Global Vision Impairement
Globally, 1.5 billion people are estimated to have a vision impairment. This represents a significant
proportion of the global population who require eye care and other services and are likely to face
barriers in the day-to-day life. This figures includes:
• 36 million people are blind
• 217 million have moderate or severe vision impairment
• 189 million have mild vision impairment
• 1.1 billion people have presbyopia (near vision impairment)
In 1970, the situation of eye care in Nepal was in its early stage. The first long -term health plan (1977-1990) identified eye care as an important area of health service. The Second Long-term Health Plan (1997-2017) and Health Sector Strategy III have stressed on the public-private partnership in health service. The eye care services picked momentum after Nepal Blindness Prevention and Control Project was started in 1990 at the joint initiative of Nepal Government and the World Health Organization.
Considerable progress was made in the field of Eye Care during the period of 1980 to 1990. During
this period a rapid progress was made in the field of infrastructure of eye care, development of trained human resources and the investment and output in the eye care sector. Even in the period that followed, non-governmental and private organisations like Nepal Netra Jyoti Sangh, TU Teaching Hospital, B.P. Koirala Lion Eye Research Centre, B. P. Eye Foundation, Tilganga Eye Foundation, Nepal Eye Hospital, Lions Club and Red Cross made considerable contribution in the expansion and promotion of eye care services.
Nepal Government formed an apex unit for eye care with an intention to run and develop eye care
services in a more effective and coordinated way in accordance with the national policy. A subcommittee under this unit has prepared a document of strategic plan on eye care (2002-2019) as well as an outline of a twenty year plan.
‘Sight right for all’ campaign was formally started from November 19, 1999. A mid-term review of this program was made in 2010. A mid-term evaluation was carried out for eye care in 2010 for Vision 2020. The mid-term evaluation has shown that Nepal has made a considerable progress in the field of eye care services. This can be taken as a good model for public-private partnership (PPP). Studying from the criteria of World Health Organisation (WHO) Nepal’s status of blindness has declined from 0.81% in 1981 to 0.35 % in 2011. Though the situation of blindness has decreased more than half, there has been no significant decline in the number of the blind as the population of the country has doubled in comparison with that of 1981.
Though considerable progress was achieved in mitigating blindness in the past decades, there is a need to implement more effective programmes to reduce the blindness to 0.2% and a lot of effort should be made to realise the vision of sight for all. In this period, considerable development has been achieved in the sector of infrastructure development also. At present, the services at primary eye care centres/ eye hospitals are available in all the districts of the country. The technology applied in eye care has been regularly updated to the global standard.
In Nepal, there has also been significant increase in the number of specialized human resources for eye care such as Ophthalmologists, Optometrists and Ophthalmic Assistant. Several academic institutions are producing human resource in eye care acquiring self sufficiency in its capacity to train its own Human Resource with expansion of training centers. Altogether 4 academic institutions are producing 35 Ophthalmologists per year and 2 institutions are producing 46 optometrists every year. Likewise 7 eye care institutions are producing 360 Ophthalmic Assistant per year. The productivity of Ophthalmologist is high as 270 surgically active ophthalmologists are performing more than 350,000 surgeries per year. Despite substantial increase in the number of ophthalmologists, ophthalmic assistant and optometrists, the existing number of all categories of human resource in eye care falls some short of the required number as per the WHO VISION 2020 norms.
There is also inequity in distribution of existing eye health human resources (HR) with more than one
third (35.37 per cent) of the total ophthalmologist working in province 3 serving only 20.87 percentage of total population followed by 20.8 per cent ophthalmologist working in province number one serving only 17.11 per cent of total population. Likewise only 2 (0.65 per cent of total ophthalmologists) are working in province number six serving around 5.92 per cent of total population. Also there is an inequity in distribution of Ophthalmic Assistant and Optometrists as well with ratio of OA per 100000 populations is lowest in province 3 and 1.3 per cent of total optometrists delivering their service in province 6.
Now Nepal should move forward for integration of primary eye care centres and lower level eye care
services in the existing primary health care system. Use of the latest technologies should be encouraged with an objective of gradually improving the quality of eye care services. Provision should be made for necessary coordination and advocacy in order to prevent duplication among eye care service providers and to make information about the availability of services easily available to the people. A multi-sectoral approach should be adopted by including education, women and social welfare, drinking water and sanitation in eye care. Information flow in health care system shall be encouraged through research of scientific facts and publications. Rehabilitation program should be started in all eye hospitals of Nepal.
Outputs of fiscal year 2017/18 With all this opportunities and challenges the service output of the of the eye care services for the fiscal year 2017/18 are as given in Table 5.1
Source : DOHS