The Internet offers widespread access to all types of information including health information.¹ The fast Internet access  in our country has opened up new possibilities. Eye health information is plentiful on Internet but majority of  the sites  provide information only in English language. Searching and obtaining reliable information in Hindi is very difficult.  No country could have original development using a foreign language neither can it establish its own identity in the field. Thus in order to give benefit of good health to common people, it is important that EHEM should be made available in Hindi.

Blindness in our country cannot be attributed to  clinical causes alone because  inspite of good facilities and  competent resources for treatment, we do witness cases of lens induced glaucoma, amblyopia, corneal ulcers, opacities, misuse of steroid eye drops, absolute glaucoma, advance diabetic eye disease and many more . Various studies have also shown that people in our country have poor awareness about eye diseases.^2,3  Illiteracy and ignorance of diseases, its risk factors and treatment contribute to increase in number of people not being able to access the health care. Creating public awareness is necessary  as  health education  not only imparts knowledge about the symptoms of diseases but also about  the various  treatment options, comply with the treatment process and understand the necessity of follow ups. This will definitely help in reducing the burden of blindness. 

Health literacy: is the ability to obtain, read, understand and use healthcare information to make appropriate health decisions and follow instructions for treatment.⁴ 

Health education:  is one way by which we can improve health literacy. The World Health Organization defined Health Education as consciously constructed opportunities for learning involving some form of communication designed to improve health literacy, including improving knowledge, and developing life skills which are conducive to individual and community health.⁵ The skills of health professionals, the media, and government and private sector agencies to provide health information in a manner appropriate for their audience are  as  important as an individual’s skill because the interactions between layman  and professionals influence the health literacy of the individual and the society.⁶

Education of consumers is beneficial as a well-informed society is an essential infrastructure of a health system. Paradoxically, there is voluminous literature for health care professionals but very little for patients and for the needs of general public.

Vision of other countries about health education: Different countries have addressed the need of their people by making EHEM available not only in official language but also in different local languages.⁷   

Role of Internet in health Education: The internet is a powerful tool for connecting people to information, ideas, resources, services, and other people.  In last few years, internet has grown as an important tool for health education in many countries  due to its ability to deeply engage large numbers of targeted individuals and communities over a sustained period of time.⁸ 

But it is being neglected in our country. India is now third in the world in number of internet users, behind only the U.S and China.⁹  Youth in India is getting hooked on to Internet.¹⁰ If used properly, it can help us to spread health literacy economically to wide spread population in  small time.¹¹ Readymade and easily available material will not only be used by immediate users to improve their knowledge but can be used by media people, NGOs, practitioners and the health workers for educating their target group. We need websites not only in Hindi language but also in numerous other Indian languages so that people can be empowered to take responsibility of their own health.

An extensive search with the key words was done on internet (on all websites and the database) for  eye health education and related information in Hindi. Various sites of agencies working in the field of eye care like government, private, NGOs, various ophthalmic societies of different states, private and government eye hospital, charitable hospital were searched extensively for EHEM in Hindi.

There is poor availability of material related to eye health education in Hindi language for the public on government and private health sites who are the providers of large proportion of eye health services in India. Only few sites (Table 1,2) showed some EHEM. Majority of the information was available at foreign sites with almost negligible information at Indian sites. Out of about 58 ophthalmic societies and other optician and pharmaceutical sites, none has EHEM available  in Hindi or in any other local language.There is no study reported on the availability of Eye Health Education Material (EHEM) for public in Hindi language.

Language barriers significantly affect quality of care in the health care system.¹²

“In the 2001 Indian census, 258 million (258,000,000) people in India reported Hindi to be their native language. As per the Article 343 (1) of the Indian constitution "The official language of the Union shall be Hindi. Hindi is the native language of most people living in Delhi, Uttar Pradesh, Uttarakhand, Chhattisgarh, Himachal Pradesh, Chandigarh, Bihar, Jharkhand, Madhya Pradesh, Haryana, and Rajasthan.¹³ Health literacy and literacy are closely related but not identical. Health literacy is influenced by the language we speak. The NHP (National Health Portal) has been launched with the domain name for NHP (nhp.gov.in or nhp.org.in) but still sufficient information is not available in Hindi language.¹⁴

Efforts by IT sector to improve Hindi language usage on the internet: We are a country of billion today with 52 million active users of internet, that will increase to 500 million by 2017.¹⁵ Hindi is one of the seven languages of India that can be used to make web addresses.¹⁶

Google is also focusing on Hindi. It has Launched Indian Language Internet Alliance the (ILIA), hindiweb.com, improved version of the Voice Search in Hindi ,the voice-assistant  had got an Indian accent, faster Hindi keyboard , fifteen  Hindi font families. Now search in Hindi is gaining more focus, and better features.¹⁷ With increase in mobile and internet users in India now non-English speakers are also availing this platform. Health programme promoters have to make their online experience as easy as the English speakers.

The first war against blindness has been successfully fought by launching National Programme for Control of Blindness (NPCB) in 1976 even prior to the World Health Organization.18 By strengthening the infrastructure of eye care services in the government, voluntary and private sectors, cataract is adequately addressed in many parts of country.¹⁹ Now a strong foundation is ready to take on the future challenges i.e. the second battle against blindness due to other conditions more complicated than cataract. Diabetic retinopathy, glaucoma, uncorrected refractive error, age-related macular degeneration etc. are posing growing threats to vision of  the millions .While blindness due to cataract is curable by a simple day care surgical intervention, other conditions encompass a multitude of problems that are asymptomatic at the treatable stage but when a person presents for treatment with loss of vision, it is often  too late for intervention. These conditions can be treated and even prevented in some cases, only by treating them before it is too late. Without sufficient education and awareness, millions of people do not realize that they have a condition that needs treatment, or they do not know what to do. To address this, widespread easily-understandable eyes health education program is needed.²⁰ To rationalize the expectations from the  providers by the clients, patients and relatives about the visual outcome in  these conditions and  in cataract associated with them, we have to create appropriate new materials in the  language of the target audience rather than translating a document that already exists in English. 

To use internet as a tool for clearly communicating health information and improving health literacy we need to develop various strategies, guidelines and models.

Although primary responsibility for improving health literacy lies with public health and eye professionals, the healthcare and public health systems but no single group or organization can address this issue on its own, initiatives must be taken by all the sectors in making a proper system for collecting, compiling, analyzing and displaying the information related to various eye conditions and diseases, risk factors and management on internet. A web based National Health information and management system (NHIMS) or eye health education program can be established. 

Proper EHEM should be prepared in simple and most popular language, which general public with average literacy can understand. However, for this to happen , the website has to be designed and implemented properly. Users should be able to find and read whatever they want to understand and act appropriately. Though, multilingual websites are now being created and due to translation it is now possible to get fairly correct and understandable version of the original content in Hindi. A bigger problem relates to the content in videos. It must be ensured that health information should not be incomplete or inaccurate. Periodic research should be conducted to evaluate the perception of public, change in the quality of life of individuals, and efficiency of this system to spread the information. Based on the data and the research findings, policy briefs should be prepared along with suggestions to improve the material and revise strategies through discussion with the technical committees and decision makers. NHIMS will keep monitoring trends of information use and upgrading them time to time as per evolving knowledge.  Instead of being silent bystanders, end users should be actively involved in decision making, planning and provide feedback to the system.²¹

One big step has already been taken by health ministry by making a “people’s ministry accessible to the people’’ and  by promoting use of Hindi in official work and on the social media platform.²² Now government websites, official documents and health-related standing committee materials are made available in Hindi language. Official accounts on Twitter, Facebook, Google, YouTube and blogs are prepared in Hindi and English languages. Websites of health Ministry, National AIDS Control Organisation, AIIMS, Integrated Disease Surveillance Programme and the directorate of health research agencies such as the National Centre for Disease Control and Indian Council for Medical Research are now developed in Hindi language.

Now it’s our turn to show strong commitment for improving health literacy. All cadres who are involved in the eye care, should prepare various type of  eye health education material in Hindi and their local language to improve health literacy and fight against blindness in our country.