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World Sight Day 2008

Fighting vision impairment in later life

Dr Abu Rai han
Word Sight Day (WSD) is an annual event of awareness which aims at raising global attention concerning the current reality of 300 million people living with blindness and vision impairments worldwide. It is coordinated by International Agency for the Prevention of Blindness (L\PB) under the VISION 2020 global initiative. This year’s WSD was on October 9 and it focuses on the ageing eye, and vision impairment in older people. The headline of the theme “Eyes on the future" and strap line "fighting vision impairment in later life” recognises — in a world where populations are ageing and individuals are living longer, blindness from chronic conditions are also on the rise. By 2025, there will be twice as many as older people worldwide as there were in 2000.
The prevalence of visual impairment and blindness increases with age. Eighty percent of the 37 million blind people in the world are the older population. Cataract, glaucoma, diabetic retinopathy and age related macular degeneration are among others that may increase the risk of blindness with aging. Good eye sight is the most fundamental need of human being for economic productivity and living a quality life. Good vision can help older people remain active and .less dependent at the later age of their life.
Bangladesh is one of the signatory courtiers of the global campaign for elimination of avoidable
blindness known as “VISION 2020: The Right to Sight". The main focus of this initiative is to build sustainable eye care systems in each member countries which can contribute in die elimination of avoidable blindness through strengthening health human resources, health infrastructure and public education.
In Bangladesh, if the quality of eye care service is not improved significantly and the delivery system is not changed in favor of the poor people, the country may not achieve the global target; blindness will remain as one of the major public health problems. Eighty percent of die blindness in Bangladesh is due to the cause of cataract — a simple condition that can be easily treated to restore sight. In cataract the natural lens of the eye becomes cloudy due to aging and some other factors. Cataract lens can easily be removed from the eye and replaced by a clear artificial lens (called IOL implantation). Its surgical technology is simple and available. One ophthalmologist who has a training in ophthalmic microsurgery can easily perform at least 1500 cataract surgery in a year if there is supportive infrastructure. Simplification of cataract surgical techniques, introduction of appropriate technology and short training in ophthalmic microsurgery have made the service one of the most cost effective surgical treatments in the entire health science.
Over the last few decades, there have been many campaigns against cataract blindness and projects were undertaken to
eliminate cataract blindness in many countries including Bangladesh. International development organisations and NGOs supported these projects and backlog of cataract cases were removed at least for partial in many countries. However, very little capacity has been retained in Bangladesh to continue to provide quality cataract surgical care after the withdrawal of project support. This is primarily due to the focus of those projects in
reducing the backlogs rather than developing sustainable and permanent capacities. Development of capacity for any healthcare programme is a complex issue and requires not only appropriate human resources and equipment, but also requires optimum use of resources, systems ensuring clinical and managerial effectiveness, good governance and quality leadership.
There are about 750,000 blind people in Bangladesh of whom
about 80 percent is due to cataract. Currently only about 140,000 cataract surgeries arc performed to restore sight each year (National Performance Review of 2007) against the need for 320,000 cataract surgeries annually. Huge number of cataract patients remains untreated as blind. As a result, the country is losing the economic productivity from those who are needlessly blind. Moreover, the cost of sufferings from blindness including the indirect cost of care is also enormous.
There are 626 ophthalmologists and 618 midlevel eye care staffs who are playing a supportive role in delivering eye care services in Bangladesh for a population of population of 145 million. Number of ophthalmologists is inadequate and that of midlevel eye care staffs are grossly inadequate in the country. WHO and IAPB recommend that for every 100 population there should be at least one ophthalmologist and four midlevel eye care staffs (1:4 in ratio). This functional combination of eye care team seems to be very effective and efficient in the delivery of services and to enhance the surgical productivity of ophthalmologists. However, team building is one component of the service delivery and there are other essential components that need to be restructured and strengthened in order to increase the performance at all level.
The current challenge is to find the appropriate modalities on how essential eye care services could be made accessible and
affordable to the poor people. A comprehensive district eye care programme can be the best way to move forward. Training and positioning of ophthalmologists and midlevel staffs at the district and sub-district level hospitals are very important to establish the service. Strengthening infrastructure at those level with the establishment of eye hospitals by NGOs in some priority districts could help reducing the intensity of eye diseases to a significant extent.
Government should implement the proper regional and centra) level monitoring system. Public-Private-NGO partnership in eye care can lessen the financial burden. An integrated approach and appropriate modalities of delivering cost effective quality eye care service for the rural and urban poor is badly needed and it could be achieved by introducing health insurance scheme, demand side financing and linking eye care service with micro-credit programmes in several districts. Initial results of these programmes are very encouraging and they eliminated many simple barriers of service uptake by rural poor people, gender discrimination in service utilisation and sustainability of eye care programmes.
The International and local NGOs can make a big shift in the delivery of sustainable quality eye care services if the policy and support from the government are conducive and encouraging.
The writer is the Country Director of ORBIS International in Bangladesh