairment and blindness are a pre-requisite for planning eye care services. While this can be attained by conducting regular detailed prevalence studies, they are logistically expensive, resource-intensive and time consuming. But their utility in providing reliable information for goal setting, planning and starting up eye care services cannot be underrated. To bridge the gaps, rapid methodologies in data collection and prevalence studies may be adopted for acquiring a baseline data to understand the depth of the problems, which may then be scaled for planning health care services. Methods like 'Rapid Assessment of Visual Impairment (RAVI)' involving randomly selected human subjects 50 years and older would prove to be very beneficial in understanding the gaps and plan effective primary and secondary level eye care services in both rural and urban areas.

References:

  • Prasad M., S. Malhotra S, M. Kalaivani, P. Vashist, S.K. Gupta. 2020. Gender differences in blindness, cataract blindness and cataract surgical coverage in India: a systematic review and meta-analysis. British Journal of Ophthalmology, 104:220-224.
  • Rao, G. N. 2020. Universal Health Care: Can Indian Ophthalmologist Community Set an Example?. Indian Journal of Ophthalmology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7003579/
  • Shenoy, J. 2017. India has largest number of malnourished children in the world: Study. Times of India. November 1, 2019. https://timesofindia.indiatimes.com/india/india-has-largest-number-of-malnourished-children-in-the-world-study/articleshow/61405188.cms

टिप्पणियाँ

ट्रेंडिंग

दाँव उल्टा पड़ा: राहुल गांधी के रूप में हम एक साधारण इंसान को नायक होते देख रहे हैं

-  अमिता नीरव  संघ औऱ बीजेपी ने राहुल गाँधी पर जो सोचकर ‘इन्वेस्ट’ किया था, उसके परिणाम गंभीर रूप से नुकसानदेह आ रहे हैं। ये थोड़ी अटपटी बात लग सकती है, लेकिन सोचिएगा कि संघ और बीजेपी ने राहुल गाँधी को जितना गंभीरता से लिया, उनकी संभावनाओं को लेकर वे जितना श्योर थे, उतना तो खुद राहुल और कांग्रेस भी नहीं थी।

બે-રોકટોક રણ અભયારણ્ય વિસ્તારમાં માફિયાઓનું અન-અધિકૃત અને ગેર-કાયદેસર પ્રવૃત્તિઓ

- અગરિયા હિત રક્ષક મંચ  કચ્છના નાના રણમાં શિકારપૂર, કાનમેર રણ વિસ્તારમાં જમીન માફિયા જુથ વચ્ચેની આંધાધૂંધ ગોળીબાર થયો તેમાં એક વ્યક્તિ નો જીવ ગયો. આ ઘટનાથી ફરી એકવાર કચ્છના નાના રણની જમીન પર ગેરકાયદેસર કબજો કરી તેનો સોદો કરનારા જૂથો, ટોળીઓની વાત ચર્ચામાં આવી છે. 

हिंदी आलोचना जैसे पिछड़ चुके अनुशासन की जगह हिंदी वैचारिकी का विकास जरूरी

- प्रमोद रंजन*   भारतीय राजनीति में सांप्रदायिक व प्रतिक्रियावादी ताकतों को सत्ता तक पहुंचाने में हिंदी पट्टी का सबसे बड़ा योगदान है। इसका मुख्य कारण हिंदी-पट्टी में कार्यरत समाजवादी व जनपक्षधर हिरावल दस्ते का विचारहीन, अनैतिक और  प्रतिक्रियावादी होते जाना है। अगर हम उपरोक्त बातों को स्वीकार करते हैं, तो कुछ रोचक निष्कर्ष निकलते हैं। हिंदी-जनता और उसके हिरावल दस्ते को विचारहीन और प्रतिक्रियावादी बनने से रोकने की मुख्य ज़िम्मेदारी किसकी थी?

ગુજરાતના સ્થાપના દિવસે યાદ કરીએ ભારતના વિશ્વપ્રસિદ્ધ ગુજરાતી પુરાતત્વવિદ્ ને

- ગૌરાંગ જાની*  આજે કોઈ ગુજરાતી એ કલ્પના પણ ન કરી શકે કે વર્ષ ૧૮૩૯ માં જૂનાગઢમાં જન્મેલા એક ગુજરાતી વિશ્વ પ્રસિદ્ધ બની શકે! પણ આપણે એ ગુજરાતીને કદાચ વિસરી ગયા છીએ જેમણે ગિરનારના અશોક શિલાલેખને દોઢસો વર્ષ પૂર્વે ઉકેલી આપ્યો.આ વિદ્વાન એટલે ભગવાનલાલ ઈન્દ્રજી. ૭ નવેમ્બર, ૧૮૩૯ ના દિવસે જૂનાગઢના પ્રશ્નોરા નાગર બ્રાહ્મણ પરિવારમાં તેમનો જન્મ થયો હતો. જૂનાગઢના એ સમયે અંગ્રેજી શિક્ષણની સગવડ ન હોવાને કારણે તેમને અંગ્રેજી ભાષાનું જ્ઞાન ન હતું પણ પાછળથી તેમણે ખપ પૂરતું અંગ્રેજી જાણી લીધું હતું.

राम के महल में आग लगाता हनुमान: चर्चित सोशल मीडिया इनफ्लुएंसर दिलीप मंडल

- प्रमोद रंजन  चर्चित सोशल मीडिया इनफ्लुएंसर दिलीप मंडल ने अचानक राजनीतिक पलटी मारी है और राजद-सपा-स्टालिन आदि के खेमे को छोड़ कर राष्ट्रीय स्वयंसेवक संघ के लिए बैटिंग करने लगे हैं। कई लोगों में उनके कथित पतन से दु:ख खीज और गुस्सा है।

नफरती बातें: मुसलमानों में असुरक्षा का भाव बढ़ रहा है, वे अपने मोहल्लों में सिमट रहे हैं

- राम पुनियानी*  भारत पर पिछले 10 सालों से हिन्दू राष्ट्रवादी भारतीय जनता पार्टी (भाजपा) राज कर रही है. भाजपा आरएसएस परिवार की सदस्य है और आरएसएस का लक्ष्य है हिन्दू राष्ट्र का निर्माण. आरएसएस से जुड़ी सैंकड़ों संस्थाएँ हैं. उसके लाखों, बल्कि शायद, करोड़ों स्वयंसेवक हैं. इसके अलावा कई हजार वरिष्ठ कार्यकर्ता हैं जिन्हें प्रचारक कहा जाता है. भाजपा के सत्ता में आने के बाद से आरएसएस दुगनी गति से हिन्दू राष्ट्र के निर्माण के अपने एजेण्डे को पूरा करने में जुट गया है. यदि भाजपा को चुनावों में लगातार सफलता हासिल हो रही है तो उसका कारण है देश में साम्प्रदायिकता और साम्प्रदायिक मुद्दों का बढ़ता बोलबाला. इनमें से कुछ हैं राम मंदिर, गौमांस और गोवध एवं लव जिहाद. 

આપણા સમાજમાં દીકરીના માતપિતાનો દરજ્જો દીકરાના માતાપિતા કરતાં નિમ્ન કક્ષાનો કેમ?

- તૃપ્તિ શેઠ  થોડાંક દિવસ પહેલાં એક દુકાનમાં ખરીદી કરવાં ગઈ અને એ બહેન જે દુકાન પર બેઠાં હતાં એ ફોન પર વાતો જ કર્યા કરતાં હતાં . હું કંટાળીને આગળ જવા ગઈ તો એ મને કહે , "સોરી !  મારી મમ્મીને હું રોજ આ સમયે ફોન કરું છું કેમ કે એ મંદિરમાં રહે છે અને ત્યાં ઈલેક્ટ્રિસિટી નથી. એ પાંચ રૂપીઆમાં ફોન રોજ ચાર્જ કરાવે અને મારી સાથે વાત કરે." મે પૂછ્યું તારી મમ્મી કેમ એકલી રહે છે, તો એનો જવાબ હતો કે મારા બે ભાઈઓએ મારી મમ્મીને એના ઘરમાંથી કાઢી મૂકી છે એટલે એક ગામના છેવાડે આવેલાં મંદિરમાં રહે છે અને ત્યાં કામ કરે છે . મે કહ્યું ,” તું કેમ તારી મમ્મીની બોલાવી લેતી નથી ? “ તો મને કહે, મારી મા કહે છે કે છોકરીને ઘરે પાણી પણ પીએ તો  પાપ લાગે. 

તત્વચિંતક રાજનીતિજ્ઞ મોદીનાં લોકસભાની ચૂંટણી સંદર્ભે મહાન વ્યાખ્યાનો પ્રકાશિત કરવા જોઈએ

- ઉત્તમ પરમાર  વિશ્વના મહાન તત્વચિંતક રાજનીતિજ્ઞ અને આપણા મહાન વડાપ્રધાન આદરણીય નરેન્દ્રભાઈ મોદી 2024ની લોકસભાની ચૂંટણી સંદર્ભે જે જાહેર વ્યાખ્યાનો આપી રહ્યા છે, એ માત્ર ભારતના વડાપ્રધાનોના નહીં પરંતુ વિશ્વના વડાપ્રધાનોના પ્રવચનો પૈકી સર્વશ્રેષ્ઠ પ્રવચનો છે.

एक बहुत बड़ा झूठ: मुसलमानों की आबादी बढ़ती रही तो हिन्दू अल्पसंख्यक बन जाएंगे

- राम पुनियानी  चुनावी मौसम जैसे-जैसे समाप्ति की ओर बढ़ रहा है, वैसे-वैसे समाज को बांटने वाला प्रचार भी अपने चरम पर पहुँच रहा है. भाजपा के मुख्य प्रचारक स्वयं प्रधानमंत्री मोदी है. इस चुनाव में उनका पूरा नैरेटिव इस झूठ के  आसपास बुना गया है कि अगर इंडिया गठबंधन सत्ता में आया तो वह सारी सुविधाएं और लाभ केवल मुसलमानों को देगा. हर चीज़ पर मुसलमानों का पहला हक होगा और संविधान में इस तरह के बदलाव किये जाएंगे जिससे हिन्दू इस देश के दूसरे दर्जे के नागरिक बन जाएंगे. मोदीजी हमें जॉर्ज ऑरवेल के उपन्यास “नाइनटीन एट्टी-फोर”  की याद दिलाता है, जिसमें सच को सिर के बल खड़ा कर दिया जाता है. हिन्दुओं में यह डर पैदा किया जा रहा है कि देश में मुसलमान सारे विशेषाधिकार हासिल कर लेंगे.

हीट-एक्शन नीति में अनौपचारिक व खुले-में-कार्यरत मजदूरों को शामिल नहीं करना निंदनीय

- नेशनल अलायन्स ऑफ़ पीपुल्स मूवमेंट्स  पूरे भारत में 'चुनावी गर्मी' ज़ोर पकड़ चुकी है, जो हम सभी को साफ़-साफ़ दिखाई भी दे रही है। हालाँकि, एक और गर्मी है जो नागरिकों, विशेष रूप से करोड़ों खुले में काम करने वाले श्रमिकों को प्रभावित करती है, यह न तो 'चुनावी मुद्दा' है और न ही इस पर सामाजिक रूप से पर्याप्त ध्यान दिया जाता है। भारत के ग्रामीण और शहरी दोनों हिस्सों में मेहनतकश लोग, जो चिलचिलाती धूप में भी हमारे गाँवों और शहरों के लिए अनाज पैदा करते हैं, हर तरह का निर्माण कार्य करते हैं, शहरों व गांवों को चलाते हैं, हमें विभिन्न प्रकार की सेवाएँ प्रदान करें, लेकिन इसी वर्ग का अभी तक 'मुख्यधारा' के जलवायु न्याय और नीतिगत विमर्श में पर्याप्त रूप से प्रतिनिधित्व नहीं किया गया है।