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Enabling inclusive eye health during the new normal

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Dr GVS Murthy, Vice President – South, Public Health Foundation of India (PHFI) and Director, Indian Institute of Public Health, Hyderabad shares his insights on the possibilitiesfor eye care beyond lockdown for the differently-abled

Inclusion is one of the significant parameters to strengthen nation’s social development agenda. Yet, inaccessibility is an everyday challenge for Persons with Disabilities (PwDs). From education and employment to health and mobility, there is always a ‘new normal’ for the differently-abled. Issues like COVID-19 further add to the existing physical and attitudinal barriers faced by the differently-abled.

Let’s define three major challenges and possible solutions, both for the PwDs and eyecare ecosystem, to enable inclusion at these unprecedented times.

In the already dwarfed employment opportunities, the first and foremost challenge is that the pandemic has increased financial insecurity for PwDs. You may very well imagine the loss of livelihoods, education and social support for the differently-abled in these challenging times. It is thus, extremely critical to ensure availability of health services, including eye health, at an affordable cost.

With a likelihood of reduced funding for the Trust hospitals during and post COVID-19, several eye hospitals in the country face sustainability challenges. There is a need for eye hospitals to implement innovative subsidisation for health services. The hospitals can continue reaching out to the marginalised and PwDs, by leveraging small community insurance or Self Help Group (SHG) schemes. Smaller, yet targeted philanthropic/Corporate Social Responsibility (CSR) funding for individual cases can come in handy at this time. Taxing or charging extra on products like contact lens, refractive surgery, etc. by hospitals can also cover the needs of PwDs.

Continuity of inclusive services though can be ensured with policy advocacy. While some states have already included cataract surgeries under Ayushman Bharat, there is a need for advocacy to enable maximal coverage of eye procedures under the scheme.

Secondly, COVID-19 has brought about additional infection risks for PwDs, compared to all other people. The basic precautionary measures of social distancing and hand washing don’t come easy for PwDs. As many of the differently abled rely on family members and care givers, the chances of them being infected increases significantly. The visually impaired, for example, need tactical touch mechanism for their daily activities, which increases their chance of being infected. Moreover, as over 80 per cent of the PwDs in India are above 60 years of age, the risk of mortality is higher for them due to COVID-19. The double whammy-stigma due to disability on one hand and COVID infection on the other, might affect PwDs adversely.

It is, therefore, crucial that eye hospitals either take the health services to PwDs or adopt remote and innovative technology solutions. Eye hospitals can reach out to PwDs close to their residence through dedicated mobile services or vision centres. This can include post-surgery follow-up, refraction, etc.

Tele-consultation is particularly helpful as travel, especially during lockdown, brings its own challenges and risks for PwDs. Video consultation, with sign language interpreters and clear diction will be helpful, both for the hearing and visually impaired. Simple solutions like couriering medical supplies/delivering supplies through vision centres or field staff can not only help hospitals avoid crowding, but also he lp PwDs access services from the safety of their homes. To address the mental stress, anxiety and depression of differently-abled at these challenging times, a 24*7 dedicated helpline can be set up.

Lastly, inaccessible information about COVID-19 is another major concern for the PwDs. This is because the precautionary measures on COVID in accessible formats are hardly available for understanding and use of PwDs. I would highly recommend eye hospitals to set up cost-effective disability-friendly information booths at hospitals, which can be easily accessed for information and support required. Partnering with Disabled People Organisations (DPOs) can also help eye hospitals facilitate comprehensive health camps and visual assessment in communities.

Finally, and most importantly, I cannot stress enough on the significance of involving PwDs in planning and rolling out health services, now and in the future. Nothing about PwDs should be implemented without inclusion of PwDs themselves.

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