Globally, at least 2.2 billion people have a vision impairment or blindness, of whom at least 1 billion have a vision impairment that could have been prevented or has yet to be addressed. More reliable data on the met and unmet eye care needs, however, are required for planning. Also, the burden of eye conditions and vision impairment is not borne equally. The burden tends to be greater in low- and middle-income countries and underserved populations, such as women, migrants, indigenous peoples, persons with certain kinds of disability, and in rural communities. Population growth and ageing, along with behavioural and lifestyle changes, and urbanization, will dramatically increase the number of people with eye conditions, vision impairment and blindness in the coming decades.
Aconsiderable progress was made in the field of eye care during the period of 1980 to 1990. During this period rapid progress was made in the field of infrastructure development, service expansion, human resources development, resource mobilization and outputs in the eye care service in the country.
Nepal is one of the first countries in South Asia to launch VISION 2020: The Right to Sight a global campaign initiated by World Health Organization on November 19, 1999. After launching of Vision 2020, the programme became more focused according to the guideline and target provided by theVision 2020. Strategic plan for eye care services in Nepal was developed by the Ministry of Health/ Apex Body for Eye Health from 2002-2020. The disease-focused strategies were adopted and various vertical programmes for Cataract, Trachoma, Xerophthalmia, Refractive Error and Low Vision were launched. A mid-term evaluation for this initiative was also conducted in 2010. The mid-term evaluation highlighted that Nepal has made considerable progress in the field of eye care services in last one decade. The second long-term health plan (1997-2017) and Health Sector Strategy III stressed on the public-private partnership in health service and the Ministry of Health started to allocate some fund for eyecare services.
There has also been a 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 the expansion of training centres. 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. In 1981 there were only seven ophthalmologists in the country. This number has now reached 350. At present there is one ophthalmologist for an estimated population of 90000. In 1981 there was not even one optometrist in Nepal. Now there are 520 optometrists in the country. The number of ophthalmic assistants has also reached 1025. The number of other directly involved health workers and nurses has also reached 450 and the number of eye care managers and equipment maintenance personnel is also increasing gradually. The number of necessary human resource for effective management of eye care service is still a challenge.
A significant development is also seen in terms of infrastructure development in this period; now almost all the districts have either primary eye care centre or eye hospital. The technology adopted in eye care practice in the country is regularly updated and of internationally accepted standards.
Trachoma was the second leading cause of blindness in Nepal in 1981. In 2002, NNJS and the Ministry of Health and Population launched the National Trachoma Programme (NTP) with the objective of eliminating trachoma from all the 20 endemic districts in Nepal by 2017. A four-pronged strategy for elimination of this disease – SAFE (Surgery for trichiasis, Antibiotics to clear infection, Facial cleanliness, and Environmental improvement to limit transmission) was identified as the key strategies to be implemented to achieve this goal. After the program implementation, now trachoma has been eliminated from Nepal as a public health problem. Nepal’s success in eliminating trachoma as a public health problem could serve as a model for other countries that are grappling to end trachoma as the deadline for global elimination for trachoma nears.
Global Eye Health Action Plan
Nepal is also a signatory to Global Eye Health Action Plan endorsed by the Sixty-sixth World Health Assembly which has opened a new opportunity to make further progress with additional efforts to prevent visual impairment and strengthen rehabilitation of the blind in communities.
In view of the need to develop/strengthen effective policies to achieve the global target of reduction of prevalence of avoidable visual impairment by 25% by 2019 from the baseline of 2010, Nepal has also operationalized the Global Action Plan in Nepal. Based on the 3 objectives of the Global Action Plan (2014-2019}, various recommendations have been made to Government, WHO and International Partners to develop/strengthen effective policies to achieve the global target.
National Health Policy of Nepal and Eye Care
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 to citizens.
The policy aims to develop and expand oral, eye, ENT and specialized health services to all levels. In order to achieve this, the 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. The eye health unit will be established at the Federal Ministry of Health to coordinate, cooperate and regulate the present eye care program in the country.
Source: Annual Report DOHS 2075/76