The LVPEI pyramidal model for eye care delivery is a tiered structure developed through a top down approach and functioning as community-based model . The bottom three levels of the model provide eye care service delivery in underserved rural areas with its high quality, comprehensive eye care to all people using a strategically constituted ‘eye care team’.
L V Prasad eye institute pyramidal model for eye care service delivery
At the bottom of the pyramid are Vision Health Guardians (VHGs), who serve a population of 5000. VHGs are drawn from the community they serve and are either volunteers or receive a small honorarium. They are trained locally for a period of 2 weeks in all aspects of primary eye care and some aspects of primary health care. The main task of VHGs is to create community awareness, conduct school and community screenings, distribute spectacles, screen for diabetes and hypertension, and work in coordination with other cadres of community health workers (in the areas of maternal and child health, immunization, water and sanitation, etc.). This integration of primary eye care with primary health care by involving VHGs in rural India is a promising concept. In the long term, communities are expected to take ownership of health promotion and monitoring and develop innovative, locally specific models for delivery of health care.
On a pilot basis, LVPEI integrated eye health screening with community development initiatives in a remote village (Ada) in Jainath mandal (a subunit of a district) of Adilabad district, in the northern part of AP in India.[11
] VHGs screened the entire village for eye diseases, diabetes, and hypertension. Some of the novel community development initiatives included development of vision gardens (by growing sweet potato, papaya, drumstick, and curry leaf plants as sources of beta carotene) and livelihood support in the form of vocational training by VHGs in collaboration with Nongovernmental Organizations (NGOs). Based on the results of the pilot, the Community Linked Initiative Project (CLIP) has been initiated to replicate the work across Jainath mandal (with a population of around 40,000) with the help of VHGs. This project is being implemented in collaboration with Operation Eyesight Universal (OEU).
The next tier comprises the Vision Center (VC) network , which is a primary care service delivery unit for a population of 50,000. A VC is managed by a Vision Technician (VT), a high school graduate with 1 year of basic training in optometry. The VT is usually identified from the local district and after training is usually posted in the same district. The VTs main function includes the “3Rs”, that is, refraction, recognition, and referral. The VT works in tandem with the community eye care (CEC) team, including the VHGs, to develop horizontal linkages and identify opportunities to expand the reach and impact of primary level interventions. For instance, LVPEI is currently piloting a model to identify glaucoma and diabetic retinopathy at the primary level, which could potentially lead to early diagnosis and limit their blinding impact. Each VC is linked to a network of 10 VHGs. In addition, a VC is linked to a Service Center (SC).
The next tier is composed of a “SC”, which is a secondary level eye care unit for a population of 500,000. A SC relies on a comprehensive eye care approach.[12
] Each hospital is managed by a team of 20–25 eye care personnel and the main function at this level is provision of comprehensive eye care examination services, diagnosis and treatment of all eye conditions, provision of surgical services for cataract, primary glaucoma, corneal tears, and nonblinding eye conditions like pterygium, naso-lacrimal duct blockage, and laser for glaucoma and retina. In addition, a SC also provides low vision and rehabilitation services. Each SC is linked to a cluster of 10 VCs.
This network of 100 VHGs, 10 VCs, and 1 SC for a population of 500,000 is also known as a Village Vision Complex (VVC). The VVC is an example of an integrated model of primary and secondary care service delivery . At present, LVPEI established 10 SCs and more than 88 VCs thus far.
The top two tiers of the model are represented by the Tertiary Center (TC), which serves a population of 5 million, and a Center of Excellence (COE), which serves a population of 50 million. These centers are located in urban areas and provide tertiary level care, training for all cadres of eye care personnel, eye banking services, low vision and rehabilitation services, and also conduct research. The TC and the COE are also involved in eye health advocacy, policy, and planning.