Skip to main content

Understanding inclusivity in eye care: for poor, marginalized, affordability is a concern

By Simi Mehta, Anshula Mehta, Arjun Kumar, Kuldeep Singh
Vision is not just critical to an individual’s growth and development but has direct implications for national and global development. It holds the potential to boost the global economy in a fair and equitable manner. It enables everyone to live their lives to the fullest, releasing their potential to learn, to work, and to lead fulfilled and productive lives.
Blindness and Visual Impairment was defined as presenting Visual acuity (VA) <3/60and <6/18 in the better eye, respectively. However, on closely observing the situation in India, prevalence of blindness remains a major health and social issue in a vast country like India which has a population of over 1.4 billion and where access to health care, education and decent livelihood for all remains a pipeline dream.
The population coverage and treatment resources are disproportionately distributed. Additionally, social, economic, and demographic factors can reduce an intervention’s success. A large proportion of the “neglected population” (Rao, 2015) constituting people from urban slums or tribal areas, illiterates from socially and economically backward groups, women and children, people with disabilities, migrants, and refugees, are at the receiving end of relatively poor health care. Inequity in healthcare can take place at the level of availability, accessibility, and affordability.

Prevalence of Blindness in India

According to the National Blindness and Visual Impairment Survey of 2015-19, the Rural-urban wise prevalence of blindness in the Indian population above 50 years is given below. The prevalence of blindness is higher in the rural population as compared to the urban population. It can be attributed to poor access to health care services in rural areas, exacerbated further by poor road conditions, higher levels of poverty, higher dependence on public transport that are often overcrowded and or untimely.
The age-wise prevalence of blindness (%) in the population above 50 years in India is given below. As we move from the lower to higher categories of age, the prevalence of blindness increases exponentially.
Social determinants based on scheduled castes, scheduled tribes, women and children, religious minorities, and the queer community determine the accessibility patterns of healthcare in India. These social inequities are unfair and unjust and reveal the societal make-up of a country. Apart from social determinants, statist interventions also play a significant role in ensuring accessibility of healthcare services. For example, Information, Education, and Communication (IEC) services and their prevalence in a society determine the ease with which citizens can approach and access healthcare services.
Women bear a disproportionate burden of health inequity anywhere around the world, and the case is no different for visual impairment. 609 million out of the 1.1 billion people around the world with vision loss are women, which is about 55% (Vision Loss Expert Group/Global Burden of Disease (VLEG/GBD) 2020 Model). The gender disparity widens further where eye care is concerned. In a 2020 study, women were found to have 35% higher odds of being blind and 69% higher odds of being cataract blind, but with 27% lower odds of getting cataract surgery (Prasad et al., 2020).
In India as well, the trends and disparities between men and women in terms of the prevalence of blindness in the population above 50 years can be identified by the graph below:
Researchers have seldom driven their work towards the geography of the parts of the population who grapple with disabilities. To alleviate specific future research challenges, funding for specific R&D departments is needed. Approaching these communities with promotive actions to prevent future eye-based disabilities would be an important state intervention. This should be done with the purpose of preventing: future economic losses, isolation of the disabled from society and economic burden of the caregiver.
According to the study on ‘Bridging the gap: Tapping the agriculture potential for optimum nutrition’ jointly by ASSOCHAM and EY, India houses the world's highest number of malnourished children (Shenoy 2017). The Government of India will need to focus on improving nutritional security in the country. Considering that Vitamin-A deficiency is associated with childhood blindness, this becomes all the more urgent.
The literacy-wise prevalence of blindness in the population above 50 years is given below. Evidently, blindness is substantially higher among illiterates as compared to other categories. The estimates for 5th to 9th class pass and 10th class pass and above are roughly comparable, while the prevalence for 4th class pass is marginally higher than the former.

Affordability of Healthcare Services:

Income levels are crucial determinants of affording quality healthcare services. With a rising share of private healthcare, service provisioning amid the declining public healthcare system is a barrier to the affordability of healthcare. According to the Economic Survey of 2020-21, 60% of expenditure on healthcare services is out-of-pocket (OOP) expenditure. To effectively reduce this expenditure to 30%, the survey has suggested raising the ratio of healthcare expenditure/GDP to 2.5% from the present 1%. For the poor and marginalized, affordability remains a concern towards availing eye care. Affordable spectacles and treatment options must assume paramount importance for an inclusive eye care system.

Conclusions:

Thus, the above description clearly points through official data of the National Blindness and Visual Impairment Survey of 2015-19 that universal eye care in India is far from reality. Thus, the Leaving No One Behind motto of the Sustainable Development Goals of the United Nations is put at risk. Further, there are several converging goals that are impacted, for example: SDG 1- No Poverty, SDG 2 - Zero Hunger, SDG 3 - Good Health and Well-Being, SDG 4 - Quality Education, SDG 5 - Gender Equality, SDG 8 - Decent Work and Economic Growth, SDG 10 - Reduced Inequalities, SDG 11 - Sustainable Cities and Communities, which are indispensable if we have to ensure the Right to Sight for all in the country.
Hence, it is of utmost importance that such inequities are fully and urgently addressed. Continued collection of information on low vision and blindness will help improve understanding of the problem and assist in developing newer strategies.

Future Directions of Research:

Access to reliable data on the prevalence of visual impairment and blindness are a pre-requisite for planning eye care services. While this can be attained by conducting regular detailed prevalence studies, they are logistically expensive, resource-intensive and time consuming. But their utility in providing reliable information for goal setting, planning and starting up eye care services cannot be underrated. To bridge the gaps, rapid methodologies in data collection and prevalence studies may be adopted for acquiring a baseline data to understand the depth of the problems, which may then be scaled for planning health care services. Methods like 'Rapid Assessment of Visual Impairment (RAVI)' involving randomly selected human subjects 50 years and older would prove to be very beneficial in understanding the gaps and plan effective primary and secondary level eye care services in both rural and urban areas.

References:

  • Prasad M., S. Malhotra S, M. Kalaivani, P. Vashist, S.K. Gupta. 2020. Gender differences in blindness, cataract blindness and cataract surgical coverage in India: a systematic review and meta-analysis. British Journal of Ophthalmology, 104:220-224.
  • Rao, G. N. 2020. Universal Health Care: Can Indian Ophthalmologist Community Set an Example?. Indian Journal of Ophthalmology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7003579/
  • Shenoy, J. 2017. India has largest number of malnourished children in the world: Study. Times of India. November 1, 2019. https://timesofindia.indiatimes.com/india/india-has-largest-number-of-malnourished-children-in-the-world-study/articleshow/61405188.cms

Comments

Post a Comment

TRENDING

The silencing of conscience: Ideological attacks on India’s judiciary and free thought

By Sunil Kumar*  “Volunteers will pick up sticks to remove every obstacle that comes in the way of Sanatan and saints’ work.” — RSS Chief Mohan Bhagwat (November 6, 2024, Chitrakoot) Eleven months later, on October 6, 2025, a man who threw a shoe inside the Supreme Court shouted, “India will not tolerate insults to Sanatan.” This incident was not an isolated act but a continuation of a pattern seen over the past decade—attacks on intellectuals, writers, activists, and journalists, sometimes in the name of institutions, sometimes by individual actors or organizations.
Post a Comment
»

N-power plant at Mithi Virdi: CRZ nod is arbitrary, without jurisdiction

By Krishnakant* A case-appeal has been filed against the order of the Ministry of Environment, Forest and Climate Change (MoEF&CC) and others granting CRZ clearance for establishment of intake and outfall facility for proposed 6000 MWe Nuclear Power Plant at Mithi Virdi, District Bhavnagar, Gujarat by Nuclear Power Corporation of India Limited (NPCIL) vide order in F 11-23 /2014-IA- III dated March 3, 2015. The case-appeal in the National Green Tribunal at Western Bench at Pune is filed by Shaktisinh Gohil, Sarpanch of Jasapara; Hajabhai Dihora of Mithi Virdi; Jagrutiben Gohil of Jasapara; Krishnakant and Rohit Prajapati activist of the Paryavaran Suraksha Samiti. The National Green Tribunal (NGT) has issued a notice to the MoEF&CC, Gujarat Pollution Control Board, Gujarat Coastal Zone Management Authority, Atomic Energy Regulatory Board and Nuclear Power Corporation of India Limited (NPCIL) and case is kept for hearing on August 20, 2015. Appeal No. 23 of 2015 (WZ) is filed, a...
Post a Comment
»

History, culture and literature of Fatehpur, UP, from where Maulana Hasrat Mohani hailed

By Vidya Bhushan Rawat*  Maulana Hasrat Mohani was a member of the Constituent Assembly and an extremely important leader of our freedom movement. Born in Unnao district of Uttar Pradesh, Hasrat Mohani's relationship with nearby district of Fatehpur is interesting and not explored much by biographers and historians. Dr Mohammad Ismail Azad Fatehpuri has written a book on Maulana Hasrat Mohani and Fatehpur. The book is in Urdu.  He has just come out with another important book, 'Hindi kee Pratham Rachna: Chandayan' authored by Mulla Daud Dalmai.' During my recent visit to Fatehpur town, I had an opportunity to meet Dr Mohammad Ismail Azad Fatehpuri and recorded a conversation with him on issues of history, culture and literature of Fatehpur. Sharing this conversation here with you. Kindly click this link. --- *Human rights defender. Facebook https://www.facebook.com/vbrawat , X @freetohumanity, Skype @vbrawat
1 comment
»

Citizens’ group to recall Justice Chagla’s alarm as India faces ‘undeclared' Emergency

By A Representative  In a move likely to raise eyebrows among the powers-that-be, a voluntary organisation founded during the “dark days” of the Indira Gandhi -imposed Emergency has announced that it will hold a public conference in Ahmedabad to highlight what its office-bearers call today’s “undeclared Emergency.”
Post a Comment
»

Celebrating 125 yr old legacy of healthcare work of missionaries

Vilas Shende, director, Mure Memorial Hospital By Moin Qazi* Central India has been one of the most fertile belts for several unique experiments undertaken by missionaries in the field of education and healthcare. The result is a network of several well-known schools, colleges and hospitals that have woven themselves into the social landscape of the region. They have also become a byword for quality and affordable services delivered to all sections of the society. These institutions are characterised by committed and compassionate staff driven by the selfless pursuit of improving the well-being of society. This is the reason why the region has nursed and nurtured so many eminent people who occupy high positions in varied fields across the country as well as beyond. One of the fruits of this legacy is a more than century old iconic hospital that nestles in the heart of Nagpur city. Named as Mure Memorial Hospital after a British warrior who lost his life in a war while defending his cou...
Post a Comment
»

New RTI draft rules inspired by citizen-unfriendly, overtly bureaucratic approach

By Venkatesh Nayak* The Department of Personnel and Training , Government of India has invited comments on a new set of Draft Rules (available in English only) to implement The Right to Information Act, 2005 . The RTI Rules were last amended in 2012 after a long period of consultation with various stakeholders. The Government’s move to put the draft RTI Rules out for people’s comments and suggestions for change is a welcome continuation of the tradition of public consultation. Positive aspects of the Draft RTI Rules While 60-65% of the Draft RTI Rules repeat the content of the 2012 RTI Rules, some new aspects deserve appreciation as they clarify the manner of implementation of key provisions of the RTI Act. These are: Provisions for dealing with non-compliance of the orders and directives of the Central Information Commission (CIC) by public authorities- this was missing in the 2012 RTI Rules. Non-compliance is increasingly becoming a major problem- two of my non-compliance cases are...
Post a Comment
»

Urgent need to study cause of large number of natural deaths in Gulf countries

By Venkatesh Nayak* According to data tabled in Parliament in April 2018, there are 87.76 lakh (8.77 million) Indians in six Gulf countries, namely Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates (UAE). While replying to an Unstarred Question (#6091) raised in the Lok Sabha, the Union Minister of State for External Affairs said, during the first half of this financial year alone (between April-September 2018), blue-collared Indian workers in these countries had remitted USD 33.47 Billion back home. Not much is known about the human cost of such earnings which swell up the country’s forex reserves quietly. My recent RTI intervention and research of proceedings in Parliament has revealed that between 2012 and mid-2018 more than 24,570 Indian Workers died in these Gulf countries. This works out to an average of more than 10 deaths per day. For every US$ 1 Billion they remitted to India during the same period there were at least 117 deaths of Indian Workers in Gulf ...
Post a Comment
»

World Bank arm accused of hiding crucial report on Gujarat’s Tata Mundra power project

By A Representative   The Centre for Financial Accountability (CFA) has accused the Compliance Advisor Ombudsman (CAO), the accountability arm of the International Finance Corporation (IFC), of concealing crucial evidence related to the Tata Mundra coal power project in Gujarat during the period when the case was being heard in U.S. courts. In a press statement released on October 10, 2025, CFA said that the CAO’s final monitoring report, which was completed in 2019 but released only in September 2025, revealed that IFC had failed to take remedial action for years, even as environmental and livelihood harms to local communities worsened.
Post a Comment
»

Epic war against caste system is constitutional responsibility of elected government

Edited by well-known Gujarat Dalit rights leader Martin Macwan, the book, “Bhed-Bharat: An Account of Injustice and Atrocities on Dalits and Adivasis (2014-18)” (available in English and Gujarati*) is a selection of news articles on Dalits and Adivasis (2014-2018) published by Dalit Shakti Prakashan, Ahmedabad. Preface to the book, in which Macwan seeks to answer key questions on why the book is needed today: *** The thought of compiling a book on atrocities on Dalits and thus present an overall Indian picture had occurred to me a long time ago. Absence of such a comprehensive picture is a major reason for a weak social and political consciousness among Dalits as well as non-Dalits. But gradually the idea took a different form. I found that lay readers don’t understand numbers and don’t like to read well-researched articles. The best way to reach out to them was storytelling. As I started writing in Gujarati and sharing the idea of the book with my friends, it occurred to me that while...
Post a Comment
»