National Programme for Control of Blindness

The National Programme for Control of Blindness (NPCB) is a public health initiative launched by the Government of India to reduce the prevalence of avoidable blindness and to provide comprehensive eye care services to the population. Established in 1976, it was among the earliest national-level programmes of its kind in the world, reflecting India’s recognition of blindness as a significant social and economic concern. Over time, it has evolved into a major component of the country’s health infrastructure, integrating preventive, promotive, curative, and rehabilitative approaches to eye health.

Background and Rationale

At the time of the programme’s inception, India was estimated to have around 1.2% prevalence of blindness, which translated to millions of individuals suffering from visual impairment. The major causes identified were cataract, trachoma, refractive errors, glaucoma, corneal blindness, and vitamin A deficiency.
Blindness was recognised not only as a medical problem but also as a major obstacle to economic productivity and social well-being. The Government of India, with technical and financial support from the World Health Organization (WHO), established the NPCB to address these challenges through systematic planning, community involvement, and sustained resource allocation.

Objectives of the Programme

The key objectives of the NPCB are as follows:

• To reduce the prevalence of blindness from 1.4% (1976 baseline) to 0.3% by 2020, in alignment with the Vision 2020: The Right to Sight global initiative.
• To strengthen eye care service delivery at all levels of the health system—primary, secondary, and tertiary.
• To provide free and quality eye care to economically weaker sections, particularly in rural and underserved areas.
• To control and treat common causes of blindness, such as cataract, refractive errors, corneal blindness, and diabetic retinopathy.
• To develop human resources for eye care by training ophthalmic surgeons, optometrists, and ophthalmic assistants.
• To promote eye health awareness through Information, Education, and Communication (IEC) activities.

Evolution and Renaming

In 2017, the programme was renamed the National Programme for Control of Blindness and Visual Impairment (NPCBVI) to reflect its broadened scope—from merely preventing blindness to addressing all forms of visual impairment, including those that are correctable through spectacles or medical intervention.
The renaming signified a paradigm shift from curative services towards comprehensive eye health, incorporating screening, early detection, and community-level interventions.

Organisational Structure and Implementation

The NPCB operates as a centrally sponsored scheme, implemented through the State Health Societies and the District Health Societies under the National Health Mission (NHM) framework. The Directorate General of Health Services (DGHS) under the Ministry of Health and Family Welfare serves as the national nodal agency.
At various administrative levels:

• National Level: Policy formulation, coordination, funding, and evaluation.
• State Level: Implementation through State Blindness Control Societies.
• District Level: Operational management through District Programme Managers and ophthalmic assistants.

The programme collaborates with non-governmental organisations (NGOs), eye hospitals, medical colleges, and international development partners to extend its reach.

Major Components and Interventions

1. Cataract Control: Cataract is the leading cause of blindness in India. The programme conducts mass cataract surgery camps, provides intraocular lens (IOL) implants, and ensures post-operative care. Financial assistance is given to institutions and NGOs performing cataract surgeries, prioritising rural and poor populations.
2. School Eye Screening: Implemented in collaboration with the Ministry of Education, this component focuses on early detection of refractive errors among school children. Students diagnosed with vision defects are provided with free spectacles. Teachers are trained to identify children with visual difficulties.
3. Corneal Blindness Prevention and Management: Includes eye donation promotion, establishment of eye banks, and corneal transplantation services. Public awareness campaigns encourage voluntary eye donation under the slogan “Netra Daan—Mahadaan”.
4. Control of Other Eye Diseases: The programme supports the prevention and treatment of diseases such as glaucoma, diabetic retinopathy, vitamin A deficiency, and trachoma through regular screening and medical intervention.
5. Human Resource Development: Regular training is provided for ophthalmic personnel, including ophthalmic surgeons, optometrists, ophthalmic assistants, and nurses. Medical colleges are supported to strengthen their ophthalmology departments.
6. Infrastructure Development: Upgradation of District Hospitals, establishment of Vision Centres at Primary Health Centres (PHCs), and equipping of eye wards with modern surgical instruments are key infrastructure initiatives.
7. Information, Education, and Communication (IEC): Public awareness campaigns, community outreach, and health education initiatives are organised to promote early reporting of eye diseases and to encourage preventive behaviour.

Achievements of the Programme

Since its inception, the NPCB has made significant progress in reducing blindness in India:

• The prevalence of blindness has reduced from 1.4% in 1976 to 0.36% by 2019, according to national surveys.
• India performs over 5 million cataract surgeries annually, one of the highest in the world.
• Over 32,000 Vision Centres and Eye Care Units have been established across districts.
• Millions of schoolchildren have been screened, with lakhs provided free corrective spectacles.
• Eye banking activity has expanded, with more than 700 eye banks and eye donation centres operational across India.

These outcomes demonstrate the effectiveness of a sustained, multi-sectoral approach to blindness prevention and visual rehabilitation.

Partnerships and International Cooperation

The NPCBVI operates in partnership with global and national organisations such as:

• World Health Organization (WHO) – for technical guidance and evaluation.
• International Agency for the Prevention of Blindness (IAPB) – for implementing Vision 2020: The Right to Sight.
• Sightsavers, Lions Clubs International, and Orbis International – for NGO collaboration and funding support.
• State Governments and Medical Institutions – for regional implementation.

Such partnerships have enhanced the programme’s resource base, outreach, and technological capability.

Monitoring and Evaluation

Periodic National Blindness and Visual Impairment Surveys are conducted to assess programme performance. Indicators include prevalence of blindness, number of surgeries performed, and population coverage of eye care services.
The Health Management Information System (HMIS) under the NHM collects and analyses data on performance indicators from districts and states, enabling evidence-based policy decisions.

Challenges and Limitations

Despite its success, the NPCB faces several challenges:

• Uneven access to eye care services in remote and tribal areas.
• Shortage of trained ophthalmologists and paramedical eye care personnel.
• Inadequate awareness leading to delayed treatment-seeking behaviour.
• Limited eye donation rates, resulting in a shortage of corneal tissues.
• Increasing burden of lifestyle-related eye diseases, including diabetic retinopathy and glaucoma.

Addressing these challenges requires continued investment, community participation, and integration of eye health into general healthcare delivery systems.

Recent Initiatives and Future Directions

In recent years, the NPCBVI has adopted several innovations to enhance service delivery:

• Establishment of Mobile Ophthalmic Units (MOUs) to reach remote populations.
• Integration of tele-ophthalmology for remote diagnosis and consultation.
• Inclusion of universal eye health in the National Health Policy 2017.
• Special emphasis on screening for diabetic retinopathy and retinopathy of prematurity (ROP).
• Collaboration with Ayushman Bharat – Health and Wellness Centres for community-level eye care.

Future goals focus on achieving universal eye health coverage, strengthening research and innovation, and ensuring sustainable blindness prevention through early intervention and health education.