Tripura Vision Centre Project

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Registration Name : eINDIA2011/AN/240
Project Category : eHealth::Best Govt Policy Initiative of the year
Project Name : Tripura Vision Centre Project

Details of Applicant
Name : Sukumar Deb
Address : 1st Floor Office of the Medical Superintendent IGM Hospital
City : Agartala
State : Tripura
Country : INDIA
Zip Code : 799001

Details of Project/Implementing Agency
Name of Organisation : IL&FS Education & Technology Services Limited
Address : 1st Floor, South Wing,,Karumuttu Centre,498 Anna Salai, Nandanam
City : Chennai
State : Tamilnadu
Country : INDIA
Zip Code : 600035
Name of the head of Organisation : Mr.PremAnand S
Website : http://www.ilfsindia.com/projects1.asp?Category=2&Project=12&subLink=125

Brief description of the programme/project/Initiative :
Tripura has been facing acute shortage of modern ophthalmologic infrastructure & specialists. There is only one public sector civil hospital, the Indira Gandhi Memorial (IGM) Hospital in the capital of the state, that serves the need for all the primary, secondary & tertiary care support. Seventy-five percent of the population that resides in the rural areas has to spend considerably on transportation & accommodation to avail the service. At present, a total of 17 Ophthalmologists & 26 Ophthalmic Assistants/Optometrists are catering to the needs of 37lakhs residents. By 2014, the numbers are estimated to reduce further as out of the 17 Ophthalmologists, 10 will retire from the service, implying that only 8 or 9 Ophthalmologists will be providing eye care to a projected population of 40lakhs. Owing to the future situation, to offer a programmatic solution the state government decided to adopt information & communication technology to extend the benefits of the advance medical sciences to the entire population, including the remote & inaccessible parts of the state, through Tripura Vision Centre Project. The Tele-ophthalmology project required setting up of vision centres in all the blocks of the state in order to decentralize eye care to meet the requirements of the rural population of Tripura. The project was implemented in three phases to cover all 40 Blocks of rural Tripura. The Govt. of Tripura in an innovative approach decided to establish all VCs adjacent to all the Community Information Centre in the Block premises, in order to leverage the existing Tripura State Wide Area Network(T-SWAN) infrastructure. It helped VCs to use dual connectivity, one from the CIC, i.e. TSWAN & another is from privet PMLS-VPN network provided by a private service provider. Broadband internet connectivity has been installed at individual centers for ensuring the required bandwidth availability. Although this approach has been designed to provide best in class connectivity based on the physical, regional and other infrastructural barriers. The applications and the database for this project are located at a server created at specific central hub, created for this purpose. The applications include: a) Video conferencing server b) Patient Record database server; this is used to record and keep track of patient information on an electronic platform between OA & the doctors. One server will be installed for this purpose. c) It has patient record module which has custom designed components. d) Online and real-time MIS to track progress of patients, consultations, cases etc The project has screened more than 1, 36,769 patients till 30th September, 2011, majority of the patients visited VCs for treatments related to refractive errors. Before establishing the VCs, it was observed that percentage of women being screened in the government hospital was considerably low. With establishing of Vision Centres, eye care service was taken to the door steps to the rural people, which increase the number of women being screened in the centres. Prior to the implementation of the project 34percentwomen were screened &after setting up of VCs which increases up to 44percent. The numbers of patients with Cataract surgical requirements are lesser & are referred to secondary eye care service hospital only after video consultation & preparing the patient for surgery after all preliminary examination & testing. Tele-ophthalmology helps in reducing the unnecessary patients transfer to secondary eye care centre. Thus the project enhances the capacity of the existing ophthalmological service in Tripura. The State Government has devised an ambitious plan to scale the benefits of the project to primary and preventive health care segment also. It is expected that the 12th year plan of the nation is seriously considering incorporating the model as a way of delivering Health care services to remote and backward areas of the country using Information & Communication Technologies with health care service provisioning.

Why was the project started :
The Vision Centres are envisaged as the next generation delivery points for Eye care services by the State, which will enable achieve the following objectives; ? An effective Eye Care delivery Channel ? Pro-Citizen with vibrant approach from the State ? Accountability for every single patient ? Cost effective & efficient way of delivering Eye care ? To find solutions for challenges in the health care service delivery; ? Lack of qualified medical doctors ? Functional Access points for patients ? Accountability of patients identified ? A structured escalation of patients to the tertiary care support ? Reduced cost of servicing rural patients and reduce cost of accessing eye care services by patients.

Objective :
The Vision Centres are envisaged as the next generation delivery points for Eye care services by the State, which will enable achieve the following objectives; 1. An effective comprehensive eye care delivery channel 2. Pro-Citizen with vibrant approach from the State 3. Accountability for every single patient 4. Cost effective & efficient way of delivering Eye care

Target group : The project serves a rural population of 30Lakhs people in remote areas spread across 40 blocks of 4 districts in the State of Tripura. Primary and Preventive eye care solutions through Vision centres as eye care delivery channels with easy access and in affordable way. Complete eye care consultation, glass and medical prescription advised from remotely by doctors Health Education and awareness creation at village level.
Geographical reach : Government of Tripura for its 37, 48,074 plus population realized the need for taking proactive measure in controlling needless blindness and to build a sustainable eye care solution for its people and decided to harness the benefits of the Vision centre model.Population in those block areas -Melaghar-108018, Boxanagar-44064, Hezamara-328895, Jampuijala-43969, Jirania-128196, Kalyanpur-42872, Kathalia-54347, Mandhai-43876, Mohanpur-158974, Mungiakami-35518, Tulashikar -45039, Dukli-45857, Teliamura-78736, Padmabil-27417, Khowai-62144, Kakraban-66045, Matabari-124529, Satchand-78104, Amarpur-81698, Rajnagar-83198, Rupaichari-39346, Bagafa-121451, Salema-109324, Manu-65861, Kumarghat-75256, Gournagar- 92426, Pecharthal-32208, Panisagar-97927, Kadamtala -105282, Killa- 31065, Dumbornagar-42122, Damcharra-20854, Ambassa- 43597, Ompi- 41833, Hyrishyamuk- 48214, Chowmanu- 78946, Dasda- 84287, Bishalghar- 123433, Karbook- 48660,Jampuihil -16400
Date from which the project became operational : 7 April 2007
Is the Project still operational : YES

10 points that make the programme/project innovative?

  1. To overcome the challenges of inadequate ophthalmologic care in the state, the Health & Family Welfare Department, Govt. of Tripura, in 2007 established one pilot tele-ophthalmology centre to utilize Information & Communication Technologies to facilitate quality eye care to the rural citizens. Based on the acceptance of the technology by the citizens as a means to offer healthcare service, the department approved the setting up of 40 Vision Centre(VCs) across the state which was completed in phased manner.
  2. This project has significantly contributed in saving the vision of rural citizens in terms of avoiding needless blindness
  3. This project enhances the capacity of prevalent eye care system of the State of Tripura by structurally integrating primary, secondary & tertiary care.
  4. It provides an accountable, structured framework to enable quality healthcare in the existing system. It also enables decentralisation of the healthcare system, which was centralized at State Headquarters.
  5. It’s a scalable model and is scaled upwards to cover whole State of Tripura in a phased manner
  6. It reduced the burden to the Secondary Healthcare System at State Headquarters by reducing the flow of primary care patients. It also reduced associated costs like transport, food and accommodation to the patients.
  7. It enables us to achieve the goals set out in “Vision 2020 – The Right to Sight” which is a global initiative for combating blindness being initiated by International Agency for Prevention of Blindness.
  8. The Vision Centers have provided equitable access of health facilities across genders. Out of the total patients screened till date, 44% are women and 56% are men which clearly indicate the gender equality for access.
  9. The project has screened more than 1, 36,769 patients till 30th September, 2011,
  10. The project provides the foundation for further scaling of health care needs in the block such as child care, pre and postnatal care, monitoring of vaccination in the block, control outbreak of diseases, etc

List the 5 achievements of the programme/project?

  1. The project has screened more than 1, 36,769 patients till 30th September, 2011,
  2. The Vision Centers have provided equitable access of health facilities across genders. Out of the total patients screened till date, 44% are women and 56% are men which clearly indicate the gender equality for access.
  3. Tele-ophthalmology helps in reducing the unnecessary patients transfer to secondary eye care centre. Thus the project enhances the capacity of the existing ophthalmological service in Tripura. Only Patients requiring tertiary or secondary care support are required to visit the hospital, thus saving on time & money for the patient.
  4. This project has significantly contributed in saving the vision of rural citizens in terms of avoiding needless blindness. c. It provides an accountable, structured framework to enable quality healthcare in the existing system. It also enables decentralisation of the healthcare system, which was centralized at State Headquarters.
  5. Observing the success & reliability of the Tripura Tele-ophthalmology Project, the Planning Commission of India has done an independent study and the model is expected to be recommended in the 12th Five Year Plan.

List the 5 key challenges faced while implementing the programme/project/initiative

  1. Eye care services involves lot of Images to be taken and transmitted to the doctor, we ensure that the connectivity is available at all the required time so as to enable the patient consult the doctor.
  2. Examination and data entry errors that were observed initially were promptly identified by the doctors and have gradually come down as the domain skill levels of OA with Doctor-OA close coordination have highly improved making the Vision centre more reliable for the people. So there is NO gap between content services and citizens.
  3. ICT tools by themselves cannot bring much change to the lives of people but coupled with human interest and attitude change, these ICT tools can bring in lot more positive change to any sector of development like education, health and agriculture.
  4. Remoteness and Geographical spread of Block locations are very remote, sensitive areas and security issues were posed to the field staff, suppliers, and service providers.

List the 5 points how can the programme serve as a model that can be replicated or adapted by others?

  1. The project is unique. This initiative is first of its kind in the country particularly in the North Eastern State.
  2. The Vision Centre is a comprehensive model for providing primary and preventive eye care in a decentralized manner using the benefits of Information and communication technologies (ICT) integrated with the medical eye care solutions.
  3. The model empowered trained paramedics or ophthalmic assistants to provide eye care services at the grass root level. The model of vision centre is envisaged by the Vision 2020 – The Right to Sight, a global initiative of International Agency of Prevention of Blindness (IAPB – a global machinery working across the world for the prevention of avoidable blindness).
  4. Thus this program, can serve as a model that can be replicated or adapted by others.
  5. IL&FS ETS has replicated the model and the learning from implementing this project in other health projects for the States like Bihar.

List 5 points to elaborate on the scalability of the programme/project/initiative

  1. It’s a scalable model and is scaled upwards to cover whole State of Tripura in a phased manner
  2. As of now, there are no consultation charges and also the medicines are provided free of cost to the citizens by the Govt. of Tripura.
  3. The project was designed in three phases and all the three phases are complete and 41 centers are completely functional.
  4. As Govt. of Tripura, owns the project there is no need of a revenue generation from this project.
  5. However a similar project elsewhere (without support of State Govt.) can be made self sustainable by a suitable business model

Documents publishing URL :

http://indiagovernance.gov.in/bestpractices.php?id=932

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