Vision Care for All
The LVPEI Pyramid of Eye care
LVPEI’s model of Eye care, represented by a pyramid, emphasizes the creation of sustainable permanent facilities within communities, staffed and managed by locally trained human resources, and linked effectively with successively higher levels of care.
- The pyramid rests on a foundation of community involvement, in the form of VISION GUARDIANS, trained young people who, through door-to-door surveys and other informal means, keep an eye on the eye health of around 5000 people.
- The second level has VISION CENTRES, which serve the primary eye health needs of the community. Each Vision Centre caters to a cluster of villages with a target of around 50,000 people. The Vision Centres draw upon local talent; they are staffed by persons from the local communities trained to address their Eye care needs. The initial capital investment needed to set up such a center is around US $ 10,000 (20 cents per person).
- The Vision Centres are networked with larger SECONDARY EYE CARE CENTRES that serve a population of 500,000 and provide ophthalmological care that can diagnose all diseases and offer high quality surgical care for cataract—the most common cause of blindness. These centers employ a team approach with almost all members of the team recruited from the local community and trained at the advanced tertiary center. The initial investment needed for such a center is US $ 100,000 (20 cents per person).
- The secondary centers are linked to TERTIARY CARE HOSPITALS/TRAINING CENTRES in cities, that provide a comprehensive range of services as well as training, each serving 5 million people. The establishment costs for such a center amount to US $ 1.0 million (again, 20 cents per person).
- The tertiary Eye care centers are linked to a CENTRE OF EXCELLENCE catering to a population of 50 million, which does service delivery for complex diseases, training of trainers of subspecialties and rehabilitation, while also engaging in advocacy. The total cost of setting up a center of excellence is US $ 10 million (20 cents per person).
This model does not depend on external funding or expertise in the long term, as the Vision Centres have the potential to grow into community hubs that address other health needs beyond ophthalmic needs. The cost of providing care, from base to apex, is just US$ 1 per person served.
The Experience Thus Far
LVPEI now has 89 Vision Centres providing primary care in the districts and villages of Andhra Pradesh, linked to secondary service centers which are in turn linked to LVPEI tertiary centers in Hyderabad, Vizag and Bhubaneswar (Orissa). The Government of India has adopted the pyramid as a model of Eye care service delivery in its current five-year plan budget and the model will soon be rolled out in other states in a phased manner.
While the LVPEI model evolved as a ‘top down’ model, this has allowed it to leverage its existing linkages at the global and national level to bring the advantage of learning and influence to the grass roots. The development at all levels, but especially at the secondary and primary level, is based on community need, and is a tripartite arrangement between the community, LVPEI and an implementation agency, often an international NGO that supports the development with financial and material resources.
The Vision Centres have helped not only bring services within the reach of villages that have been beyond the pale of most health care services, but have also become important points of community health awareness and education programs that have a potential to change attitudes toward and service uptake of not only Eye care programs, but also other social and health interventions in these areas.