The annual report of the Department of Health Services (DoHS) for fiscal year 2077/78 (2020/2021) is the twenty-seven consecutive report of its kind. DOHS Annual Report 2077/78 focuses on the objectives, targets and strategies adopted by Nepal’s health programs and analyses their major achievements and highlights trends in service coverage over three fiscal years. This report also identifies issues, problems and constraints and suggests actions to be taken by health institutions for further improvements.
The main institutions that delivered basic health services in 2077/78 were the 201 public hospitals including other ministries, the 2,082 non-public health facilities, the 189 Primary Health Care Centers (PHCCs) and the 3,794 Health Posts (HPs) primary health care services were also provided by 11,699 Primary Health Care Outreach Clinic (PHCORC) sites. A total of 16,950 Expanded Program of Immunization (EPI) clinics provided immunization services. These services were supported by 49,605 Female Community Health Volunteers (FCHV). The information on the achievements of the public health system, NGOs, INGOs and private health facilities were collected by DoHS’s Health Management Information System (HMIS).
Mental health, oral, eye, ENT (ear, nose and throat) health services shall be developed and expanded;
6.17.1. Primary treatment of eyes shall be integrated into basic health services.
6.17.2. Eye health services shall be developed and expanded with public-private partnership and an eye health unit shall be set up in the federal Ministry of Health for coordination, partnership and regulation.
Vision impairment is a global public health problem that needs urgent attention. Recently the Vision Loss Expert Group (VLEG) has come up with the estimates on the magnitude and projections of vision loss and its key messages i.e 1.1 billion have vision loss primarily because they do not have access to eye care services. Likewise, over 90% of those with vision loss live in low- and middle-income countries. 73% of people with vision loss are over 50 years old and 55% of people with vision loss are women. The number of people with vision loss will rise from 1.1 billion to 1.7 billion people, mainly due to population growth and population ageing. An additional 1 billion people live with eye health conditions that need on-going access to services to optimize their vision and maintain their ability to function in society. By 2050 more than half the global population is going to need ongoing, regular access to eye care services to maintain their eye health. These
numbers are projected to increase in the next couple of decades as population age.
Commitment to VISION 2020 in Nepal was demonstrated by the establishment of Apex Body for Eye Health Committee at the Ministry of Health and Population for formulating partnership of eye care organisations together with WHO to develop and implement national eye care policy, act as the directing, facilitating and coordinating authority and encourage the technical cooperation. National Plan of Action was prepared under the leadership of Apex Body for Eye Health to achieve the goal of VISION 2020 in Nepal. Several achievements can be credited to VISION 2020 and efforts of eye health stakeholders of Nepal, both direct and indirect, during the last two decades in terms of infrastructure development, human resources development, disease control (Reduction in the prevalence of blindness from 0.84% to 0.35%, significant decline in blinding xerophthalmia, elimination of trachoma as a public health problem) and advocacy. Some added newer initiatives while others helped in either enhancing or sustaining ongoing programmes.
However the number of blind people (120,000 in 2010) was about the same as in 1980-81 (117, 623), and still, about 275,000 people had severe visual impairment (inability to count fingers at 6 meters) indicating that severe visual impairment for economic emancipation remains a serious public health problem. Women continue to carry two-thirds of blindness. People living beyond district headquarters, Dalits and low-income people everywhere have limited access to eye care services. Close to one million children have either disabling visually impairment or are unable to use their visual potential optimally because of lack of a simple pair of glasses. Nepal will be getting fresh data on the prevalence of blindness and visual impairment soon as Provincial Rapid Assessment of Avoidable Blindness survey has been completed except in Sudurpaschhim Pradesh. Preliminary findings of completed provinces shows that the prevalence of blindness has not been
reduced significantly compared to data of the 2010 survey. However, the cataract surgical coverage at visual acuity 3/60 level and visual outcome of the cataract surgery has been significantly improved in recent years. The prevalence of blindness ranges from 0.7% in Bagmati Province to 1.7% in Lumbini Province of Nepal.
The main causes of blindness are untreated cataract and posterior segment eye diseases. Proportion of untreated cataract remains highest in Province 2 (88.5%) while it accounts least in Gandaki Province (42.6%). Posterior segment diseases account for 44.7% of all causes of blindness in Gandaki Province while they account only 4.9% in Province 2. Prevalence of refractive error is 15.7% – 25.9% in people aged 50 years and above. The unmet need for refractive error is maximum in Karnali Province (70.1%) and minimum in Bagmati Province (29.3%). Prevalence of functional low vision (FLV) among 50 years and above ages is 0.5% – 1.3%. The main barriers to uptake cataract surgical services were Affordability, Accessibility, lack of felt need, Fear of surgery.
Recently WHO launched World Report on Vision which provides a strategic path to achieve sustainable eye health systems and universal eye health coverage (UHC). Its first recommendation is the inclusion of eye care as an integral part of UHC. The United Nations Political Declaration on UHC has also stated that UHC cannot be achieved without eye care. It recognizes that one of the key criticisms of VISION 2020 (and indeed, many other ‘vertical’ health programmes) has been its isolation and targeted focus on eye health alone. Its key recommendation is the implementation of integrated people-centred eye care. Also, the impact of vision loss cuts across many of the Sustainable Development Goals. Improving eye health helps to reduce poverty (Goal 1) and helps to
deliver on quality inclusive education, gender equality and decent work and economic growth (Goals 4, 5 and 8).
The Government of Nepal has also issued a new National Health Policy in line with the right to health guaranteed by the constitution, list of functions to be carried out by all three levels of government, relevant policies, challenges in health sector and achievements made so far in relation to providing health services
The policy aims to develop and expand oral, eye, ENT and specialized health services to all levels. In order to achieve this, government has planned to integrate the primary eye care into the basic government healthcare system and eye care services will be further developed and expanded as per the public private partnership policy. Eye health unit will be established at Federal Ministry of Health to coordinate, cooperate and regulate the present eye care program in the country.
Source: DOHS Annual Report 2077/78