Gaiha Shivani M, Shukla Rajan, Gilbert Clare E, Anchala Raghupathy, Gudlavalleti Murthy V S
South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, Kavuri Hills, Madhapur, Hyderabad, India.
Department of Clinical Research, International Centre for Eye Health, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
Indian J Endocrinol Metab. 2016 Apr;20(Suppl 1):S42-50. doi: 10.4103/2230-8210.179773.
The growing burden of avoidable blindness caused by diabetic retinopathy (DR) needs an effective and holistic policy that reflects mechanisms for early detection and treatment of DR to reduce the risk of blindness.
We performed a comprehensive health policy review to highlight the existing systemic issues that enable policy translation and to assess whether India's policy architecture is geared to address the mounting challenge of DR. We used a keyword-based Internet search for documents available in the last 15 years. Two reviewers independently assessed retrieved policies and extracted contextual and program-oriented information and components delineated in national policy documents. Using a "descriptive analytical" method, the results were collated and summarized as per themes to present status quo, gaps, and recommendations for the future.
Lack of focus on building sustainable synergies that require well laid out mechanisms for collaboration within and outside the health sector and poor convergence between national health programs appears to be the weakest links across policy documents.
To reasonably address the issues of consistency, comprehensiveness, clarity, context, connectedness, and sustainability, policies will have to rely more strongly on evidence from operational research to support decisions. There is a need to involve multiple stakeholders from multiple sectors, recognize contributions from not-for-profit sector and private health service providers, and finally bring about a nuanced holistic perspective that has a voice with implementable multiple sector actions.
糖尿病视网膜病变（DR）导致的可避免失明负担日益加重，这需要一项有效且全面的政策，该政策应反映出DR的早期检测和治疗机制，以降低失明风险。
我们进行了一次全面的卫生政策审查，以突出有助于政策转化的现有系统性问题，并评估印度的政策架构是否适合应对DR日益严峻的挑战。我们使用基于关键词的互联网搜索，查找过去15年中可用的文件。两名审查员独立评估检索到的政策，并提取国家政策文件中描述的背景信息、面向项目的信息和组成部分。使用“描述性分析”方法，根据主题对结果进行整理和总结，以呈现现状、差距和未来建议。
缺乏对建立可持续协同效应的关注，这需要在卫生部门内部和外部建立完善的合作机制，以及国家卫生项目之间的融合不佳，这似乎是各政策文件中最薄弱的环节。
为了合理解决一致性、全面性、清晰度、背景、关联性和可持续性问题，政策将不得不更有力地依赖于运筹学证据来支持决策。有必要让多个部门的多个利益相关者参与进来，认可非营利部门和私立卫生服务提供者的贡献，最终形成一个细致入微的整体视角，发出具有可实施的多部门行动的声音。
