The Entally vision centre is one of 13 across the city that provide subsidised eye care services.
Sightsavers India will take any route to ensure people who need eye care can access it: partnering with government and private hospitals, working with existing systems and creating new ones.
In Kolkata, patients’ only choice used to be between expensive private facilities and over-subscribed, underserviced government hospitals. But working with Mission for Vision, Sightsavers established a network of community vision centres to provide affordable eye care for the thousands of people living in the poorest areas of the city.
All the centres have a business plan, and aim to become self-sufficient. “If we could break even, we could become sustainable,” explains Sandip Banerjee, programme development manager for Sightsavers’ partner Mission for Vision. “The building has been given to us free of cost by the community – we only pay the electricity charges, maintenance and cleaning. To get the sustainability we decided on registration fees, spectacle fees – all very cheap.” Entally has been so successful that it has managed to replace all its equipment from its own funds.
At first, it took time to convince patients eye care was important. But after raising awareness through leaflets, puppet shows, magic shows and word of mouth, the centre now sees about 500 patients a month.
One patient, 18 year-old Urmilla, was having difficulty studying because of the irritation and itching in her eyes. “I had to pay fees of 30 rupees [£0.34]. I have a financial problem in my house, but I can pay this much, I think it’s worth it. I heard everywhere that this place was very good for eyes, so that’s why I came.” She was prescribed eye drops, which she was happy to take to help her study. “I want to grow up and do something with my life,” she explains.
Sanjida Begum and her mother Hasmatu share a tiny room in a slum building in the middle of Kolkata. She relies on a small market trading business to care for both of them, yet when she started to lose her sight to cataracts, an already challenging situation became almost impossible.
“I am struggling – I have to earn for myself at this age,” she told us. “I sell bananas, at the market so it was very difficult for me to live without vision.
One of the biggest challenges I faced was handling money – I used to get cheated. I used to give more back to the customers, orcustomers gave less and I wasn’t aware of it. Within 10 days my full savings got exhausted and I had to borrow from others to continue working. But now no one can cheat me.”
She started to hear good things about the Sightsavers-supported Entally vision centre. “People used to say to me: you are blind and you are a burden to us. I thought there was no use in keeping my life – I will end it. But when I got my sight back, I got renewed energy to live again. That vigour had got lost, but I need to live more years. Sight is equal to life for me.”
The vision centres treat minor ailments and provide glasses, but if patients have more serious problems such as cataracts, they need to be referred to a hospital for further treatment or surgery.
Ahvijit Das runs the social care programme at Susrut, a private ophthalmology hospital. Money from paying patients, along with support from organisations like Sightsavers, is used to cover the costs for people who can’t afford the full cost of the operation. “If the patient can only pay a percentage, we support with the rest,” says Ahvijit. “If they can’t pay anything, that’s OK. Our main objective is the patient doesn’t lose out because of their financial condition.”
Working with partners generates a best-practice model that can help convince governments to incorporate eye care in their health care provision. High demand in the Kolkata vision centres has caught the local government’s attention. “We gave the data to the municipal corporation, and they feel it is important, so they have given places in various government buildings for us to set up vision centres,” Sandip explains.
The aim is for the government to take over running the centres in their facilities, and to eventually include eye care in all their health care. “Now the government understands what primary eye care is,” Sandip continues. “They are incorporating our data into their own information system – they are showing that there is a need for eye care.”
In rural areas, cataract patients previously faced expensive travel costs and six-month waiting lists in the state hospital. But after four years of advocacy in Jharkhand, the government agreed to develop eye departments in four of its district hospitals, and integrate vision centres in community health centres.
With support from Sightsavers to renovate wards and operating theatres where needed, and to provide training for community health care workers in basic eye screening, every household in the districts has the opportunity to been seen by a qualified eye health worker and receive good-quality treatment if they need it.
These facilities are benefiting people like Vijay, a supervisor in a private firm. He had cataracts, which meant he couldn’t read or write to record the workers’ activity, and he was very worried he’d be forced to leave his job.
He was able to be treated at Sadar Hospital Ramgarh in Jharkhand: the day after his cataract surgery, we met him just as his bandage was being removed. He opened his eyes and after a few seconds a smile spread across his face as he realised he can see.
He put his hands together over his heart and bowed in a gesture of gratitude. “I am very blessed!” he exclaimed. “My vision is better – I am very happy. The pictures on the wall – I can see them now, I can read the writing. I am confident that I will be able to go back to work. I will do my work more comfortably than before.”
The hospital and community outreach runs effectively with government resources, as well as a Sightsavers coordinator to provide technical support and help with maintaining quality standards. There’s no risk of funding being pulled or patients having to start paying for eye care, and the government is implementing similar services across the state.
The demonstration and scale-up approach is showing it’s possible to introduce quality eye care where none existed before. With the support of government and private partners, sustainable services can be available to all.
All photos ©World Health Organization/Arko Datto