India: Nayana Eye Care & WDF

As part of my role with the International Diabetes Federation (IDF) and Novo Nordisk, I volunteered to go to rural Karnataka (southern India) for 10 days to see the Nayana eyecare clinic in action. The clinic is part of a wide range of care and outreach programs funded by the World Diabetes Foundation (WDF) in India. These include footcare, diabetes camps, eyecare and diagnosis. The WDF also funds many projects in other developing nations around the world.

The clinic runs as part of the Vittala International Institute of Opthalmology (VIIO), and is supported by the WDF. The aim of the clinic is to take care and expertise into rural Karnataka in an effort to diagnose, treat and educate local doctors and patients about diabetic eye care.

The clinic itself is housed in an Ashok Leyland van, carrying vital laser, fundus cameras, ultrasound and plenty more equipment. It is also equipped and prepared to do Fundus Angiograms. The van travels for around 25 days a month, visiting rural towns and villages treating patients.

VIIO recognised that part of the problem in India is that the only care for people with diabetes is located in state capitals such as Bangalore (the centre for VIIO). Travel costs, accomodation costs, lost income from days spent away from work and a general fear of large cities and unknown doctors prevents nearly every patient from following up in the traditional model of care. Originally, when VIIO was stationary in Bangalore, their referred patients from rural Karnataka would have a 100% drop-out after the first consultation. Patients could not simply go back 3 months later for the above reasons. As such, they could not follow up with care, significantly effecting the chances of saving their own vision.

However, with the Nayana mobile eye care clinic, the doctors from VIIO and Prabha Eye Hospital (both based in Bangalore) are able to travel with the clinic and treat patients in their local towns. The VIIO & Prabha doctors act as consultants, and educate the local doctor(s) in eye treatment using lasers and other tools on the van. In tricky situations, the consultants will often do the treatment, with the referring doctor viewing the procedure through modified instruments specially made for the clinic.

The clinic used to visit 8 districts, but has now grown to 13, with plans for further expansion soon. On average, around 30-45 patients would be consulted per day, with around 20 needing treatment - with that treatment being delivered the same day.

Subbakrishna Rao, the project manager for Nayana, explained that "the main success of this program has been around the recruitment of the local doctors. They get a financial benefit from referring the patients to us, and the patients get treated quickly and without any hassles from going to Bangalore." He explains the simple model to us, that when patients pay for treatment, the clinic keeps 30%, and the local referring doctor keeps 70%. Those who cannot pay for care do not have to. The financial benefit has been the main incentive for most of the local doctors. "Without the incentive, why should doctors refer patients to us?" Rao says. The bonus is also for the patients, and with the education the doctors receive while attending the clinic with their patients, they can then convey this on in future to their patients. "There is a big problem, and that is that some patients do not like other doctors or doctors they do not know. At least here they can be treated and cared for by their own doctors".


The success of such a project is hard to guage, as Rao identifies. Whether it be financially sound, socially equitable or about saving vision, Rao does not talk of any of this when talking of a target. He says that the way to show that this project is succeeding is that "by next year, it [Nayana] will be self-sustainable." The bonus of this is obvious; "We can continue our work, keep expanding and most of all offer the care that is so urgently needed".

Alex