Report of a Situation Analysis and Evaluation of Existing Programmes for Screening and Treatment for Diabetic Retinopathy
Non communicable diseases (NCDs) i.e. cardiovascular disease, cancer and diabetes are recognized as increasingly important causes of death and disability globally, including among rural populations in low income countries. Diabetic retinopathy (DR) is a complication of diabetes which can lead to irreversible visual loss and blindness. However, good control of diabetes reduces the risk of sight threatening diabetic retinopathy (STDR), and it has been estimated that early detection and treatment can reduce the risk of blindness from DR by 90%. Diabetic retinopathy is likely to become a leading cause of blindness over the next 20 years and will affect the poorest people most, as 80% of people with diabetes live in low-middle income countries (LMIC).
India is home to 65million diabetics and it is estimated that this number will rise to 109 million by 2035. One out of every five people with diabetes in India has some degree of DR and an estimated 6 million have the severe, sight threatening form (STDR) which requires treatment.
Services for diabetes and diabetic retinopathy in India
In India, services for people with diabetes and for blindness control are provided by the public health system as well as private practitioners and the not for profit sector. The Ministry of Health and Family Welfare has a program for control of NCDs (the National Programme for Prevention and Control of Cardiovascular disease, Diabetes and Stroke) and for blindness (the National Blindness Control Programme). Little information is currently available concerning the services being provided and whether there are major gaps in relation to the prevention of DR or treatment of people identified with STDR.
A range of different approaches are being used by the government and not-for-profit sector in India to detect and treat DR. However, it is not known which of these approaches is most effective, sustainable, and efficient, or which approach could readily be taken to scale to meet the emerging challenge of blindness from DR.
The purpose of this study was to assess current service delivery for the management of diabetes and for the treatment of DR in government and private facilities in 11 of the major cities in India. Another purpose was to evaluate different approaches being employed by 14 leading eye care providers in India, to detect and treat DR in relation to efficiency, effectiveness, sustainability and scalability.
A. Assessment of eye care services for diabetics and diabetic retinopathy
Quantitative and qualitative techniques were used. Semi structured interviews were conducted with staff and patients in diabetic clinics and in eye clinics. An observational checklist was used to assess all aspects of the health system e.g. staffing levels, infrastructure, technology and equipment, presence of protocols and information for patients. Cities and clinics to be visited were selected focusing on geographical distribution and size. In each city government and private clinics for diabetes and eye care were selected and visited by the research team. The 11 cities were Mumbai, Ahmedabad, Bengaluru, Bhubaneshwar, Chennai, Delhi, Hyderabad, Jaipur, Kolkatta, Pune and Surat.
B. Evaluation of programmes for the detection and treatment of diabetic retinopathy
Service providers were identified who run programmes outside the eye hospitals to detect and treat STDR. Fourteen eye providers were visited and interviewed to obtain information on the processes involved and to assess efficiency, effectiveness sustainability and scalability of each programme.
Five teams, each led by a senior public health expert with trained investigators, collected the data.
For the Results and the entire report:
For the “Diabetic Retinopathy in India” section on the ICEH website: