Childhood Eye Care

Dr, Reeta GurungDeputy Medical Director

Disease Burden: Overall View

Population 2.8 million

Children 40% of the population

The Bhaktapur Eye Survey (1986-87) showed that 30% of children in p y y ( )Nepal have some or other eye problems at a given time.

NGEHG 2, 453,858 (2007-2009) in 16 eye hospitals only 14% were children

So many children with eye problem might have still left behind

1524 cataract surgery was performed in children in 2010g y p

Disease Control - Major Disease Control Major Blinding Diseases in Nepal

Corneal Blindness

Others:GlaucomaRefractive Error and Low VisionRetinal Disorders TrachomaOthers

Krishna Gopal Shrestha

Strategies for screening, case finding in community, networking with providers in communitynetworking with providers in community

Female community health volunteers (48000).

School teachers to screen the children with visual problem and CECs and hospitals are conducting school

i screening programmes.

Traditional healersTraditional healers

Health posts/Sub health posts of the GoNp p

Community eye centres or primary eye care centres in h di ithe districts

Community Eye Centre/Primary Eye Centres= 70

Di t i t E CDistrict Eye Care

Visual Acuity test Out patient – Examination

Supervision meeting

Medical dispensingRefraction

School tea

Spectacle fitting Spectacle dispensingMeasuring IOP

achers

Facilitating referral, treatment and rehabilitation(as necessary) rehabilitation(as necessary)

Community health volunteers

Integration of eye health care with general health care at least in the primary level.

All CECs/PECs (70) are run by the bigger eye hospitals

Refer the patients to the nearest eye hospitals

LVA clinics in almost all Big Eye Hospitals and in many PECs/CECs

Training (HR capacity building) of paediatric ophthalmology team, technicians, social workers, teachersteachers

No of Ophthalmologist 150

In Nepal 8 fellowship trained Paed Ophthalmologists are working

5 hospitals are having regular GA services to cater for the paed Casesthe paed. Cases.

Orbis is helping to build the Paed. Team in TIO. p g(Ophthalmologists, Optometrists with training on Low vision, Orthoptists, Anaesthetic assistants and paediatric nurses)nurses)

Tilganga Institute of ophthalmology:Himalayan Childhood blindness Alleviation

d E H lth I iti ti 2007 2009and Eye Health Initiative 2007-2009

Objectives: Objectives: Promote, prevent and treat childhood eye diseaseDevelop Paed. Ophthlmology teamTrain and mobilise community health volunteers to screen the

childrenUse existing infrastructure and it’s maximum useUse existing infrastructure and it s maximum use

Project ModalityService delivered through 3 levelsa.TIO b. CECs c. Community volunteersNetworking and support from Gov. line agencies, local NGOs

lead to success of this projectlead to success of this project

Himalayan Childhood blindness Alleviation d E H lth I iti ti 2007 2009 and Eye Health Initiative 2007-2009

(Contd…)

HR trained in hospitala Paediatric Ophthalmologist 1a. Paediatric Ophthalmologist 1b. Paediatric Nurse 2c Anaesthetic Assistant 2c. Anaesthetic Assistant 2d. Low vision 2e Orthoptist 2e. Orthoptist 2f. Training of trainers 9

Himalayan Childhood blindness Alleviation and Eye Health Initiative 2007 2009 and Eye Health Initiative 2007-2009 (Contd…)

HR Traineda. Teachers 154b. Traditional healers 46

C 2c. FCHVs 127d. Drug retailers 133

H l h k 191e. Health workers 191f. Others 52TOTAL 702TOTAL 702

Himalayan Childhood blindness Alleviation and Eye Health Initiative 2007-2009 and Eye Health Initiative 2007 2009 (Contd…)

Achievements

Training 702Training 702

Screening in the community 405371 (96% by FCHVs)FCHVs)Children examined in TIO and CECs 53096

In collaboration with other NGOs INGOs MoE MoHP CTEVT In collaboration with other NGOs, INGOs, MoE, MoHP, CTEVT Curriculum on Paed eye care for the training of FCHVs, Teachers, TH was completed

Production of IEC materials on childhood blindness.

Establishment of infrastructureEstablishment of infrastructureOrbis is working in Nepal in 8 different eye hospitals including TIO 2010-214.

Infrastructure development (Creat Child friendly environment in the clinics)Infrastructure development (Creat Child friendly environment in the clinics)

Equipment

Training of the human resources to build the Paed. Oph. team

Screening of the patients in the CECs and refer them to the base hospital for possible free treatmentpossible free treatmentIn 3 out of 10 TIO run CECs it is planned to start primary level paed. Services by training and orienting the OA/Nurse in Paed. Ophthalmology. These CECs will have special Children friendly rooms, special refraction services. F d b f l d f h h ld h Free distribution of glasses and more screening of the children in the community

Refraction and distribution of the glasses in the hospital and in CECs

OBJECTIVE 1 St th d t i OBJECTIVE 1. Strengthen advocacy to increase Member States political, financial and technical commitment in Childhood Eye Care

How is it being met at the Member State level?level?

Signatory of V2020 the right to sight initiative

Formation of Apex body for Eye Health in the MoHP with Secretary of H&P as a chair person

Eye Care is the 7th in Essential health care

MoHP has allocated Fund to the NGO

Big funder of the upcoming National Children’s eye and ear hospital and rehabilitation hospital

How is it being met at the Member State level?level?

Mid term review of the action plan on eye health by the government which was initiated and funded by various government which was initiated and funded by various NGOs, Government of Nepal and WHO. Launching of the book on the report of the MTR as part of WSD celebration.

W d Si h d l b i i i d T lk Word Sight day celebration is carried out every year. Talk show in the national TV, Surgical and screening of patients.

Active role of the NGOs to involve the government in all eye care activitiesy

OBJECTIVE 2. Develop and strengthen national policies, plans and programmes for eye health and prevention of blindness and visual impairmentp p

How is it being met at the Member State level?level?a. Integration of eye health into general health system by

training the health post in charges in primary eye care training the health post in charges in primary eye care As a pilot project in 15 districts. Replicate in Other districts later.

b. Establishment of CEC/PEC in those districts where h i i ll (5 di i )there is no service at all (5 districts)

Shift f f t t t th b i lt ?????c. Shift focus from cataract to other subspecialty?????

d Refraction services in PHC of the Governmentd. Refraction services in PHC of the Government

OBJECTIVE 3. Increase and expand research for the prevention of blindness and

visual impairmentvisual impairment

How is it being met at the Member State level?level?

All academic institutions have research wing who is the member of the NHRC.All residency programmes has to have reasearch topics for each residentP l f bli d d 1980 81Prevalence of blindness study 1980-81Nepal has just finished it’s RAAB in all the 14 zones of the country. It will definitely give fresh data to review our y y gwork of the past and on the basis of the results to plan further. R tl d t d h i Bh kt l d Recently conducted research is Bhaktapur glaucoma and visual impairment study – Population based research.Presbiopia studyp y

How is it being met at the Member State level?

Keratometry in Eyes with Bilateral Pediatric Cataract at Tertiary Eye Care Center in Nepal. Nepal Med Coll J 2009; 11(3): 203-204.. Ocular morbidity in Orphanages Published in J Nepal Med Assoc, 2010; y p g J p , ;49(177): 29-32.Pediatric screening by community volunteers in intervention districtsRed reflex screening for Retinoblastoma: early diagnosis and treatmentV lid ti f di t i i b it h lth kValidation of pediatric screening by community health workersPatient satisfaction at tertiary and community eye centre in NSeasonal Hyper Acute Pan Uveitis: A Descriptive Study Corneal ulcer: A pilot studyCorneal ulcer: A pilot studyModel of community screening by volunteersAwareness and Knowledge of childhood eye health problems in rural communityO l bidi d fi hild i l d b i Ocular morbidity under five years children in rural and urban areas in NepalEffectiveness of training of volunteers in community

OBJECTIVE 4. Improve coordination between partnerships and stakeholders at national and international levels for the prevention of blindness and visual impairment

How is it being met at the Member State level?level?

Coordination between all the stakeholders is one of the key strategies of the action plan on eye care formulated by the government with the help of the NGOs in 2001.

Most of the NGOs working in the eye care are represented in the Apex body for eye health

The majority of the eye care system in Nepal is NGO driven with own agendas but to coordinate the activities of each organisation they are in the process of formation of NGO forum in Nepalprocess of formation of NGO forum in Nepal.

Researches are being started to conduct together or to complement each other e.g. RAAB.

Orbis is being one of the major INGOs working with 8 eye hospitals in the national level in paed. Ophthalmology since 2010

OBJECTIVE 5. Monitor progress in elimination of avoidable blindness at national regional and global levelsnational, regional and global levels

How is it being met at the Member State level?level?

Mid term review of the plan of action.

RAAB

Eye hospitals have computerized patients recording system

Eye health data in Central HMIS

Use of CSOM to monitor the outcome of cataract surgery in some programmes