2012 caribbean v2020 regional meeting
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Celebrating the 12th year of Vision 2020: The Right to Sight in the Caribbean
Preventing blindness and visual impairment while restoring sight and creating opportunities for persons whose sight cannot be restored
Lower All Saints Road - P.O. Box 1517 - Antigua, West Indies Tel: 1-(268)-462-4111/462-6369/562-2216 - Fax: (268)-462-6371
E-mail: arvel.grant@eyecarecaribbean.com; keva.richards@eyecarecaribbean.com;
frank.bowen@eyecarecaribbean.com; carolyn.gopaul@eyecarecaribbean.com Website: www.eyecarecaribbean.com; www.ccb1967.com www.v2020caribbean.com
2012 ANNUAL MEETING OF VISION 2020 COMMITTEES - REPRESENTATIVES FOR
THE CARIBBEAN
AGENDA
VENUE: The Savannah Suite, Pegasus Hotel, Georgetown, Guyana Tuesday 11th & Wednesday 12th Dec, 2012
CHAIR: Arvel Grant, CEO, CCB-Eye Care Caribbean
This meeting is being implemented with the technical and financial support of:
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AGENDA
2012 ANNUAL MEETING OF VISION 2020 COMMITTEES - REPRESENTATIVES FOR THE CARIBBEAN
Purpose of the meeting:
This meeting will provide a platform for sharing, learning and networking and will strengthen links between V2020 Committees and persons involved in eye health.
Participants will become familiar with perspectives from other areas and will be exposed to new thinking, technologies and opportunities that they can use to benefit eye health service delivery in their countries.
The meeting will also be used to launch a 6-monthly web-based conference call involving Vision 2020 Committee Representatives from across the CARICOM area, using CCB-Eye Care Caribbean’s VENTRILO-based conferencing facility.
DAY ONE: Tuesday 11th December, 2012 START TIME: 8.15 am to 5.00 pm
OPENING SESSION
8:15 - 8:30 Getting seated and meeting your neighbors
8:30 – 8:40 Call to order and welcome
Moment of Meditation
Arvel Grant,
CEO, CCB-Eye Care Caribbean
Meeting Chair
8:40 – 8:50 Roll call of delegates Keva Richards,
Vision 2020 Project Manager,
CCB-Eye Care Caribbean
Doc. 1: List of Delegates; page 7
8:50 – 9:00 House-keeping matters and questions for clarification
Charles Vandyke,
Vision 2020 Programme Manager, Eye Care Guyana
SETTING THE CONTEXT
9:00 – 9:20 Vision 2020 : The Right to Sight - A global initiative
A look at global progress in our effort to guarantee The Right To Sight
Dr Louis Pizzarello (MD,MPH)
Chairman for the North American Region of the International Agency for the Prevention of Blindness (IAPB)
Doc. 2: Hyderabad Declaration; page 9
Doc. 2.1: WHO Resolution. Page 11
9:20 – 9:35 WHO Action Plan on Avoidable Blindness 2014-2019
The process to date; What’s in Draft Zero; what happens next.
Dr Juan Carlos Silva (MD, MPH) Regional Advisor in Prevention of Blindness, PAHO-WHO
Doc. 3: Session Presentation; page 12
9:35 – 9:50 Strategic Framework for V2020 - Caribbean Region (2010)
Recap on Indicators and Priorities
Dr Juan Carlos Silva
Doc. 4: Strategic Framework for V2020 (Caribbean Region); page 15
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9:50 -10:05 Delivering V2020 in the Caribbean
(EC Contract No. DCI-NSA PVD / 2009 / 222-937)
Progress to date and planned actions
Philip Hand,
Programme Manager (Caribbean), Sightsavers;
Doc. 5: Session Presentation; page 35
10:05 – 10:15 Q & A on all Presentations Facilitated by Arvel Grant
10:15 – 10:45 COFFEE BREAK
IMPLEMENTING V2020 PROGRAMMES – DISEASE CONTROL & RESEARCH
10:45 – 11:00 Glaucoma KAP studies –
Barbados, Guyana, Jamaica & St. Lucia
Dr Dawn Grosvenor
Consultant Ophthalmologist, & Glaucoma Specialists& Principal Investigator- Barbados
Doc. 6: Abstract; page 37
11:00 -11:15 Diagnosing and treating Glaucoma in an ethnically diverse society –
The Guyana experience
Dr S. Sugrim
Consultant Ophthalmologists, & Glaucoma Specialists, Georgetown Public Hospital, Guyana.
Doc. 7: Abstract; page 38
11:15 – 11:30
Preliminary results of a KAPB study among cataract patients in Kingston Jamaica - Factors influencing uptake of cataract surgery among older patients in Jamaica
Dr Norman Waldron
Researcher
University of the West Indies, Mona Campus
Department of Community Health and Psychiatry
Doc. 8: Abstract; page 40
11:30 -11:45
Chlamydia as a cause of childhood blindness - a review of specimens at the University Hospital Of The West Indies - Chlamydia trachomatis frequency in patients presenting to Ophthalmology Clinics in Kingston, Jamaica
Dr Sandra Jackson
Researcher
University of the West Indies, Mona Campus
Department of Community Health and Psychiatry
Doc. 9: Abstract; page 42
11:45 – 12:10 Training Eye Health Theatre Nurses for the Caribbean
The Role of the Dominica Health Services
Dr Hazel Shillingford-Ricketts
Consultant Ophthalmologists & Associate Professor, University Of Ottawa
Doc. 10: Session Presentation; page 44
12:10 – 12:30 Advancing Optometry Worldwide
An address to the World Council of Optometry Conference, June 2012
Peter Ackland,
CEO of IAPB
Video Presentation
12:30 – 12:45 Q & A Facilitated by Arvel Grant
12:45 – 1:45 LUNCH BREAK (Own Account)
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NON-COMMUNICABLE DISEASES (NCD’s)
1:45 – 2:00
Non-Communicable Diseases
Overview
NCDs and Visual Impairment
Facilitated by PAHO Office
Doc. 11: IAPB Briefing Paper – Blindness & the NCDs (2011); page 46
WORKING TOGETHER TO ACHIEVE V2020 GOALS – GROUP WORK
2:00 – 2:10
Group Work Objectives
Defining Groups
Philip Hand
2:10 – 4:00 Includes working Coffee Break
Group Work
Group 1:
Integrating Eye Health into National Health Plans & Policies
Group 2:
Identifying practical and cost-effective ways to train eye health professionals in / for the region
Group 1:
Facilitator:
Dr.Juan Carlos Silva
Resource Person:
PAHO NCD Expertise
Rapporteurs:
Emma Bernard & Frank Bowen
Doc. 12: Group Work Activity Group 1; page 50
Doc. 12.1: World Bank LAC Factsheet, Jamaica; page 51
Doc. 12.2: World Bank LAC Factsheet, Eastern Caribbean; page 53
Group 2:
Facilitator
Charles VanDyke
Resource Person:
Dr Hazel Shillingford-Ricketts
Rapporteurs:
Keva Richards & Philip Hand
Doc. 13: Group Work Activity Group 2; page 54
4:00 – 4:30 Presentation and discussion of Group Work
Facilitated by Philip Hand
4:30 – 4:45 Video Presentation Kathy Barrett,
Communications Officer, CCB-Eye Care Caribbean
4:45 – 5:00 Closing remarks (end of day 1) Arvel Grant
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DAY TWO: Wednesday 12th December, 2012 8.30 am to 5.00 pm
STATUS OF V2020: THE RIGHT TO SIGHT
8:30 – 8:45 Call to order and welcome Arvel Grant
8:45 – 12:15
Coffee Break to be included at convenient time
The Status of V2020: The Right to Sight in participating countries
Each national delegation is invited to present for up to 15 minutes:
Antigua & Barbuda
Barbados
Belize
Commonwealth of Dominica;
Grenada
Guyana (The Republic)
Haiti (The Republic)
Jamaica
St. Kitts & Nevis
St. Lucia
St. Vincent & The Grenadines
Suriname (The Republic)
Trinidad & Tobago (The Republic)
Facilitated by Dr Juan Carlos Silva
Doc. 14: National Data Template; Page 56
Doc. 14.1: Page 62
Doc. 14.2: Page 67
Doc. 14.3: Page 73
Doc. 14.4: Page 78
Doc. 14.5: Page 86
Doc. 14.6: Page 91
Doc. 14.7: Page 96
Doc. 14.8: Page 102
Doc. 14.9: Page 110
Doc. 14.10: Page 115
Doc. 14.11: Page 121
Doc. 14.12: Page 126
Doc. 14.13: Page 131
12:15 – 12:30 Regional Analysis Keva Richards
12:30 – 12:45 Q & A Arvel Grant
12:45 – 1:45 LUNCH BREAK (Own Account)
INCORPORATING PREVENTION OF BLINDNESS PROGRAMMES INTO PRIMARY HEALTH CARE
1:45 – 3:00
Incorporating Prevention of Blindness programmes into Primary Health Care
A plenary discussion with resource input by: Charles Vandyke, Conrad Harris, Florence Mayas & Tony Avril
Facilitated by Dr. Martin Christmas, Director of Primary Health Care, Dominica
Doc. 15: Perspectives on Primary Eye Care; page 136
Doc. 16: Declaration of Alma-Ata; page 138
3:00 – 3:30
COFFEE BREAK
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FUTURE INITIATIVES
3:30 – 3:50 Rapid Assessments of Avoidable Blindness (RAAB)
Overview of RAAB
RAABs in the Caribbean
Dr Juan Carlos Silva & Philip Hand
Doc. 17: Rapid assessment of avoidable blindness survey methodology (ICEH); page 144
3:50 – 4:15 Low Vision
Introductory Session
Denise Godin,
CCB-Eye Care Caribbean Low Vision Focal Person
Doc. 18: Introduction to Low Vision; page 147
Doc. 19: When someone has low vision (Community Eye Health Journal 2012) page 153
4:15 – 4:30 Video Presentation Kathy Barrett
4:30 – 4:45 Ventrilo V2020 Conferencing Senator Kerryann Ifill
4:45 – 5:00 Closing Remarks (end of Meeting) Arvel Grant
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LIST OF DELEGATES
No. Country Name Post Organisation Group
1 Antigua & Barbuda
Arvel Grant Chief Executive Officer Caribbean Council for the Blind 1
2 Antigua & Barbuda
Carolyn Gopaul Operations & Lab Services Manager Caribbean Council for the Blind 2
3 Antigua & Barbuda
Frank Bowen Resource Mobilisation Manager Caribbean Council for the Blind 1
4 Antigua & Barbuda
Keva Richards V2020 Project Manager Caribbean Council for the Blind 2
5 Antigua & Barbuda
St. Clair Soleyn Statistician Ministry of Health 1
6 Antigua & Barbuda
Nyoka Reynolds PAS Ministry of Health 2
7 Antigua & Barbuda
Edson Joseph Permanent Secretary Ministry of Health 1
8 Barbados Dawn Grosvenor Glaucoma Specialist 2
9 Barbados Senator Kerryann Ifill President of the Senate (Barbados) Ministry of Health 1
10 Belize Leolyn Garcia Dir. of Programmes & Senior Optometrist Belize Council for the Visually Impaired 1
11 Columbia Luisa Casas Luque Education Officer Brien Holden Vision Institute 2
12 Columbia Dr. Juan Carlos Silva Regional Advisor in Prevention of Blindness PAHO/WHO 1
13 Dominica Dr. H. Shillingford-
Ricketts Consultant Ophthalmologist Ministry of Health 2
14 Dominica Dr. Martin Christmas Director of Primary Health Care Ministry of Health 1
15 Dominica Nurse Nicole Alleyne Ophthalmic Nurse Ministry of Health 2
16 Dominica Nathalie Murphy Executive Director Dominica Association of Persons with Disabilities 1
17 Grenada Nurse Esther Charles Manager Ophthalmic Department General Hospital 2
18 Grenada Hermlyn Andrew Rehabilitation Field Officer Grenada Society of Friends for the Blind 1
19 Guyana Michele Ming President-Elect CARIOA/Guyana Optometry Assn 2
20 Guyana Dr. Shailendra Sugrim V2020 Chairman Ministry of Health 1
21 Guyana Charles Vandyke National V2020 Program Manager CCB-Eye Care Guyana 2
22 Guyana Dr. Rameeza McDonald Consultant Ophthalmologist Linden Hospital 2
23 Guyana Dr. Shamdeo Persaud Chief Medical Officer Ministry of Health 1
24 Guyana Roubinder Rambaran Manager Ministerial Secretariat 1
25 Guyana Dr. Emanuel Cummings Dean-Faculty of Health Sciences University of Guyana 2
26 Guyana Pauline Lucas-Cummings Programme Officer Delegation of the EU to Guyana, Suriname, Trinidad and Tobago and for the Dutch Overseas Countries and Territories
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27 Guyana Karen Roberts Focal Point NCDs PAHO Office 2
28 Haiti Florence Mayas Project Manager La Société Haïtienne d’Aide aux Aveugles (SHAA) 2
29 Haiti Dr. Valery Blot National V2020 Coordinator Comité national de Prévention de la Cécité (CNPC-Haiti) 1
30 Jamaica Jeff James Director HelpAge Caribbean 2
31 Jamaica Dr. Norman Keith Waldron
Researcher UWI-Mona Campus 1
32 Jamaica Dr. Sandra Jackson Researcher UWI-Mona Campus 2
33 Jamaica Conrad Harris V2020 Coordinator Jamaica Society for the Blind 1
34 Jamaica Dr. Marlene Smith-Day Consultant Ophthalmologist Mandeville Eye Clinic, SRHA 2
35 Jamaica Nurse Joyce Gooden Nurse Mandeville Eye Clinic, SRHA 2
36 St. Kitts & Nevis
Sandra Williams Assistant Nurse Manager J. N. Frances General Hospital 1
37 St. Kitts & Nevis
Sonia Daley Matron Ministry of Health 2
38 St. Lucia Denise Godin Low Vision Focal Person St. Lucia Blind Welfare Association 2
39 St. Lucia Emma Bernard-Joseph V2020 Coordinator St. Lucia Blind Welfare Association 1
40 St. Lucia Anthony Avril Executive Director St. Lucia Blind Welfare Association 1
41 St. Lucia Nurse Juliette Joseph Asst. Principal Nursing Officer Ministry of Health 2
42 St. Vincent & the Grenadines
Dr. Orly James Adams Senior Registrar Cato Milton Memorial Hospital 2
43 Trinidad & Tobago
Rudolph Paponette Former 2nd
Vice President Trinidad & Tobago Blind Welfare Association 2
44 Trinidad and Tobago
Dr. Akenath Misir Chief Medical Officer Ministry of Health 1
45 Trinidad & Tobago
Earl Henry Policy Development Specialst Ministry of Health 1
46 United Kingdom Philip Hand Caribbean Program Manager Sightsavers
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47 USA Louis Pizzarello Chairman of N.A. Region Internation Agency for the Prevention of Blindness 2
48 USA Joan Mcleod Director M&E, LAC, Sr. Technical Advisor ORBIS 1
Preventing blindness & visual impairment; while restoring sight and creating opportunities for persons whose sight cannot be restored.
Lower All Saints Road - P.O. Box 1517 - Antigua, West Indies Tel: 1-(268)-462-4111/462-6369/562-2216
Fax: (268)-462-6371 E-mail: arvel.grant@eyecarecaribbean.com; carolyn.gopaul@eyecarecaribbean.com; frank.bowen@eyecarecaribbean.com
Website: www.eyecarecaribbean.com
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ZERO DRAFT “UNIVERSAL ACCESS TO EYE HEALTH: A GLOBAL ACTION PLAN, 2014-2019”
ZERO DRAFT “UNIVERSAL ACCESS TO EYE HEALTH: A GLOBAL ACTION
PLAN, 2014-2019”
Juan Carlos Silva
PROGRESS - Global Level
2004
WHO estimated:
• 314 million people with visual impairment.
• Including 45 million blind.
2010
• WHO estimates:
• 285 million people were visually impaired,
• Including 39 million blind.
Lessons Learnt 2009-2013
• Eye health included into broader NCDs frameworks
• Assess the magnitude and causes of blindness and VI & trends
• Setting national targets & monitoring
Background
• WHO WHA endorsed the Action Plan for the prevention of avoidable blindness and visual impairment 2009-2013
• At the 130th session of the WHO Executive Board (2012). – Progress report 2009 - 2013 plan reviewed
– Develop new action plan for the period 2014–2019.
Lessons Learnt 2009-2013
• Develop & implement national policies
• Integrate eye diseases control programs into wider health care delivery systems
• Engagement with private sector & social entrepreneurship: HR & financial allocations
• Strengthen partnerships = Effectiveness
Lessons Learnt 2009-2013
• Operational research to provide evidence on:
– appropriate cost-effective strategies
– improving and preserving eye health in communities
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GLOBAL ACTION PLAN, 2014-2019”
Goal MEASURABLE Indicators
To reduce blindness and visual impairment as a global public health problem
(i) Magnitude of blindness in the world
(ii) Magnitude of severe and moderate visual impairment in the world
GLOBAL ACTION PLAN, 2014-2019”
Objective 1 Measurable Indicators
Evidence generated and used to advocate for increased political and financial commitment of Member States for eye health.
Number (%) of countries undertook and published prevalence surveys over the last five years in 2018
Number (%) of countries published eye care service assessment over last five years in 2018
Observation of World Sight Day.
GLOBAL ACTION PLAN, 2014-2019”
Objective 2 Measurable Indicators
National policies, plans and programs for eye health integrated into national health systems
# (%) of countries with policies and/or plans for eye health.
# (%) of countries with an eye health committee, and/or a national coordinator
# (%) of countries including products for eye care as part of their national list of essential medicines.
GLOBAL ACTION PLAN, 2014-2019”
PURPOSE Measurable Indicators
To improve eye health through comprehensive eye care services integrated in health systems
(i) Eye care personnel per million population
(ii) Cataract Surgical Rate
GLOBAL ACTION PLAN, 2014-2019Activities Objective 1
• Undertake population based surveys
• Assess the capacity of Member States to provide comprehensive eye care service delivery and identify gaps in service provision
• Document best practice in eye health programmes and use them to advocate for improving eye health programs
GLOBAL ACTION PLAN, 2014-2019Activities Objective 2
• Provide leadership and governance
• Secure financial resources
• Develop and maintain a sustainable workforce
• Provide comprehensive eye care services at 1 2 and 3 levels.
• Technology and medicine
• Indicators in national information system
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GLOBAL ACTION PLAN, 2014-2019”
Objective 3 Measurable Indicators
Multi-sectoral engagement and effective partnerships for improved eye health strengthened.
Number (%) countries that refer to a multi-sectoralapproach in their national eye health plans and policies
Number (%) of countries having eye health incorporated into poverty reduction & wider socioeconomics policies
GLOBAL ACTION PLAN, 2014-2019Activities Objective 3
• Engage non-health sectors PBL policies and plans.
• Enhance effective international and nationalpartnerships and alliances.
• Integrate eye health into poverty reduction strategies, initiatives and socioeconomic policies.
Thank you
STRATEGIC FRAMEWORK FOR VISION 2020: THE RIGHT TO SIGHT
CARIBBEAN REGION
PAN AMERICAN HEALTH ORGANIZATION
WORLD HEALTH ORGANIZATION VISION 2020 Barbados 2010
STRATEGIC FRAMEWORK FOR VISION 2020: THE RIGHT TO SIGHT
CARIBBEAN REGION
PAN AMERICAN HEALTH ORGANIZATION WORLD HEALTH ORGANIZATION VISION 2020 Barbados 2010
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CONTENTS ACKNOWLEDGEMENT ACRONYMS INTRODUCTION 1. DISEASE CONTROL AND PREVENTION OF VISUAL IMPAIRMENT…………………………………………………………… 4 1.1 REDUCE BLINDNESS AND VISUAL IMPAIRMENT IN ADULTS 1.1.1 Reduce cataract blindness………………………………………………………………………………………………………………… 4 1.1.2 Reduce blindness from diabetic retinopathy……………………………………………………………………………………..5 1.1.3 Reduce blindness due to open-angle glaucoma (OAG)………………………………………………………………………7 1.1.4 Reduce visual disability due to uncorrected refractive errors in adults……………………………………………. 7
1.2 REDUCE BLINDNESS AND VISUAL IMPAIRMENT IN CHILDREN
1.2.1 Reduction of the preventable & of treatable causes of childhood blindness……………………………………. 8 1.2.2 Reduce visual disability by detecting and treating uncorrected refractive errors in school children…9 1.3 REDUCE THE BURDEN OF BLINDNESS AND VISUAL IMPAIRMENT IN THE GENERAL POPULATION 1.3.1 Enhance vision related quality of life for people with functional low vision……………………………………..10 1.3.2. Inclusive services……………………………………………………………………………………………………………………………..11 2. EYE CARE SYSTEMS 2.1 CENTRAL ORGANIZATION, LEADERSHIP AND GOVERNANCE…………………………………………………13 2.2 EYE CARE WORKFORCE………………………………………………………………………………………………………….13 2.3 MEDICAL PRODUCTS AND TECHNOLOGY……………………………………………………………………………….14 2.4 EYE CARE INFORMATION SYSTEMS AND MONITORING ………………………………………………………..14 3. EYE CARE PROMOTION, PUBLIC EDUCATION & ADVOCACY 3.1. ADVOCACY ………………………………………………………………………………………………………………………………………… 15 3.2. PUBLIC AWARENESS AND EDUCATION ……………………………………………………………………………………………….15 BIBLIOGRAPHY ANNEX 1
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ACRONYMS CBM Christoffel Blinden Mission CCB Caribbean Council for the Blind IAPB International Agency for the Prevention of Blindness ICEE International Centre for Eye Care Education ICEVI International Council for Education of People with Visual INGO International Non Governmental Organizations MoH Ministry of Health MoE Ministry of Education NGDO Non-governmental Development Organization OAG Open Angle Glaucoma OSWI Ophthalmological Society of the West Indies PAAO Pan American Association of Ophthalmology PAHO Pan American Health Organization PBL Prevention of Blindness PEC Primary Eye Care PHC Primary Health Care ROP Retinopathy of Prematurity UNCRPD United Nations Convention on the Rights of Persons with Disabilities WBU World Blind Union WHO World Health Organization
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ACKNOWLEDGEMENT The valuable financial support provided by CCB, Sightsavers, CBM and the Pan American Health Organization, Regional Office of the World Health Organization, which made possible the services assessment, this meeting and document is gratefully acknowledged.
The organizations participating in the consultation consisted on the Ministry of Health of Dominica, Ministry of Health of Grenada, Ministry of Health Guyana, Ministry of Health of Jamaica, Ministry of Health of St Vincent, Eye Care Guyana, Caribbean Optometrists Association, Société Haïtienne D’Aide aux Aveugles (SHAA), National Prevention of Blindness Committee of Haiti, Jamaica Society for the Blind, St Lucia Blind Welfare Association, CCB-Eye Care Caribbean, Sightsavers, CBM, ORBIS International, Help Age International, International Agency for the Prevention of Blindness-IAPB, Operation Eyesight, International Center for Eye Care Education and the Pan American Health Organization-PAHO-WHO. The meeting participants consisted on Hazel Shillingford-Ricketts, Joan McLeod-Omawale, Dave Duncan, Julian McKoy-Davis, Lucine Edwards, Narine Singh, Charles Vandyke, Ava-Gay Timberlake, Peter Ackland, Pat Ferguson, Nelson Rivera, Jillia Bird, Nigel St Rose, Conrad Harris, Anthony Avril, Philip Hand, Arvel Grant, Frank Bowen, Keva Richards, Kathy Barrett, Gavin Henry, Rachelle Noelsaint, Reginald Paul, Martin Ruppenthal, Juan Carlos Silva.
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INTRODUCTION Blindness and low vision are a public health problem throughout the world, this is why the World Health Organization (WHO) and the International Agency for the Prevention of Blindness (IAPB) together with NGOs have launched VISION 2020 - the global initiative for the elimination of avoidable blindness. This initiative that brings together governments, WHO, international and national NGOs, as well as associations of professionals in eye care, aims to determine global, regional and national plans of action in prevention of avoidable blindness and inclusive services. In the Caribbean VISION 2020 was officially launched in Trinidad-Tobago in April 2000. The World Health Organization’s Fifty-Sixth World Health Assembly approved Resolution WHA56.26, which requested the Director to strengthen WHO’s collaboration with Member States on the Global Initiative for the Elimination of Avoidable Blindness. In Resolution WHA59.25, the Fifty-Ninth World Health Assembly reaffirmed its commitment to give priority to the prevention of blindness. The 144th Session of the Pan American Health Organization - PAHO Executive Committee recommended that the Directing Council adopt a resolution as a way to bolster regional and national efforts to reach the objectives of the Plan of Action for the Prevention of Avoidable Blindness and Visual Impairment. In September 2009 the 49th PAHO Directing Council - WHO 61st Session of the Regional Committee approved the prevention of blindness plan of action and passed the resolution (Annex 1). In the year 2002 a VISION 2020 strategic plan was developed for the Caribbean region through a series of in-house discussions in PAHO, as well as through meetings with member states, the IAPB, national and international non-governmental organizations and scientific societies. In the Caribbean, PAHO, implement the VISION 2020 initiative in alliance with the IAPB, Sightsavers, Caribbean Council for the Blind-CCB, CBM, ORBIS and the ICEE. Significant progress has been achieved in the Caribbean in the prevention of avoidable blindness, and access to eye care services has been increasing in most countries working in this initiative. On December 1st 2009 PAHO, CCB, Sightsavers, CBM, ORBIS and all Caribbean Vision 2020 partners organized a meeting in Barbados to review and update the Vision 2020 Caribbean Plan that was produced in the year 2002. This new strategic framework for VISION 2020 in the Caribbean Region was prepared utilizing a very participatory methodology that included consultation with several Ministries of Health of the English speaking countries, national and international partners and incorporated the strategies of the Plan of Action on the Prevention of Avoidable Blindness and Visual Impairment approved by the PAHO 49th DIRECTING COUNCIL in 2009. This strategic framework serves as a guideline to support countries and stakeholders in priority setting and objectives development, it does not pretend to be a norm and each country may adapt it to its own realities, priorities and resources. Each priority established by a country should utilize a primary health care approach and have a referral system available for quality care for every condition.
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1. DISEASE CONTROL AND PREVENTION OF VISUAL IMPAIRMENT The most prevalent causes of blindness in the Caribbean are non-operated cataract and glaucoma, followed by diabetic retinopathy and uncorrected refractive errors. Childhood blindness is not as prevalent, but is a main cause of blinding years in the population. An important percentage of blindness in the Caribbean region is avoidable (preventable or curable). Cataract and diabetic retinopathy can be cured with relatively inexpensive surgical treatments; refractive errors are correctable with simple optical devices; and preventive strategies and effective referral systems can reduce the burden of childhood blindness. The application of new technology can be used in future to improve the detection and treatment of glaucoma.
1.1 REDUCE BLINDNESS AND VISUAL IMPAIRMENT IN ADULTS
1.1.1 Reduce Cataract blindness
In Latin America and the Caribbean, cataract (opacification of the lens) is the most prevalent cause of blindness; cataract surgery has been shown to be one of the most cost-effective of all health care interventions. Most cataracts are age-related and cannot be prevented, but cataract surgery with insertion of an intraocular lens (IOL) is highly effective, providing almost immediate visual rehabilitation.
Magnitude of Problem The results of the Barbados Eye Study show that 12% of people 40-84 years old have visual impairment or visual acuity worse than 6/12 (normal value 6/6). Three percent (3%) have severe visual impairment worse than 6/60 and most have cataract or lens opacities, thus demonstrating that most visual impairment in this population is associated with lens opacities.
Issues
Inadequate public awareness of cataract and how it can be rectified with a straightforward surgical procedure, leading to low demand for services.
Numerous barriers between needs and services, including poor availability and accessibility and high costs. Evidence of good vision outcomes lacking after surgery. Insufficient information on outputs and outcomes in public sector, private sector and bilateral cooperation
initiatives.
Expected Outcome
Provide cataract surgical services at a rate adequate to eliminate the backlog of cataract, at a price that is affordable for all people, both rural and urban and with high success rate in terms of visual outcome.
Proposed actions for Member States
Make national assessments of cataract surgical services, including availability, access, affordability and quality, as well as collection and management of information and data.
Measure prevalence of cataract blindness, determine services coverage level and identify barriers to access in selected countries.
Develop country and district-specific cataract service plans with measurable targets that address equity (availability, accessibility, affordability) and quality of services.
Ensure eye health services are integrated into a primary health care system to detect and refer people with eye diseases.
Develop a human resources development plan for cataract surgical services.
Promote high-quality surgery and ensure satisfactory visual outcomes and patient satisfaction.
Develop appropriate communication strategies for the target population- viz. adults 50 years and older.
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Proposed actions for organizations supporting VISION 2020 activities
Provide technical cooperation for the design of Rapid Assessment of Avoidable Blindness (RAAB) and similar studies.
Develop a situation analysis of cataract surgical services at regional and national levels.
Advocate and provide technical cooperation for development and implementation of national cataract plans.
Mobilize resources with regional and international partners. Indicators
Reach a cataract surgical rate (CSR) of 2,000 per 1 million population per year in the majority of countries by the year 2014. (See Table 2 below)
4 countries utilizing a cataract outcomes monitoring tool/system in 2014.
Table 2. Caribbean Cataract Surgical Rate, Year 2009
Country Population CSR year 2010 Target 2014
Thousands
Antigua 88 1345 1800
Bahamas 342 2500 3000
Barbados 256 2001 2500
Belize 307 1648 2000
Dominica 67 1746 2000
Grenada 104 1062 1500
Guyana 762 1700 2000
Haiti 10,033 440 1000
Jamaica 2719 1000 1500
St Lucia 172 843 1500
St Vincent 109 1066 1500
Trinidad 1339 2600 3000
1.1.2 Reduce the prevalence of blindness from diabetic retinopathy
Diabetes causes weakening of the blood vessels in the body. Retinal blood vessels are particularly susceptible and weakening of these blood vessels, accompanied by structural changes in the retina, is termed as diabetic retinopathy. Diabetic retinopathy is symptomless in its early stage and eye examinations/screening is the only way to identify affected people to prevent them from going blind. Evidence-based treatment is available to significantly reduce the risks of blindness and of moderate vision loss. Clinical studies spanning more than 30 years have shown that appropriate treatment with laser can reduce the risks by more than 90%. Magnitude of the problem The prevalence of diabetes among adults in Latin America and the Caribbean varies from country to country. More than 75% of patients who have had diabetes mellitus for more than 20 years will have some form of diabetic retinopathy. After 15 years of diabetes, approximately 2% of people become blind, and about 10% develop severe visual impairment. In Barbados, 18% of persons of African descent between the ages of 40 and 84, report having a history of diabetes mellitus; among people with diabetes 30% has diabetic retinopathy 8.6% of diabetics have
clinically significant macular edema and 1% has proliferative diabetic retinopathy needing laser treatment.
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Issues Inadequate medical management and control of diabetes. Inadequate development of detection and referral systems. Insufficient public awareness relating to cause and prevention of blindness due to diabetes. Insufficient awareness and knowledge of PHC practitioners, general physicians and internists regarding their
role in the prevention of blindness due to diabetes. Limited number of ophthalmologists with training in diagnosis and treatment of diabetic retinopathy. Inadequate technological infrastructure in the health services. Poor resourcing and low capacity of national diabetes associations.
Expected Outcome
Countries implementing early detection, referral and treatment for diabetic retinopathy Proposed actions for Member States
Integrate blindness prevention strategies into national diabetes programs and ensure their incorporation into non communicable chronic diseases programs of the Ministries of Health.
Encourage strategies for prevention, early detection and effective treatment of diabetes and hypertension, which will prevent complications that lead to blindness.
Develop public awareness programs to target groups that are at high risk.
Establish referral systems from services for diabetics to the ophthalmologic services.
Establish screening services using digital photography to detect and refer treatable diabetic retinopathy.
Ensure laser treatment services for diabetic retinopathy are available, accessible and affordable.
Proposed actions for organizations supporting VISION 2020 activities
Perform a situation analysis of the management of diabetic retinopathy in the Region as a baseline for planning and advocacy.
Conduct national assessments of services for diabetic retinopathy in selected countries.
Develop education packages and training programs for the general public and health care providers.
Develop continuing medical education programs for ophthalmologists and optometrists.
Support countries in the development of screening programs and laser services for Diabetic Retinopathy.
Establish regional protocols and management guidelines
Establish an inter-country referral system for treatment according to an established protocol.
Diabetes Associations playing a lead role in awareness raising and prevention of blindness due to diabetes. Indicators
Situation analysis conducted in five selected countries by the year 2014. At least three of the selected countries integrate early detection and treatment programs for diabetic
retinopathy into non-communicable chronic diseases programs by the year 2014. Increase the number of countries with digital photograph screening and laser treatment programs from 1
to 4 by the year 2014.
1.1.3 Reduce the incidence of blindness due to open-angle glaucoma (OAG) in high-risk groups
OAG is a major public health problem in the Afro-Caribbean population, where it is a major cause of visual loss and the leading cause of irreversible blindness. Vision 2020 programs need to include mechanisms for glaucoma detection and treatment for high-risk segments of the population, including persons of African descent in the Caribbean population, persons over 40 years of age, and individuals with a family history of glaucoma. Magnitude of the problem Open Angle Glaucoma prevalence in Afro-Caribbean people over 40 years of age is over 7% and increases with age. In the Barbados Eye Study, OAG affected 1 in 11 Afro-Caribbeans older than 50 years of age, reaching a prevalence
24
of 1 in 6 in those over 70 years. About 2% of individuals over 40 years are blind and, of that percentage, one-third are blind due to OAG. Issues High disease frequency. Very limited availability of sensitive and specific screening methods at reasonable cost. Silent nature of the disease. Late detection and poor compliance. High cost of medication. Lack of public awareness about need for people over 40 years of age to get eyes checked for glaucoma. Expected Outcome Strengthen national programs for detection and treatment of glaucoma in segments of the population with
risk factors as outlined in national eye care plans. Proposed actions for Member States
Include glaucoma detection as an integral part of comprehensive eye examinations for persons over 40 years of age.
Ensure that eye care units are have the capacity (equipment & HR) to provide glaucoma diagnosis and treatment.
Increase awareness among the general population of the importance of regular eye examinations and glaucoma screening for those over age 40, as well of other risk factors for glaucoma.
Provide affordable treatments and medications. Proposed actions for organizations supporting VISION 2020 activities
Utilize available epidemiologic information to promote early detection and treatment in countries in high-risk groups.
Utilize best practices to promote and design public awareness programs and interventions.
Mobilize technical and financial resources to strengthen national eye care services in glaucoma detection and treatment
Train professionals to implement existing evidence-based protocols. Indicators
Increasing from 3 to 6 the number of countries carrying out glaucoma community awareness programs by the year 2014.
A regional procurement and distribution system for affordable glaucoma medications Number of countries including glaucoma eye medications in subsidized drug list and encouraging
practitioners to use it
1.1.4. Reduce visual disability by detecting and treating uncorrected refractive errors in adults
The Barbados Eye Studies found high prevalence of myopia and hyperopia in adults. Most adults over 50 years of age suffer presbyopia. Proposed actions for Member States
Include refraction in a comprehensive eye examination to identify spectacles requirements in adults.
Increase public awareness through information, education, and communication strategies. Proposed actions for organizations supporting VISION 2020 activities
Promote and support screening and refractive errors correction in adults, including presbyopia.
25
1.2. REDUCE BLINDNESS AND VISUAL IMPAIRMENT IN CHILDREN
1.2.1 Reduction of the preventable causes and of treatable causes of childhood blindness. Magnitude of the problem As the causes of Blindness in children differ from those in adults, different control measures are needed; childrens’ eye problems need timely attention or they may become irreversibly blind; specific expertise and equipment are required. While data is limited, the following causes of childhood blindness has being reported in the Caribbean Region: Retinopathy of Prematurity (ROP) , cataract and glaucoma in children have been reported in some countries, corneal scarring (the drying out and scarring of the outer eye because of vitamin A deficiency) is not common and has been reported in a few countries. However, visual impairment from trauma is commonly reported in Jamaica, especially among boys. Issues Insufficient data about the causes or magnitude of childhood blindness and visual impairment in the
Caribbean. Lack of policies that support inclusion of an eye care component in Maternal & Child Health programs. Insufficient awareness and knowledge among pediatricians, obstetricians, general physicians and health
personnel about their role in prevention of children’s visual impairment and blindness. Insufficient involvement of general ophthalmologists in prevention of childhood blindness programs. Expected Outcome Provide services to detect and treat children with Retinopathy of Prematurity, congenital cataract, congenital glaucoma and corneal ulcer or scarring, and other non-blinding eye problems, such as strabismus, trauma, Proposed actions for Member States
Integrate childhood blindness prevention with early diagnosis, evaluation and treatment into all national maternal and child health plans and policies.
Assess the main causes of blindness and visual impairment in children in the Caribbean as a base for future planning.
Promote detection of eye diseases and eye problems as part of the national policies in maternal and child health.
Provide ocular prophylaxis of newborns to prevent neonatal conjunctivitis through utilization of Povidone Iodine.
Reduce blindness in premature babies due to retinopathy of prematurity Prevention of blindness due to ROP is planned on three levels: a) Primary prevention: reduce the incidence of ROP through improved prenatal and neonatal care. b) Secondary prevention: early identification of severe cases of ROP in premature babies in neonatal care through regular examination of those deemed to be high-risk by skilled ophthalmologists and timely treatment with laser or cryotherapy of severe ROP c) Tertiary prevention: restore useful vision in children with retinal complications through vitreoretinal
surgery and/or offer rehabilitation.
Promote systems, networks and protocols for safe neonatal care, adequate referral, and follow-up.
Elaborate and promote national guidelines and minimum acceptable standards.
Ensure the availability of the necessary equipment for primary prevention, examination and treatment.
Improve the quality of available information on neonatal care. Proposed actions for organizations supporting VISION 2020 activities
Collect and analyze information on causes of childhood blindness in school children who are blind utilizing the appropriate documentation.
Conduct national assessments of needs and resources for ROP programs.
Organize regional and national workshops to increase awareness.
Organize regional and national training programs for professionals (obstetricians, pediatricians, nurses, and ophthalmologists).
Promote the utilization of regional guidelines on neonatal care and ROP programs.
26
Support countries in the development of ROP services
Organize a referral pediatric ophthalmology center Indicators
Documentation on causes of childhood blindness in school children who are blind in the Caribbean. Increase the number of countries that have a national ROP prevention policy from 1 to 4 by the year 2014. Number of countries that are implementing an eye care component in maternal and child care programs. Number of countries with capacity (pediatric oriented ophthalmologists and equipment) in tertiary facility to
perform pediatric cataract, ROP examinations and treatment, and other blinding and non-blinding children’s eye conditions.
1.2.2 Reduce visual disability by detecting and treating uncorrected refractive errors in school children
Magnitude of the problem According to epidemiologic studies in Latin America PAHO-WHO estimates that about 7% of school children may
require spectacles for correction of refractive errors.
The steps in the provision of refraction services are as follows: (a) Screening: identification of individuals with poor vision which can be improved by correction. (b) Eye examination: to evaluate the condition of the eye and identify coexisting pathologies
requiring care. (c) Refraction: determine what correction is required. (d) Dispensing: provide and supply appropriate corrective eyeglasses. (e) Follow-up: ensure compliance with prescription, care of the eyeglasses, repair or substitution of
spectacles, if needed. Issues No data available on need for spectacles in school children. No data available on best practices on refractive errors programs in schools children. Different priorities and criteria in eye care programs for school children in the different countries. Lack of policies that include an eye care component in school health programs. Small number of ophthalmologic and optometry services that diagnose refractive errors in school children of
low socio-economic status. Spectacles often too expensive for the majority of patients. Inadequate collaboration between health and education stakeholders. Lack of parent’s awareness and commitment to comply. Expected Outcome Prevention of visual impairment and blindness due to uncorrected refractive errors in school children by
integrating eye health into policies and practice in health and education sectors. Proposed actions for Member States Develop national guidelines for the detection and treatment of refractive errors, taking into account national
realities. Establish screening during the first school level and during the sixth grade. Develop and follow pilot refractive error programs to identify and disseminate best practices. Promote refractive error services and provision of spectacles in the public sector for school children, adults
and any person in need Increase availability and affordability of eyeglasses and facilitate their production through the establishment
of low-cost laboratories. Increase public awareness through information, education, and communication strategies.
27
Proposed actions for organizations supporting VISION 2020 activities
Promote the utilization of the regional guide in refractive errors programs.
Standardize technology: screening kit and affordable instruments.
Develop advocacy plan for health and educational authorities.
Promote a study in refractive error correction needs for school children.
Support development of low cost spectacle production and distribution systems. Indicators
Increase the number of countries implementing a national standard refractive errors program as part of national eye care policies and plans from 2 to 7 by the year 2014.
Increase in the spectacle labs producing affordable, quality spectacles
1.3. REDUCE THE IMPACT OF BLINDNESS AND VISUAL IMPAIRMENT IN THE GENERAL POPULATION
1.3.1 Enhance vision related quality of life for people with functional low vision.
Low-vision services are aimed at people who have residual vision that can be used and enhanced by specific aids. Low vision is currently defined as ‘visual acuity of < 6/18 down to and including 3/60 in the better eye’, from all causes.
Magnitude of the problem It is estimated that for every thousand people, 17 has low vision, of those about 6 could benefit from low vision interventions. Expected outcome
Provide comprehensive low-vision services for persons who are blind or severely visually impaired integrating clinical eye care, rehabilitation and educational services in each country.
Issues Inadequate government policy for visual rehabilitation. Limited public and eye care professionals’ awareness of low vision. Insufficient professional services and technical expertise in this specialty. Insufficient affordable optical devices for assessment and prescription. Insufficient rehabilitation and educational services for people with low vision. Insufficient adapted teaching materials and technologies for students with low vision. Proposed actions for Member States
Develop national policies on comprehensive low-vision care.
Establish low-vision services at the national level in public facilities.
Promote early identification of all children and adults who are irrevocably blind severely visually impaired and ensure that an effective referral system is in place.
Establish units that can provide comprehensive low vision services, utilizing technicians in optometry to perform low vision examinations, assess and counsel patients, prescribe optical devices and provide instruction in device use.
Promote low vision services for children as early as possible through an integrated system of clinical and pedagogic services.
Proposed actions for organizations supporting VISION 2020 activities
Organize low-vision courses at regional and national congresses of ophthalmology.
Promote the establishment of resource centers for the training of trainers, curricula standardization, and technology development.
28
Support the organization of low-vision centers in underserved countries currently without such services.
Develop a system to make low-vision aids affordable.
Advocate for national inter-sectoral policies and plans for inclusive education and for rehabilitation programs for persons who are blind
Train low-vision teams (eye care, low-vision therapy, rehabilitation, education, and social services).
Create regional or national funding bases for the purchase of devices
Develop specific continuing education programs in low vision care for existing/available personnel. Indicator
Increase the number of countries with low-vision services from 3 to 6 by the year 2014.
1.3.2. Inclusive services Children who are blind should have access to inclusive education and supportive services; adults who are blind require rehabilitation (adjustment to blindness) programs to strengthen their emotional and social capabilities; as well as training in daily living skills, orientation mobility skills, and vocational training. Insofar as it is feasible, inclusive education and adjustment to blindness services should be supported by access to adaptive aids, including devices for reading and writing; white canes; adapted domestic aids; and low-vision appliances and technologies. Issues Inadequate government policy for visual rehabilitation. Insufficient rehabilitation and educational services for people with low vision and blindness. Insufficient adapted teaching materials and technologies. Expected outcome Education and Rehabilitation services available for persons with blindness or visual disability. Proposed actions for Member States Legislation and policies approved/enacted that support implementation of the UN Convention on the Rights of
Persons with Disabilities UNCRPD (Signed in 2009) National Disability Plan is approved and implemented by the Government (MoE and MoH) Ensuring availability and accessibility of inclusive services (Rehabilitation, education and social services) Education and social services department is strengthened to provide expanded service delivery for children and
adults who are blind. MoE provides sufficient support to meet the educational needs of blind and VI students. Proposed actions for organizations supporting VISION 2020 activities Advocate for inclusive services in every country. Coordinate efforts among NGOs to resource social and education services. Make available affordable technical equipment and special supplies for blind and visually impaired. Conduct a region wide situation assessment on rehabilitation and education services for persons who are blind.
Indicator
Number of countries that are implementing national plans for inclusive education and adjustment to blindness by 2014.
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2. EYE CARE SYSTEMS 2.1 Central Organization, Leadership and Governance Expected outcome: Provide leadership and governance that ensures an effective and equitable eye care system. Involves ensuring strategic policy combined with coalition building, the provision of appropriate regulations,
incentives and accountability. Regional and National Strategy Ensure national strategic policy framework. Encourage National Committee and a Focal Person for the Prevention of Blindness that will assist the ministry
of health, education and other national authorities and organizations in the development of regulations and plans and the implementation and monitoring of programs.
Support the implementation of the plan. Keep updated information on VISION 2020 implementation at all levels. Promote networking and capacity building. 2.2 Eye Care Workforce Issues Insufficient ophthalmology and optometry training programs in the region, resulting in an inadequate number
of qualified professionals in ophthalmology, optometry and allied health personnel. In the Caribbean the surgical productivity per ophthalmologist is low, in part because several clinical
ophthalmologists do not perform surgery. Others work in private practice and limit their services to patients who can afford their fees.
In many countries primary eye care is not yet implemented. Expected outcome: Have a well-performing health workforce fair and efficient to achieve the best eye care outcomes possible given available resources and circumstances. There are sufficient numbers and mix of staff, fairly distributed; they are competent and productive. Regional and National Strategy Organize new ophthalmology and optometry training programs in the Region and strengthen those that exist. Expand numbers of mid level personnel such as refractionists, ophthalmic assistants and low vision technicians
in the delivery of eye care in the Caribbean. Identify and or train sub-specialists in pediatric ophthalmology and retinal services including the necessary
referral system for the established referral services. Train primary health care (PHC) workers in primary eye care at the national level. Establish the productivity norms for key resources (for example cataract surgeries per ophthalmologist per
year). Develop continuing educational programs. Develop manpower for equipment maintenance repair, low cost spectacle production and eye drops
preparation. Indicators
Number of countries reaching the minimum ratio set of one active ophthalmic surgeon per 50,000 populations. Number of countries reaching the minimum ratio set of one active optometrist per 50,000 populations.
Number of countries reaching the minimum ratio set of one active ophthalmic nurse per 50,000 populations Number of countries having an active PEC service integrated to the PHC service. Number of countries with network of maintenance technicians available covering all hospitals in country by
2014. Increase the number of countries having spectacles lab technicians from 3 to 6.
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2.3. Medical Products and Technologies
Issues Limited availability of affordable consumables. Limited production of spectacles and medications. Underutilization of equipment due to lack of skills. Limited government understanding of eye care equipment management. Expected outcome: To ensure an optimal supply of appropriate, high-quality, affordable equipment, instruments, consumables essential for the delivery of eye care services. Regional and national Strategy Promote the utilization of small incision cataract surgery. Produce and/or distribute affordable consumables. Provide practitioners, ministries of health, hospitals and clinics with information on good quality and affordable
appropriate technology. Ensure availability of spectacles, ophthalmic supplies and equipment at costs appropriate to local economies. Provide training to support staff in maintaining and repairing ophthalmic equipment. 2.4. Eye Care Information Systems and Monitoring Issues Insufficient data on outputs and outcomes of services to support planning, monitoring, advocacy and reporting. Expected outcomes: Include eye care in the national planning, health and education information system. Periodic information available on the situation and trends on eye care delivery in the Caribbean. Regional and national Strategy Identify mechanisms to include eye care in the present Health Management Information system. Develop data management systems for eye care: data collection, compilation, reporting and analysis Define how analysis and distribution of information will be carried out. Define procedures for annual, mid-term and final review of the strategy implementation. Identify feedback mechanisms for various levels of staff.
31
3. EYE CARE PROMOTION, PUBLIC EDUCATION & ADVOCACY About 80% of blindness is avoidable: it either results from conditions that could have been prevented or conditions that may have being successfully treated to restore sight. It is necessary that high risks groups have adequate information to ensure they look for services to detect and treat eye problems and that they increase compliance on follow-up and treatments. The aim of eye care promotion and public education is to improve knowledge, attitudes, motivation and action for high risk groups and health authorities. The promotion of eye health as part of the national health policy is, invariably, a necessary prerequisite for a National Program for the Prevention of Blindness. This fosters public awareness, leads to societal responsiveness and participation and facilitates co-ordination of activities carried out by various partners, such as non-governmental organizations, the private sector and the government itself. 3.1. Advocacy Expected Outcomes Increased political commitment in all countries to include eye health in the national health plans. Increased commitment of professional societies to regional and national eye care programs. Regional and National Strategy Ministries of Health are acquainted with the PAHO and WHO resolutions in prevention of blindness. Strengthen national data-gathering capabilities, to facilitate regional collection of epidemiological and service
delivery information and allow disaggregation of data by gender and age. Establish and keep current a register of all known persons with visual disability. Promote epidemiological and service delivery assessments. Participate in ophthalmic regional professional societies’ meeting. Promote eye care professionals gathering regionally and sub-regionally for continuing medical education and
eye care planning. Promote V2020 / Prevention of Blindness Committees gathering regionally for cross learning, skill sharing and
collaboration. Publish papers in regional scientific journals. Advocate for the inclusion of critical eye care in the national health information systems. Observe the second Thursday of October every year as World Sight Day. Celebrate any day to promote specific topics. Indicators Number of countries celebrating the World Sight Day and related days each year. Increase the number of countries implementing a national vision 2020 plan from 6 to 10 by 2014. Number of countries including eye health services in the national health plan from 4 to 8 by 2014. 3.2 Public awareness and education Expected outcome: Increased public knowledge and utilization of eye care services. Regional and National Strategy Assess the baseline data in knowledge, beliefs, attitudes and actions of the population in regard to eye care. Develop a communication program including printed and audio-visual materials. Utilise general health and eye health professionals to create public awareness. Indicators Increase the number of countries implementing an eye care public awareness program. Increase the number of people using eye care services by 30% over 5 years
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BIBLIOGRAPHY 1. World Health Organization. Vision 2020 The Right to Sight: Global Initiative for the elimination of avoidable
blindness; Action Plan 2006-2011. Geneva, Switzerland: 2007. 2. Pan American Health Organization. Forty-ninth Directing Council, 61st Session of the Regional Committee.
Washington DC, PAHO, 2009 (Resolution CD49/19). 3. Pan American Health Organization. Health in the Americas. Health conditions and Trends. Ocular Health.
Regional Volume. PAHO: Washington DC;2007:141-142. Available at: http://www.paho.org/HIA/homeing.html. Accessed: February 17, 2010.
4. Vision 2020. Latin American Region. Available at: http://www.vision2020.org/main.cfm?Type=WEFLA&objectid=2812. Accessed January 13. 2010.
5. Foster A, Resnikoff S. The impact of Vision 2020 on global blindness. Eye 2005; 19:1133-1135. 6. Gilbert C, Foster A. Childhood blindness in the context of VISION 2020—the right to sight. Bull World
Health Org 2001;79:227-232. 7. Yorston D. The global initiative Vision 2020: The right to sight childhood blindness. Community Eye Health
1999;12:44-45. 8. Limburg H, Barria F, Gomez P, Silva JC, Foster A. Review of recent surveys on Blindness and Visual
impairment in Latin America. Br J.Ophthalmol 2008;92;315-319. 9. Pongo Águila LP, Carrión R, Luna W, Silva JC, Limburg H. Ceguera por catarata en personas mayores de 50
años en una zona semirrural del norte del Perú. Pan Am J Public Health 2005,17:387-393. 10. Beltranena F, Casasola K, Silva JC, Limburg H. Cataract blindness in four regions in Guatemala—results of a
population-based survey. Ophthalmology 2007;114:1558-1563. 11. Nano ME, Nano HD, Mugica JM, Silva JC, Montana G, Limburg H. Rapid assessment of visual impairment
due to cataract and cataract surgical services in urban Argentina. Ophthalmic Epidemiol 2006;13:191-197. 12. Eduardo Leite Arieta C, Nicolini Delgado AM, José NK, Temporini ER, Alves MR, de Carvalho Moreira Filho
D. Refractive errors and cataract as causes of visual impairment in Brazil. Ophthalmic Epidemiol 2003;10:15-22.
13. Hernández Silva JR, Río M, Padilla C. Resultados del RACSS en ciudad de la Habana, Cuba, 2005. Rev Cubana Oftalmol 2006:19:1-9.
14. Duerksen R, Lansingh V. Vision 2020 in Latin America. Cataract Refract Surg Today. May 2007. 64-67. 15. Silva JC, Bateman JB, Contreras F. Eye disease and care in Latin America and the Caribbean. Survey
Ophthalmol 2002;47:267-274. 16. Limburg H, Silva JC, Foster A. Cataract in Latin America: findings from nine recent surveys. Rev Panam
Salud Publica 2009;25:449-455. 17. Duerksen R, Limburg H, Carron JE, Foster A. Cataract blindness in Paraguay—results of a national survey.
Ophthalmic Epidemiol 2003;10:349-357. 18. Lansingh VC, Resnikoff S, Tingley-Kelley K, Nano ME, Martens M, Silva JC, Duerksen R, Carter MJ. Cataract
surgery rates in latin america: a four-year longitudinal study of 19 countries Ophthalmic Epidemiol. 2010 Mar;17(2):75-81.
19. Chiriboga F. Yaruqui-Ecuador: An ongoing district VISION 2020 programme. Community Eye Health 2005;18:96.
20. Maul E, Barroso S, Munoz SR, Sperduto RD, Ellwein LB. Refractive error study in children: results from La Florida, Chile: Am J Ophthalmol 2000;129:445-454.
21. Sauerbrey M. The Onchocerciasis Elimination Program for the Americas (OEPA). Ann Trop Med Parasitol 2008;102:1:25-29.
22. Arieta CE, de Oliveira DF, Lupinacci AP, Novaes P, Paccola M, Jose NK, Limburg H. Cataract remains an important cause of blindness in Campinas, Brazil. Ophthalmic Epidemiol 2009;16:58-63.
23. Salomao S, Mitsuhiro M, Belfort R. Visual impairment and blindness: an overview of prevalence and causes in Brazil. An Acad Bras Cienc 2009;81:539-549.
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Annex 1
PAN AMERICAN HEALTH ORGANIZATION WORLD HEALTH ORGANIZATION
49th DIRECTING COUNCIL 61st SESSION OF THE REGIONAL COMMITTEE
Washington, D.C., USA, 28 September-2 October 2009
CD49/19 (Eng.)
Annex B
ORIGINAL: ENGLISH
PROPOSED RESOLUTION
PLAN OF ACTION ON THE PREVENTION OF AVOIDABLE BLINDNESS
AND VISUAL IMPAIRMENT
THE 49th DIRECTING COUNCIL,
Having reviewed Document CD49/19 Plan of Action on the Prevention of Avoidable Blindness
and Visual Impairment;
Recalling Resolution WHA56.26 of the World Health Assembly on the elimination of avoidable
blindness;
Noting that visual disability is a prevalent problem in the Region and is related to poverty and
social marginalization;
Aware that most of the causes of blindness are avoidable and that treatments available are among
the most successful and cost-effective of all health interventions;
Acknowledging that preventing blindness and visual impairment relieves poverty and improves
opportunities for education and employment; and
Appreciating the efforts made by Member States in recent years to prevent avoidable blindness,
but mindful of the need for further action,
34
RESOLVES:
1. To approve the Plan of Action on the Prevention of Avoidable Blindness and Visual
Impairment.
2. To urge Member States to:
(a) establish national coordinating committees to help develop and implement national
blindness prevention plans;
(b) include prevention of avoidable blindness and visual impairment in national development
plans and goals;
(c) advance the integration of prevention of blindness and visual impairment in existing plans
and programs for primary health care at the national level, ensuring their sensitivity to
gender and ethnicity;
(d) support the mobilization of resources for eliminating avoidable blindness;
(e) encourage partnerships between the public sector, nongovernmental organizations, private
sector, civil society, and communities in programs and activities that promote the
prevention of blindness; and
(f) encourage intercountry cooperation in the areas of blindness and visual impairment
prevention and care.
3. To request the Director to:
(a) support the implementation of the Plan of Action on the Prevention of Avoidable
Blindness and Visual Impairment;
(b) maintain and strengthen PAHO Secretariat’s collaboration with Member States on the
prevention of blindness; and
(c) promote technical cooperation among countries and the development of strategic
partnerships in activities to protect ocular health.
35
DELIVERING V2020 IN THE CARIBBEAN
© Sightsavers
Delivering V2020 in the Caribbean
Promoting Vision 2020: The Right to Sight to eliminate avoidable blindness through capacity building in Guyana, Haiti, Jamaica,
St. Lucia and the Caribbean Region
St.Lucia Blind
Welfare Association
GUYANA
A Partnership between
This project is funded by the European Union
With technical support from PAHO and Brien Holden Vision Institute Foundation
© Sightsavers
Project Update
RESULT / ACTIVITIES PROGRESS TO DATE
Strengthen partner
capacities, systems
and processes
• All project partners benefited from staff
support, computer and accounting systems
development, training and mentoring
Support development,
implementation and
review of National
Eye Health Plans with
mentoring and
support for V2020
Committees
• Project supports data collection which
facilitates review of progress against Regional
V2020 Framework indicators
• Partners contributing to development and
implementation of V2020 Plans in project
countries
• Partners and project contributed to disease
control workshops in Jamaica (LV, RE, DR)
• Supporting V2020 Committees and activities
in 3 of 4 countries
• Regional V2020 Committees meetings held
© Sightsavers
Project Update
RESULT / ACTIVITIES PROGRESS TO DATE
Infrastructure
Development
• Guyana (Georgetown and Linden) operating
theatre equipment installed Nov 2012
• Haiti - Eliziar Germain Hospital (PauP) –
damaged OT equipment being replaced
• Haiti - St Nicholas Hospital (St Marc,) – OT &
VC equipment with project partner in Haiti
pending franchise
• Jamaica – Mandeville Regional Hospital OT
and support facilities construction completed
• Jamaica - Mandeville OT equipment in situ
• Guyana & St Lucia – Spec labs upgraded
• Antigua & Jamaica – Spec lab equipment
ordered
• Vision Centres equipped in Haiti, Jamaica &
Guyana
© Sightsavers
Project Overview
Total Funding:• €5,429,856 (73.67% EC Funded)
Duration:• January 2010 – December 2014
Countries covered:• Guyana, Haiti, Jamaica, St. Lucia, Caribbean Region
Project objectives:• Reduce prevalence of blindness• Strengthen collaboration and coordination • Build capacity of partners and V2020 Committees
© Sightsavers
Project Update
RESULT / ACTIVITIES PROGRESS TO DATE
Human Resource
Development
• 11 Ophthalmology residents in training
• 16 Optometry students in training plus
project providing inputs to support 34 others
• 8 Refractionists completed training -
course also provided inputs to support 4
Refractionists funded by Government of
Antigua & Barbuda
• 607 PHC workers trained
• 87 Low Vision Counselors trained
• 4 Spectacle Lab Techs trained
• Continuous support to University of
Guyana Optometry and Refractionist courses
© Sightsavers
Project Update
RESULT / ACTIVITIES PROGRESS TO DATE
Communications • CCB website links Members and partners
and provides general information on eye
health and social inclusion.
• Newsletters, bulletins, press releases and
human interest stories produced regularly
• Over 40 videos produced that reinforce
messaging from other media and advocate
for policy development, social inclusion of
visually impaired persons and prevention of
avoidable blindness
• Support to special events such as World
Sight Day, Glaucoma Day, Blindness
Awareness Day and Health Fairs
• IEC materials & KAP Studies under
development
36
© Sightsavers
Planned activities 2013 / 14 include:
• Support to National V2020 Committees and for Regional
V2020 Meetings 2013 / 14
• Awareness activities with general health professionals
• Scholarships for 7 Refractionists
• Training LV Specialists and LV Counsellors
• Training Maintenance Techs, Lab Techs, Dispensing Techs
and PHC workers
• Surfacing Lab and Maintenance Lab (CCB Antigua)
• Operating Theatres (Haiti & St. Lucia)
• Vision Centre & Spectacle Lab (SHAA, Haiti)
• Vision Centres in Jamaica (2) and St Lucia (1)
• KAP Studies – focus on Glaucoma and DR
• RAABs – Guyana and Jamaica
© Sightsavers
Delivering V2020 in the Caribbean
We look forward to your continued
support and involvement
37
Abstract for CCB Conference Presentation on Regional KAPB Study
Glaucoma is the leading cause of irreversible blindness worldwide, but blindness from glaucoma
is preventable by early detection and appropriate treatment. There are large numbers of patients
living with this chronic disease in the Caribbean, and given the aging population and glaucoma’s
increasing prevalence with age, these numbers are likely to increase.
Successful management of glaucoma to prevent vision loss not only requires the medical
fraternity to adequately diagnose and prescribe treatment for the condition, but is heavily
dependent on the patient’s ability to successfully manage their condition: to adhere to an agreed
treatment plan, to continue to attend eye checks, and to minimize the impact on their family by
informing and encouraging others to be tested for glaucoma. This is only possible if patients
have the necessary understanding of their disease and their role in its management, and then go
on to consistently fulfill that role.
We therefore have undertaken a regional study to explore the knowledge, attitudes and practices
of persons living with glaucoma in four Caribbean countries: Barbados, Guyana, Jamaica and St.
Lucia. A structured interview, administered to a systematic sample of glaucoma patients
attending the eye clinics in the respective countries, will be used. Preparations thus far have
involved a series of consultations with management, academic and clinical staff in partner
institutions in the participating countries. We are now awaiting ethical approval by the
institutional review boards before data collection can begin.
This regional study is being conducted as part of the overall efforts of the participating
individuals and organizations, funded by the European Commission in partnership with
Sightsavers and The Caribbean Council for the Blind, to prevent low vision and blindness from
glaucoma, as one of the Vision 2020 (Right to Sight) priorities in the Caribbean.
We hope that the results from this study will enhance our understanding of the issues affecting
glaucoma patients and having an impact on their ability to manage their disease. In the long term
this should inform public health policy and clinical strategies to improve the care of glaucoma
patients.
Miss Dawn Grosvenor, MBBS, MRCOphth, FRCS (Glasg), FRCOphth
38
Diagnosing and treating Glaucoma in an Ethnically Diverse Society –
The Guyana Experience Dr Shailendra Sugrim, Consultant Ophthalmologist and Glaucoma Specialist, Georgetown Public Hospital Corporation, Georgetown, Guyana
Based on empirical data and also from studies from individual countries in the Caribbean, primary open
angle glaucoma (OAG) is the most common form of glaucoma in the Caribbean region. Studies of black
West Indian populations in St. Lucia and Barbados show a prevalence of 8.8% and 6.6%, respectively.3,4
.
Studies in other parts of the world (including the US and Europe) have shown that it’s the most common
form. Most literature contend that primary open angle glaucoma varies significantly according to race and
ethnicity. Despite the fact that people of Asian descent are more likely to develop angle closure glaucoma
(ACG), open angle glaucoma is more common (including in Japan and India). The Ocular Hypertension
Treatment Study (OHTS) showed that black race was a risk factor for conversion from ocular
hypertension to open angle glaucoma.12
However, it also showed that corneal thickness and cup-to-disc
ratio may present a better means of evaluating risk factors than race.
In Guyana, our two major ethnic groups are of Indian origin and African origin. Hence, in assuming the
prevalence risks for Glaucoma in our country, looking at data from studies with similar ethnicity gives us
an idea of what the dimension is like. In 2009, a random sampling and analysis of data from records at
Georgetown Public Hospital showed that 9% of patients presenting to the Eye Clinic were likely to
have a diagnosis of simple open angle glaucoma with majority of patients being of African
ethnicity.
Diagnosis is straightforward with advanced cases with all the characteristic features. Diagnosis becomes
more technical in early glaucoma cases or in normal tension cases. Tonometry (measuring of IOP) is now
an accepted mode of management here. Modern developments and research on glaucoma has now enabled
us to go beyond this where we need also to consider other factors such as characteristics of the neuro-
retinal rim, size of the optic nerve and the central corneal thickness. The use of Humphrey’s Visual Field
as a diagnostic tool needs to be carefully done by those trained in interpreting these fields.
In Guyana, POAG in the Afro-Guyanese population presents usually with very advanced features with a
tremendous loss of vision. This finding is common in both old and young age group. The usual approach
is to try to initiate or maximise their topical glaucoma medications until maximum tolerated medical
therapy is achieved. It’s especially difficult to convince younger patients with advanced field loss (tunnel
vision) with 20/20 central vision, to undergo surgery. Typical profile for these patients are high IOPs, deep
excavated cups with thin neuroretinal rims, C:D ratios usually 0.7 and higher. 50% of times there is a
positive family history, but this may be higher due to undiagnosed cases in the family.
Normal tension glaucoma seems to be more common in Indo-Guyanese patients who are also more prone
to diabetes. These patients present in various stages from early disease to advanced disease. Most cases
are initialised on topical glaucoma eye drops and their IOPs and Visual Fields are monitored for
effectiveness of treatment.
HVF measurement is found to be highly unreliable across the population usually due to difficulty in
interpreting the instructions during the test. Also in elderly patients, apart from comprehending the
intructions, response time affects their ability to give reliable readings. Hence, we can only rely on clinical
judgement along with IOPs as our guide for treatment.
A few cases of Primary Angle Closure Glaucoma exist and they are commoner in the indigenous
(Amerindian) population. Otherwise a few have been found in Indo-Guyanese and Afro-Guyanese
patients. Secondary ACG cases are present in cases with neovascular glaucoma and lens-induced
glaucoma. Management of these cases are initially attempted medically since our hospital does not have
39
facility for YAG Laser Peripheral Iridotomy. Patients recommended for YAG PI have the option of going
to a private hospital or at regional eye hospital in outlying district. Maybe 1-2 cases needed surgical
intervention.
Secondary Glaucomas does not affect any ethnicity in particular due to the fact that the primary causes go
across the board. Secondary cases include those from trauma (which has a male predominance), steroid
induced, inflammatory induced, lens-induced and other rare causes. Congenital Glaucoma presents rarely
and these cases are managed surgically with long-term followup at our clinics.
Availability of medications is another pertinent issue despite the fact that at least four major medicine
groups are available free to the public. Patient education is a key issue with glaucoma management.
Careful counselling is important so that patients are educated on the pattern of visual loss, their options for
treatment and also the irreversibility of glaucomatous optic neuropathy. This is difficult in a public system
where clinics are overcrowded and overtaxed with human resources. Another issue one has to deal with is
compliance. It’s difficult sometimes for patients to understand visual loss from glaucoma if they aren’t
having a noticeable scotomas or blurred visual effects. This affects their compliance.
Using race and ethnicity factors in glaucoma diagnosis and treatment is a tempting proposition, but it is
pertinent that each patient be managed with their idiosyncracies. The strongest advocate for looking at
race and glaucoma risk and treatment seems to be the fact that African-American patients are more likely
to develop OAG and more likely to become blind from the disease. The differences observed between
race/ethnicity and disease prevalence may vary according to genetics, environment, socioeconomic status
and cultural differences. For now, evaluating intraocular pressure, the optic disc, central corneal thickness
and the angle with gonioscopy seems most pertinent. One thing that is certain in patients across all racial
and ethnic divides: many are not aware that they have glaucoma.
40
The University of the West Indies
Faculty of Medical Sciences
Department of Community Health and Psychiatry
30th
April, 2012
Factors influencing uptake of cataract surgery among older patients in Jamaica
Investigators
Dr. Desmalee Holder-Nevins
Dr. Kenneth James
Dr. Norman Waldron
In collaboration with the Jamaica Society for the Blind and the Caribbean Council of the Blind
41
Summary of the study
The adult prevalence of cataract in Jamaica is unknown and the cataract surgery rate is
disproportionately low in comparison to other countries of the region, with Jamaica at only 50%
of the Vision 2020 CSR target to be achieved by 2014. An examination of the factors that
influence health-seeking behaviour and cataract surgery uptake in person age 60 years and over is
warranted.
A qualitative study is proposed. It is aimed at developing an understanding about barriers which
influence decisions about accessing cataract surgery services among person age 60 years and over
and the implications for public health actions. Qualitative interviews will be manually and
digitally recorded and after leaving the field, transcripts will be generated from these data. All
audio records will then be destroyed to protect the identity of the interviewers.
All persons selected will be apprised of the study and their rights to refuse to participate. Those
who agree to participate will be asked to give written consent, informed by full explanation that
they will not be named in any reports coming out of the study and their option to refuse or
withdraw without any sanctions against them.
Persons to be included in this study will be recruited because of the specific problem under
investigation and not because of easy availability, diminished autonomy or social bias. The
principles enunciated in the FMS/UHWI Guidelines for the conduct of research will be complied
with throughout this investigation.
42
Department of Community Health and Psychiatry
RESEARCH PROPOSAL
Chlamydia trachomatis frequency in patients presenting to
Ophthalmology Clinics in Kingston, Jamaica
Prepared by:
Dr. Sandra Jackson
Dr. Ken James
April 2012
Chlamydia trachomatis frequency in patients presenting to
Ophthalmology Clinics in Kingston, Jamaica
43
SUMMARY
Although the contribution of Chlamydia trachomatis conjunctivitis or Trachoma to visual impairment and
blindness worldwide has decreased from 15% in 1995 to 3.6% in 2002, continued monitoring and
evaluation of ocular Chlamydia serotypes is necessary in order to achieve the “Vision 2020” goal of the
elimination of avoidable blindness by the year 2020. (1) Caribbean countries face many socio-economic
and demographic challenges resulting in varying health disparities among individual countries. Poor socio-
economic conditions within certain regions of Jamaica, Jamaica’s proximity to countries such as Haiti
whereocular endemic strains of Chlamydia trachomatis exist, the international exchange of legal and
illegal- immigrants and the absence of Trachoma monitoring and evaluation services in Jamaica, are risk
factors which predispose to the resurgence of this disease. (2) This study will evaluate the prevalence of
Chalmydia trachomatis serotypes A, B, Ba and C in Kingston,Jamaicaand Trachoma associated risk
factors. Conjunctival swabs will be selected though systematicsampling of patients from two
ophthalmology clinics of different socio-demographic profiles.Amplification and qualitative detection
of Chlamydia trachomatis will be performed using real-time PCR (Sacace™ Chlamydia
trachomatis Real-TM). (3) Results of this study will be used to establish the prevalence of
Chlamydia trachomatis infection in Kingston, Jamaica and will contribute to theevaluation of
Jamaica’s status towards the elimination of infectious causes of visual impairment and blindness in
keeping with the global initiative of the World Health Organization (WHO) and Vision 2020.(3, 4)
44
Training Eye Health Theatre Nurses for the Caribbean
Training Eye Health Theatre Nurses for the Caribbean
The Role of the Dominica Health Services
Dr. Hazel Shillingford-Ricketts MBBS (UWI); FRCS (C)
Consultant Ophthalmologist
Nurse Nicole Alleyne
Registered Nurse Operating Room
Knowledge and Skills:Patient, Staff and the Environment
• Patient care: Pre-op, Intra-op and Post-op• Personal Protective Equipment• Aseptic techniques• Drugs • Ophthalmic consumables• Microsurgical instruments: Care and Handling• Waste Management• Duties of the operating room nurse
Pre op Floor or circulating nurse Scrub nurse Sterilization room Inventory management
Intra-op
The roles of the circulating or floor nurse: Safety of the patient and staff in the operating room
Ensure that the correct patient is operated on with the correct procedure
Provide the additional surgical instruments needed
Assist the scrub nurse in setting up for the surgery
Review the checklist with the scrub nurse
GOAL and OBJECTIVE
Goal: Competent Ophthalmic or Eye Health Operating Room Nurses
Objective: An apprenticeship program to train nurses to acquire a basic set of skills needed to assist at different stages in ophthalmic surgery.
Pre-op Preparation of patient before surgery dayMedical history documentedTeaching of dos and don’ts in the peri-operative period
Arrangement for:Measurement for intra-ocular lensPre op assessment by Anesthetist or Medical DoctorAdmission process with records and accounts departmentSurgical listConsent
Preparation of patient on surgery dayPatients notes and identification of correct patient for correct procedureConsent form signingVitals signsDilating eye drops
Intra-op
The roles of the scrub nurse: To set up the instruments and consumables needed for the surgery
to be performed
To go through the checklist before the surgery is started
To assist the surgeon by passing the correct instruments and consumables as needed during the operation
To assist the surgeon as needed and instructed
To pass on the instruments at the end of the surgery for cleaning and sterilization
45
Post-op
Recovery room duties
Help patients being discharged home with appropriate medications, instructions and eye clinic follow-up appointments
Hand over patients to family members or other person who accompanied them with appropriate information.
Management
• Inventory: Maintain and document adequate stocks of functioning instruments
and consumables
Update check list
Maintain equipment and ensure its state of readiness for use
• Liaise with maintenance staff for repairs
• Keep staff and self current with new surgical procedures
Sterilization
Wash instruments
Inspect instruments for damage
Package and place instruments in correct packs for sterilization
Sterilization methods
Evaluation
• Observation of skills during the program
• Feed back during tutorials
• Mock set up
• Examination
• Certification on successful completion
50
Group Work Activity
Group 1 V2020 Committees Meeting Tuesday 11th December, 2012
Time allocation: Group work – 1hr 50mins (Includes working coffee break) Feedback Presentation – 15mins
Integration of Eye Health into National Health Plans One of the Objectives of the draft WHO Action Plan ‘Universal access to eye health: a global action plan 2014-2019’ is:
National policies, plans and programmes for eye health which are integrated into national health systems developed and/or strengthened and being implemented along the lines of the WHO health system building blocks.
IAPB’s The Right to Eye Health – Hyderabad Declaration (2012) urges governments to:
Ensure that eye health and blindness prevention are prioritized and included in national health policies and plans.
Integration of eye health into National Health Plans and policies will help to maximize opportunities for development and resourcing of eye health personnel and services.
Integration of eye health into wider health care delivery systems at all levels is critical and eye health is relevant in all of the WHO health system building blocks: governance, health financing, service delivery, human resources for health (HRH), pharmaceutical management, and health information systems (HIS)
Integration opportunities exist as typically National Health Plans have sections relating to Non-Communicable Diseases (NCDs), Primary Health Care (PHC), Neo-natal care, Health promotion, Information systems and Leadership.
Objective of Group Work: Identify approaches for integration of eye health into National Health Plans
Group should: 1. Establish the current level of integration of eye health in National Health Plans
(present good and not-so-good examples) 2. Identify when your country’s current National Health Plan expires and when the
review / development process is likely to start 3. State what you can do to ensure eye health professionals & focal persons are
involved in the development of the next National Health Plan 4. Identify how eye health can be integrated in any or all of the following areas:
Governance
Health financing
Service delivery
Human resources for health (HRH)
Pharmaceutical management
Health information systems (HIS)
Group 1
54
Group Work Activity
Group 1 V2020 Committees Meeting Tuesday 11th December, 2012
Time allocation: Group work – 1hr 50mins (Includes working coffee break) Feedback Presentation – 15mins
Identifying practical and cost-effective ways to train eye health professionals in / for the region
One of the Actions of the draft WHO Action Plan ‘Universal access to eye health: a global action plan 2014-2019’ is: Develop and maintain a sustainable workforce for the provision of comprehensive
eye care services as part of the broader human resources for health workforce. The Eye Health Workforce section of the Strategic Framework for V2020: The Right to Sight – Caribbean Region has a number of indicators related to ensuring an adequate number of eye health professionals: Number of countries reaching the minimum ratio set of one active ophthalmic
surgeon per 50,000 populations. Number of countries reaching the minimum ratio set of one active optometrist per
50,000 populations. Number of countries reaching the minimum ratio set of one active ophthalmic nurse
per 50,000 populations Number of countries having an active PEC service integrated to the PHC service. Number of countries with network of maintenance technicians available covering all
hospitals in country by 2014. Increase the number of countries having spectacles lab technicians from 3 to 6. In order to achieve the expected outcomes of the Strategic Framework there is need to establish the national eye health workforce requirements and ensure adequate policies and resources are in place to enable: Initial and Refresher training Continuing Medical Education On-going access to mentors, expertise and technical support Within the Caribbean and in Latin American there are a number of facilities and personnel available to train ophthalmologist, optometrists, refractionists, ophthalmic nurses, PHC workers, community members, low vision personnel, maintenance technicians, spectacle lab technicians, dispensing technicians and other personnel involved in eye health service delivery and management.
Group 2
55
Objective of Group Work: Identify practical and cost-effective ways to train eye health professionals Group should: 1. Identify strategies for strengthening the eye health component of general primary
health care training 2. Identify ways to increase investment in and opportunities for mid-level eye health
personnel 3. Discuss the viability and usefulness of a Regional Human Resource Development
Database – which could provide training resources, information on training facilities and trainers, links to publications, etc.
Sub-groups may be formed
56
National VISION 2020 Data Collection VISION 2020: The Right to Sight: VISION 2020 is the global initiative for the elimination of avoidable blindness, a joint programme of the World Health Organization (WHO) and the International Agency for the Prevention of Blindness (IAPB) with an international membership of NGOs, professional associations, eye care institutions and corporations. VISION 2020 was officially launched in the Caribbean in Trinidad-Tobago in April 2000. The Pan-American Health Organisation (PAHO/WHO) support implementation of the Caribbean VISION 2020 initiative in alliance with the IAPB, Caribbean Council for the Blind (CCB) and a number of national and international non-government agencies and in collaboration with government ministries, departments and health facilities. National V2020 Data collection: The purpose of this National V2020 data collection form and process is to help measure achievement and progress against V2020 targets at national and regional level. This form is to be completed annually by national health authorities, with the support of National V2020 / Prevention of Blindness committees where available. The form collects data in five key areas:
1. Central Organization, Leadership and Governance 2. Disease Control 3. Human Resources 4. Infrastructure 5. Qualitative assessment (related to the eye health action plan and/or strategic
framework for each country) If you require assistance completing this form please contact: Ms Keva Richards, Project Manager V2020 Programmes, Caribbean Council for the Blind (CCB-Eye Care Caribbean) Tel: (268) 462-4111 Email: keva.richards@eyecarecaribbean.com When completed, this for is to be returned to keva.richards@eyecarecaribbean.com and to Dr Juan Carlos Silva PAHO Regional Advisor silvajuan@paho.org
57
National VISION 2020 Data Country:
Year of data: Country Population:
Source(s) of National V2020 data:
Approved by VISION 2020 National Committee or MOH: Y/N
1. Central Organization, Leadership and Governance Is there a signed National Declaration in support of VISION 2020?
Y/N - If yes, give date signed and name of Signatory
Did your country celebrate World Sight Day or other eye health related days in this period?
Y/N – if yes include a brief summary of activities
Is there an active National Vision 2020 Committee
Y/N – if yes how frequently does the Committee meet?
Was there a National V2020 workshop / meeting / conference organized in the past year?
Y/N – if yes state the focus / theme of the activity
Is there a designated focal person to assist the V2020 Committee and MoH?
Y/N Provide contact information:
Is there a National Vision 2020 strategic framework approved by the Ministry of Health?
Y/N Provide an electronic copy:
Is your country implementing a National Vision 2020 plan?
Y/N Briefly explain and provide results /progress:
Is eye health included in National health plans, policies and systems?
Y/N Provide reference and electronic copy of relevant policies, plans:
What is the Governments financial contribution to Eye Health?
Provide in local currency (& USD$ official conversion) figures and % of annual Health Budget.
58
2. Disease Control
Cataract How many cataract surgeries were performed in
the public sector in this period?
How many cataract surgeries were performed in the private sector in this period?
How many cataract surgeries were performed by others in this period (e.g. Cuban initiative, volunteers, etc.)?
Total number of cataract surgeries for this period
Are any eye departments in the country utilizing the cataract outcomes monitoring tool available at :
http://www.cehjournal.org/files/s1001.html
Y/N
Glaucoma Is there a national glaucoma IEC (Information, Education, Communication) plan / programme being implemented in your country?
Y/N – if yes provide a brief description
Are glaucoma eye medications included in the subsidized drug list?
Y/N – if yes provide a brief explanation
Diabetic Retinopathy
Has a Diabetic retinopathy Services situation analysis been conducted in your country?
Y/N – if yes state when the analysis was carried out.
Is early detection (diabetics screening and referral) integrated in the national non-communicable chronic diseases program?
Y/N
Is digital photography screening available in a. public sector, b. private sector
a. Y/N – state number screened
b. Y/N – state number screened
Are diabetic patients routinely referred to ophthalmology units for examination?
Y/N – state number referred
Are laser treatment services available in a. public sector b. private sector
a. Y/N – state number treated
b. Y/N – state number treated
Childhood Blindness
Is there any documentation on causes of childhood blindness in the country?
Y/N – if yes provide electronic copy
Is there a national Retinopathy of Prematurity (ROP) prevention policy?
Y/N – please provide electronic copy
Are there ROP screening and treatment services available?
Y/N
How many children were treated for ROP in this period?
Is eye care integrated into maternal and child health programs?
Y/N – if yes, how?
59
Are there any paediatric ophthalmologists and equipment to perform paediatric examinations and treatment?
Y/N
Please provide the following information annually: 1. Total number of children examined in out-patients
departments of eye health facilities 2. Total number of paediatric cataract surgeries 3. Total number of other paediatric eye surgeries
Refractive Error
Are there refractive error services available in the public sector?
Y/N – if yes provide a brief description
Is there a school screening programme being implemented?
Y/N – if yes provide a brief description
Are there spectacle labs producing affordable, quality spectacles (Affordable: Price not more than 3 days of salary of a medium income worker)
Y/N
Provide the number of spectacles dispensed per year (from public and not-for-profit sector):
Are there any programmes for detecting and treating presbyopia? (e.g. access to comprehensive eye examinations and reading glasses for people over 40 years of age)
Y/N
Low Vision Are Low Vision services available with 1. Trained professional(s), 2. the necessary equipment and 3. Low Vision appliances available?
Please specify if in the public sector, private sector, both or none
Y/N Y/N Y/N
Inclusive Services
Are there any national plans for inclusive education?
Y/N – please provide electronic copy(s)
Are there any national plans for rehabilitation / adjustment to blindness?
Y/N – please provide electronic copy(s)
60
3. Human Resources
Ophthalmologists Total number of ophthalmologists in country
Total number of ophthalmologists performing surgery in public sector
Total number of ophthalmologists performing surgery in private sector
Optometrists Number of Optometrists in public sector
Number of Optometrists in private sector
Refractionists Total number in country
Ophthalmic nurses Total number in country
Ophthalmic assistants
Total number in country
Primary Health Care personnel trained in Eye Health
Total number trained in this period: Brief description of training activity(s)
4. Infrastructure
Is a Preventive Maintenance programme implemented in each hospital with an ophthalmology department?
Y/N
Has an assessment of availability and adequacy of equipment at eye health facilities been carried out in this period?
Y/N – if yes what are the findings
5. Qualitative assessment (related to the eye health action plan and/or strategic framework for country) Describe the major achievements in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period:
Outline the major constrains in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period:
61
What are the proposed actions to strengthen eye health services and prevention of blindness services in your country?
What are the proposed actions to strengthen inclusive education services in your country?
What are the proposed actions to strengthen rehabilitation / adjustment to blindness services in your country?
62
National VISION 2020 Data Country: Antigua & Barbuda
Year of data: 2011-2012 Country Population: 89,700
Source(s) of National V2020 data: Ministry of Health (MSJMC)
Approved by VISION 2020 National Committee or MOH: Y/N
1. Central Organization, Leadership and Governance Is there a signed National Declaration in support of VISION 2020?
Y/N - If yes, give date signed and name of Signatory
Did your country celebrate World Sight Day or other eye health related days in this period?
Y/N – if yes include a brief summary of activities : Glaucoma Day
Is there an active National Vision 2020 Committee
Y/N – if yes how frequently does the Committee meet?
Was there a National V2020 workshop / meeting / conference organized in the past year?
Y/N – if yes state the focus / theme of the activity
Is there a designated focal person to assist the V2020 Committee and MoH?
Y/N Provide contact information:
Is there a National Vision 2020 strategic framework approved by the Ministry of Health?
Y/N Provide an electronic copy:
Is your country implementing a National Vision 2020 plan?
Y/N Briefly explain and provide results /progress:
Is eye health included in National health plans, policies and systems?
Y/N Provide reference and electronic copy of relevant policies, plans:
What is the Governments financial contribution to Eye Health?
Provide in local currency (& USD$ official conversion) figures and % of annual Health Budget.
63
2. Disease Control
Cataract How many cataract surgeries were performed in
the public sector in this period? Not available
How many cataract surgeries were performed in the private sector in this period?
Not available
How many cataract surgeries were performed by others in this period (e.g. Cuban initiative, volunteers, etc.)?
Not available
Total number of cataract surgeries for this period Not available
Are any eye departments in the country utilizing the cataract outcomes monitoring tool available at :
http://www.cehjournal.org/files/s1001.html
Y/N
Glaucoma Is there a national glaucoma IEC (Information, Education, Communication) plan / programme being implemented in your country?
Y/N – if yes provide a brief description
Are glaucoma eye medications included in the subsidized drug list?
Y/N – if yes provide a brief explanation
Diabetic Retinopathy
Has a Diabetic retinopathy Services situation analysis been conducted in your country?
Y/N – if yes state when the analysis was carried out.
Is early detection (diabetics screening and referral) integrated in the national non-communicable chronic diseases program?
Y/N
Is digital photography screening available in a. public sector, b. private sector
c. Y/N – state number screened
d. Y/N – state number screened
Are diabetic patients routinely referred to ophthalmology units for examination?
Y/N – state number referred
Are laser treatment services available in b. public sector b. private sector
a. Y/N – state number treated
b. Y/N – state number treated
Childhood Blindness
Is there any documentation on causes of childhood blindness in the country?
Y/N – if yes provide electronic copy
Is there a national Retinopathy of Prematurity (ROP) prevention policy?
Y/N – please provide electronic copy
Are there ROP screening and treatment services available?
Y/N
How many children were treated for ROP in this period?
Not available
Is eye care integrated into maternal and child health programs?
Y/N – if yes, how?
64
Are there any paediatric ophthalmologists and equipment to perform paediatric examinations and treatment?
Y/N
Please provide the following information annually: 4. Total number of children examined in out-patients
departments of eye health facilities 5. Total number of paediatric cataract surgeries 6. Total number of other paediatric eye surgeries
Not available
Refractive Error
Are there refractive error services available in the public sector?
Y/N – if yes provide a brief description
Is there a school screening programme being implemented?
Y/N – if yes provide a brief description
Are there spectacle labs producing affordable, quality spectacles (Affordable: Price not more than 3 days of salary of a medium income worker)
Y/N
Provide the number of spectacles dispensed per year (from public and not-for-profit sector):
Not available
Are there any programmes for detecting and treating presbyopia? (e.g. access to comprehensive eye examinations and reading glasses for people over 40 years of age)
Y/N
Low Vision Are Low Vision services available with 4. Trained professional(s), 5. the necessary equipment and 6. Low Vision appliances available?
Please specify if in the public sector, private sector, both or none
Y/N Y/N Y/N
Inclusive Services
Are there any national plans for inclusive education?
Y/N – please provide electronic copy(s)
Are there any national plans for rehabilitation / adjustment to blindness?
Y/N – please provide electronic copy(s) Information not available
65
3. Human Resources
Ophthalmologists Total number of ophthalmologists in country
2
Total number of ophthalmologists performing surgery in public sector
2
Total number of ophthalmologists performing surgery in private sector
2
Optometrists Number of Optometrists in public sector
1
Number of Optometrists in private sector
6
Refractionists Total number in country 4
Ophthalmic nurses Total number in country -
Ophthalmic assistants
Total number in country 2
Primary Health Care personnel trained in Eye Health
Total number trained in this period: Brief description of training activity(s)
4. Infrastructure
Is a Preventive Maintenance programme implemented in each hospital with an ophthalmology department?
Y/N
Has an assessment of availability and adequacy of equipment at eye health facilities been carried out in this period?
Y/N – if yes what are the findings
5. Qualitative assessment (related to the eye health action plan and/or strategic framework for country) Describe the major achievements in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period:
Outline the major constrains in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period:
66
What are the proposed actions to strengthen eye health services and prevention of blindness services in your country?
What are the proposed actions to strengthen inclusive education services in your country?
What are the proposed actions to strengthen rehabilitation / adjustment to blindness services in your country?
67
National VISION 2020 Data Country: Barbados
Year of data: 2011 Country Population: Approx 273,925 (World Bank)
Source(s) of National V2020 data: Ministry of Health/Queen Elizabeth Hospital
Approved by VISION 2020 National Committee or MOH: Yes
1. Central Organization, Leadership and Governance Is there a signed National Declaration in support of VISION 2020?
No
Did your country celebrate World Sight Day or other eye health related days in this period?
No. Barbados celebrated World Glaucoma Week (March 11-17, 2012)
Is there an active National Vision 2020 Committee
No
Was there a National V2020 workshop / meeting / conference organized in the past year?
Yes. The MOH met with Dr. Juan Carlos Silva in October 2011 to discuss the Draft Prevention of Blindness and Visual Impairment Eye Care Strategic Framework for Barbados and to develop Terms of Reference for a National Committee on Eye Care Services in Barbados.
Is there a designated focal person to assist the V2020 Committee and MoH?
No Provide contact information: Briefly explain and provide results /progress: In July 2012, the MOH received Cabinet approval to establish a National Committee on Eye Care Services in Barbados.
Is there a National Vision 2020 strategic framework approved by the Ministry of Health?
No Provide an electronic copy: N/A
Is your country implementing a National Vision 2020 plan?
No
Is eye health included in National health plans, policies and systems?
No Provide reference and electronic copy of relevant policies, plans:
What is the Governments financial contribution to Eye Health?
Provide in local currency (& USD$ official conversion) figures and % of annual Health Budget. This financial information is not collected specifically to Eye Health.
68
2. Disease Control
Cataract How many cataract surgeries were performed in the
public sector in this period? Eight Hundred and Forty-Five (845)
How many cataract surgeries were performed in the private sector in this period?
Information Not Available
How many cataract surgeries were performed by others in this period (e.g. Cuban initiative, volunteers, etc.)?
None. In 2010, the Barbados/Cuba Eye Care Programme – Operación Milagro was halted.
Total number of cataract surgeries for this period N/A
Are any eye departments in the country utilizing the cataract outcomes monitoring tool available at :
http://www.cehjournal.org/files/s1001.html
No
Glaucoma Is there a national glaucoma IEC (Information, Education, Communication) plan / programme being implemented in your country?
No
Are glaucoma eye medications included in the subsidized drug list?
Yes
Diabetic Retinopathy
Has a Diabetic retinopathy Services situation analysis been conducted in your country?
Yes – A Preliminary Situation Analysis Report on Eye Care Services in Barbados was completed in 2010
Is early detection (diabetics screening and referral) integrated in the national non-communicable chronic diseases program?
Yes
Is digital photography screening available in a. public sector, b. private sector
e. No f. Yes – Information
Not Available
Are diabetic patients routinely referred to ophthalmology units for examination?
No
Are laser treatment services available in c. public sector b. private sector
a. Yes – Eighty (80) b. Yes – Not Available
Childhood Blindness
Is there any documentation on causes of childhood blindness in the country?
Yes
Is there a national Retinopathy of Prematurity (ROP) prevention policy?
No
Are there ROP screening and treatment services available?
Yes
How many children were treated for ROP in this period? One Hundred (100)
69
Is eye care integrated into maternal and child health programs?
Yes – Through the primary health care system, there is one Ophthalmology unit at the Winston Scott Polyclinic which caters to the School Eye Care Services. Minor eye care conditions like conjunctivitis are managed at the primary care level by the Medical Officers in the 8 polyclinics in the country.
Are there any paediatric ophthalmologists and equipment to perform paediatric examinations and treatment?
Yes
Please provide the following information annually: 7. Total number of children examined in out-patients
departments of eye health facilities
8. Total number of paediatric cataract surgeries 9. Total number of other paediatric eye surgeries
1. Three thousand and eleven (3011) 2. Five (5)
Refractive Error
Are there refractive error services available in the public sector?
Yes – Refractive error services are available only for children ages 3 – 18 yrs.
Is there a school screening programme being implemented?
Yes – The School Eye Services Programme This was started in 1973 for the screening of children between the ages of 3-18yrs. (See Attached Report)
Are there spectacle labs producing affordable, quality spectacles (Affordable: Price not more than 3 days of salary of a medium income worker)
Yes
Provide the number of spectacles dispensed per year (from public and not-for-profit sector):
Public - 1015
Are there any programmes for detecting and treating presbyopia? (e.g. access to comprehensive eye examinations and reading glasses for people over 40 years of age)
No
Low Vision Are Low Vision services available with 7. Trained professional(s),
Yes- Prv. S No-Pub. S
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8. the necessary equipment and 9. Low Vision appliances available?
Please specify if in the public sector, private sector, both or none
Yes- Prv. S No-Pub. S Yes- Prv. S No-Pub. S
Inclusive Services
Are there any national plans for inclusive education?
No
Are there any national plans for rehabilitation / adjustment to blindness?
No
3. Human Resources
Ophthalmologists Total number of ophthalmologists in country
Twenty-two (22)
Total number of ophthalmologists performing surgery in public sector
Twelve (12)
Total number of ophthalmologists performing surgery in private sector
Not Available
Optometrists Number of Optometrists in public sector
Nil 0
Number of Optometrists in private sector
Thirty-three (33)
Refractionists Total number in country Not Available
Ophthalmic nurses Total number in country There are 11 Nurses and 1 Nursing Assistant trained in Ophthalmology. These individuals do not carry the title of Ophthalmic Nurse /Assistant
Ophthalmic assistants
Total number in country There are 11 Nurses and 1 Nursing Assistant trained in Ophthalmology. These individuals do not carry the title of Ophthalmic Nurse /Assistant
Primary Health Care personnel trained in Eye Health
Total number trained in this period: Nil
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4. Infrastructure
Is a Preventive Maintenance programme implemented in each hospital with an ophthalmology department?
No
Has an assessment of availability and adequacy of equipment at eye health facilities been carried out in this period?
No – The Preliminary Situational Analysis Report on Eye Care Services in Barbados was carried out in 2010
5. Qualitative assessment (related to the eye health action plan and/or strategic framework for country) Describe the major achievements in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period: N/A
Outline the major constrains in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period: N/A
What are the proposed actions to strengthen eye health services and prevention of blindness services in your country?
The Ministry of Health is in the process of establishing a National Committee on Eye Care Services in Barbados. The aim of the National Committee will be to develop and support a National Eye Care Policy and Strategic Plan that addresses the prevention of blindness and low vision in Barbados.
The following are the objectives of the National Committee: 1) To establish leadership and governance polices that ensures an effective and equitable
eye care system;
2) To develop strategies to assist in improving the health workforce to achieve the best eye care outcomes possible;
3) To facilitate provision of the necessary infrastructure, medical products, technology and services for eye care patients.
4) To identify mechanisms to include eye care in the Health Information System;
5) To develop cataract service plans that address equity and quality of service;
6) To identify strategies to reduce the prevalence of blindness from diabetic retinopathy and open-angle glaucoma;
7) To determine strategies to reduce blindness and visual impairment in children;
8) To develop national policies on comprehensive low-vision care;
9) To increase public knowledge of prevention of blindness and low vision and utilization of eye care services
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What are the proposed actions to strengthen inclusive education services in your country? The Ministry of Health has not identified specific actions to strengthen inclusive education services in Barbados
What are the proposed actions to strengthen rehabilitation / adjustment to blindness services in your country? The Ministry of Health has not identified specific actions to strengthen rehabilitation/adjustment to blindness services in Barbados.
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National VISION 2020 Data Country: Belize
Year of data: 2011 Country Population: 330,000
Source(s) of National V2020 data: The Belize Council for the Visually Impaired (BCVI)
Approved by VISION 2020 National Committee or MOH: No
1. Central Organization, Leadership and Governance Is there a signed National Declaration in support of VISION 2020?
YES, signed in April 2001 by Said Musa, who was then the Prime Minister
Did your country celebrate World Sight Day or other eye health related days in this period?
YES – TV, Radio and social media, Public Awareness activities on major blinding conditions (by BCVI)
Is there an active National Vision 2020 Committee
NO
Was there a National V2020 workshop / meeting / conference organized in the past year?
NO
Is there a designated focal person to assist the V2020 Committee and MoH?
NO Provide contact information:
Is there a National Vision 2020 strategic framework approved by the Ministry of Health?
YES There is a National Eye Health Plan 2010 - 2014
Is your country implementing a National Vision 2020 plan?
YES BCVI continues to provide the public eye care for the country
Is eye health included in National health plans, policies and systems?
NO
What is the Governments financial contribution to Eye Health?
Provide in local currency (& USD$ official conversion) figures and % of annual Health Budget. BCVI received a total of BZ$120,000 (US$60,000) from MOH and NHI in 2011.
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2. Disease Control
Cataract How many cataract surgeries were performed in
the public sector in this period? 225
How many cataract surgeries were performed in the private sector in this period?
N/A
How many cataract surgeries were performed by others in this period (e.g. Cuban initiative, volunteers, etc.)?
N/A
Total number of cataract surgeries for this period 225 plus
Are any eye departments in the country utilizing the cataract outcomes monitoring tool available at :
http://www.cehjournal.org/files/s1001.html
NO
Glaucoma Is there a national glaucoma IEC (Information, Education, Communication) plan / programme being implemented in your country?
NO
Are glaucoma eye medications included in the subsidized drug list?
NO
Diabetic Retinopathy
Has a Diabetic retinopathy Services situation analysis been conducted in your country?
NO
Is early detection (diabetics screening and referral) integrated in the national non-communicable chronic diseases program?
NO
Is digital photography screening available in a. public sector, b. private sector
g. NO h. NO
Are diabetic patients routinely referred to ophthalmology units for examination?
NO
Are laser treatment services available in d. public sector b. private sector
a. YES -203 b. YES – N/A
Childhood Blindness
Is there any documentation on causes of childhood blindness in the country?
YES BCVI’s register of people who are blind
Is there a national Retinopathy of Prematurity (ROP) prevention policy?
NO
Are there ROP screening and treatment services available?
NO
How many children were treated for ROP in this period?
NONE
Is eye care integrated into maternal and child health programs?
NO
Are there any paediatric ophthalmologists and equipment to perform paediatric examinations and
NO
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treatment?
Please provide the following information annually: 10. Total number of children examined in out-patients
departments of eye health facilities 11. Total number of paediatric cataract surgeries 12. Total number of other paediatric eye surgeries
1. 750 2. 5 3. 11 strabismus
Refractive Error
Are there refractive error services available in the public sector?
YES –BCVI operates 5 clinics strategically located around the country
Is there a school screening programme being implemented?
NO
Are there spectacle labs producing affordable, quality spectacles (Affordable: Price not more than 3 days of salary of a medium income worker)
YES
Provide the number of spectacles dispensed per year (from public and not-for-profit sector):
3779
Are there any programmes for detecting and treating presbyopia? (e.g. access to comprehensive eye examinations and reading glasses for people over 40 years of age)
YES
Low Vision Are Low Vision services available with 10. Trained professional(s), 11. the necessary equipment and 12. Low Vision appliances available?
Please specify if in the public sector, private sector, both or none
YES – 2 optometrists YES YES At BCVI
Inclusive Services
Are there any national plans for inclusive education?
YES -50 children who are blind in regular schools
Are there any national plans for rehabilitation / adjustment to blindness?
YES – BCVI runs a rehabilitation programme
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3. Human Resources
Ophthalmologists Total number of ophthalmologists in country
3 – All in private practice
Total number of ophthalmologists performing surgery in public sector
BCVI uses volunteers, mainly from USA
Total number of ophthalmologists performing surgery in private sector
3
Optometrists Number of Optometrists in public sector
4 working with BCVI
Number of Optometrists in private sector
None
Refractionists Total number in country 0
Ophthalmic nurses Total number in country 2
Ophthalmic assistants
Total number in country 4 with BCVI
Primary Health Care personnel trained in Eye Health
Total number trained in this period: 0 Brief description of training activity(s)
4. Infrastructure
Is a Preventive Maintenance programme implemented in each hospital with an ophthalmology department?
NO
Has an assessment of availability and adequacy of equipment at eye health facilities been carried out in this period?
NO
5. Qualitative assessment (related to the eye health action plan and/or strategic framework for country) Describe the major achievements in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period: (by BCVI)
There were no new cases of ROP due to training with neonatal unit of main hospital in previous years
More people with diabetes referred for eye examination – limited number of examinations covered by NHI
Belize Health Information System (BHIS) fully implemented at BCVI’s 6 clinics
Outline the major constrains in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period:
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Lack of inclusion of eye health in MOH’s plans and policies
What are the proposed actions to strengthen eye health services and prevention of blindness services in your country? BCVI will continue advocacy efforts
What are the proposed actions to strengthen inclusive education services in your country? All children with LV have been assessed and have received the appropriate LV aid. All children who are blind have been successfully placed in their local school. However, they receive no support from the MOE. BCVI has contracted a Braille teacher for 2013 and will continue to produce Braille materials and introduce IT skills.
What are the proposed actions to strengthen rehabilitation / adjustment to blindness services in your country? BCVI will continue its countrywide rehabilitation programme. Special emphasis will be placed on job placement and income generation for young adults.
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National VISION 2020 Data Country: Dominica
Year of data: 2011-2012 Country Population: 70,000
Source(s) of National V2020 data: Primary Health/ Princess Margaret Hospital
Approved by VISION 2020 National Committee or MOH: Yes
1. Central Organization, Leadership and Governance Is there a signed National Declaration in support of VISION 2020?
No
Did your country celebrate World Sight Day or other eye health related days in this period?
Yes Oct 11, 2012 World sight day observance theme was
"The Integrated Eye Care Team –
Working Together to Eliminate
Avoidable Blindness”
with a radio speech by the Minister of Health, talk shows by ophthalmologist both in Creole and English and presentation to patients attending eye clinic
Is there an active National Vision 2020 Committee
No –
Was there a National V2020 workshop / meeting / conference organized in the past year?
No
Is there a designated focal person to assist the V2020 Committee and MoH?
No The Director of Primary Health Care was recommended to be the Focal Person
Is there a National Vision 2020 strategic framework approved by the Ministry of Health?
No There is a draft awaiting approval by the Ministry of Health
Is your country implementing a National Vision 2020 plan?
Yes Eye care is provided free to those 18 and younger and 60 and older in the Public health sector. Cataract surgical rate over 2000 have been achieved. Opportunistic screening for glaucoma for all attending eye clinic. Glaucoma meds are provided at a subsidized cost. Diabetic fundus photography screening and
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laser treatment are available in the public sector free of charge. Screening for retinopathy of prematurity and school vision screening have reached over 90% of target. Excellent immunization and maternal and child has resulted in elimination of blindness from measles, rubella and vitamin A deficiency. Refraction is performed for all as indicated and prescription provided for spectacles.
Is eye health included in National health plans, policies and systems?
Yes National Strategic Plan For Health 2010- 2019
What is the Governments financial contribution to Eye Health?
There is no program based budgeting. Expenditure is through Budget for Primary Health Care and Secondary Care at the Main Hospital.
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2. Disease Control
Cataract How many cataract surgeries were performed in
the public sector in this period? Jan-Dec 2011- 142 Jan- Oct 2012- 154
How many cataract surgeries were performed in the private sector in this period?
None
How many cataract surgeries were performed by others in this period (e.g. Cuban initiative, volunteers, etc.)?
None
Total number of cataract surgeries for this period 2011-142; 2012 154
Are any eye departments in the country utilizing the cataract outcomes monitoring tool available at :
http://www.cehjournal.org/files/s1001.html
No
Glaucoma Is there a national glaucoma IEC (Information, Education, Communication) plan / programme being implemented in your country?
No
Are glaucoma eye medications included in the subsidized drug list?
Yes Timoptic, Pilocarpine & Diamox are provided free of charge. Alphagan, Cosopt, Trusopt xalatan, Lumigan are sold at cost price which is approx.. 50% of the cost in the private pharmacies.
Diabetic Retinopathy
Has a Diabetic retinopathy Services situation analysis been conducted in your country?
No
Is early detection (diabetics screening and referral) integrated in the national non-communicable chronic diseases program?
Yes
Is digital photography screening available in a. public sector, b. private sector
i. Yes – j. Jan-Dec 2012
748 screened 96 referred 60 DR 36 No DR Sept-Oct 2012 275 screened 41 referred 20 DR 21 No DR
k. Just obtained camera
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Are diabetic patients routinely referred to ophthalmology units for examination?
Yes– Numbers Not available
Are laser treatment services available in e. public sector
b. private sector
a. Yes – b. Jan-Dec 2011
PRP 26, CSME 12 Augment PRP 4 CSME 9 Jan-Oct 2012 PRP 20, CSME 6 Augment PRP 5 laser was non-operational for 6 months
c. None
Childhood Blindness
Is there any documentation on causes of childhood blindness in the country?
No
Is there a national Retinopathy of Prematurity (ROP) prevention policy?
No
Are there ROP screening and treatment services available?
Yes
How many children were treated for ROP in this period?
Oct 2011-Nov 2012 15 premature babies screened. None required treatment
Is eye care integrated into maternal and child health programs?
Yes Neonatology screening and school health programmes.
Are there any paediatric ophthalmologists and equipment to perform paediatric examinations and treatment?
No Paediatric Ophthalmologist
Please provide the following information annually: 13. Total number of children examined in out-patients
departments of eye health facilities 14. Total number of paediatric cataract surgeries 15. Total number of other paediatric eye surgeries
Not available No cataract surgeries performed Other surgeries 2011 – 5 2012 - 7
Refractive Error
Are there refractive error services available in the public sector?
Yes : All patients examined are refracted as indicated and
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spectacle prescribed
Is there a school screening programme being implemented?
Yes – Screening is performed for all new entrants and those leaving primary school. This is part of Primary Health Care school Health Programme. Those who fail the screening criteria are referred to see the ophthalmologist. The school year 2011-2012 2505 screened 194 failed
Are there spectacle labs producing affordable, quality spectacles (Affordable: Price not more than 3 days of salary of a medium income worker)
There is one finishing spectacle lab in Dominica
Provide the number of spectacles dispensed per year (from public and not-for-profit sector):
Rotary assisted VOSH program and faith based charity groups provide spectacles to hundreds of needy persons during Ad hoc campaigns.
Are there any programmes for detecting and treating presbyopia? (e.g. access to comprehensive eye examinations and reading glasses for people over 40 years of age)
Yes
Low Vision Are Low Vision services available with 13. Trained professional(s), 14. the necessary equipment and 15. Low Vision appliances available?
Please specify if in the public sector, private sector, both or none
1.Yes in public sector 2. No 3. No
Inclusive Services
Are there any national plans for inclusive education? Yes
Are there any national plans for rehabilitation / adjustment to blindness?
No –
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3. Human Resources
Ophthalmologists Total number of ophthalmologists in country
One
Total number of ophthalmologists performing surgery in public sector
One
Total number of ophthalmologists performing surgery in private sector
None
Optometrists Number of Optometrists in public sector
None
Number of Optometrists in private sector
One
Refractionists Total number in country
Ophthalmic nurses Total number in country One
Ophthalmic assistants
Total number in country Two
Primary Health Care personnel trained in Eye Health
Total number trained in this period: Sept 27, 2012 8-Family Nurse Practitioners 1-District Medical Doctor attended an in-service education session on V2020 programmes and Millennium Dev Goals facilitated by Ophthalmologist
4. Infrastructure
Is a Preventive Maintenance programme implemented in each hospital with an ophthalmology department?
No
Has an assessment of availability and adequacy of equipment at eye health facilities been carried out in this period?
Yes Slit lamp, laser unit, tonopen, projectors, chairs, lensemeter, operating microscope were poorly functional.
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5. Qualitative assessment (related to the eye health action plan and/or strategic framework for country) Describe the major achievements in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period: Upgrading of some of the eye equipment in the public sector: Laser Unit, Slit Lamp, Lensometer were purchased A non-mydriatic fundus camera is now available for screening in the private sector The first Friday of each month has been designated exclusively as an eye clinic for children especially those referred from the school vision program A successful Glaucoma Week of Activities climaxed with an exhibition and screening at the Princess Margaret Hospital May 29, 2012 a video titled “Vision 2020 and Dominica: Lighting the Darkness” was uploaded on You Tube at http://bouzaiproductions.weebly.com. It was an initiative of the Dominica Association of Persons with Disability and the Eye Clinic, Princess Margaret Hospital. Attendance at the 9th General Assembly of the International Agency for the prevention of Blindness in Hyderabad, India September 17-20, 2012 provided information used to guide government on vision screening for children
Outline the major constrains in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period: Lack of adequate financial resources from the government Despite passionate followup and presentation by the National Drug Committee to have the glaucoma medications: Trusopt, Cosopt, Alphagan and Xalatan/Lumigan included in the formulary, funds were not allocated to do so. Failure to reach the targeted number of diabetics for fundus photography approx. 3000:
o Unavailability of the Ophthalmic Technician conducting the Diabetic fundus photography screening program (reassignment, vacation and sick leave).
o Lack of optimal support from Primary Health Care for the diabetic screening program in protecting time when screening clinics are booked
o Lack of optimal transportation to the outlying districts
What are the proposed actions to strengthen eye health services and prevention of blindness services in your country? Adoption of the National Strategic Plan for Eye Care in Dominica. A new eye clinic with more space to accommodate additional services and staff. Digitalization of clinic data. Introduction of ‘The Healthy Eyes Activity Book’ in Primary Schools Commencement of the Dominican Glaucoma Laser Program Reactivation of the National Prevention of Blindness Committee Removal of VAT on spectacles to make them more affordable. Improving the diabetic fundus photography screening program both in the private and public sector.
What are the proposed actions to strengthen inclusive education services in your country? Ministry of Education have developed a plan of action but a partnership with the Ministry of Health has to be strengthened on that initiative.
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What are the proposed actions to strengthen rehabilitation / adjustment to blindness services in your country? Education and training of persons as Rehabilitative Officers for the Blind, especially those involved in the ‘Yes We Care’ Program.
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National VISION 2020 Data Country: Grenada Year of data: 2011-11- 2012-11
Country Population: 108,000 Source(s) of National V2020 data: Ministry of Health
Approved by VISION 2020 National Committee or MOH: Yes
1. Central Organization, Leadership and Governance Is there a signed National Declaration in support of VISION 2020?
Y/N - If yes, give date signed and name of Signatory
Did your country celebrate World Sight Day or other eye health related days in this period?
Yes May 31st 2012 School children and the business community supported World sight by wearing white ribbon
Is there an active National Vision 2020 Committee
Yes ,monthly
Was there a National V2020 workshop / meeting / conference organized in the past year?
General monthly meeting
Is there a designated focal person to assist the V2020 Committee and MoH?
Y/N Dr E. Francis Martin, Director Director Primary Health Care Email-mezzeal@gmail.com
Is there a National Vision 2020 strategic framework approved by the Ministry of Health?
Y/N Provide an electronic copy:
Is your country implementing a National Vision 2020 plan?
Yes The committee meets regularly to ensure that plans are implementing and programs run smoothly.
Is eye health included in National health plans, policies and systems?
Y/N Provide reference and electronic copy of relevant policies, plans:
What is the Governments financial contribution to Eye Health?
Provide in local currency (& USD$ official conversion) figures and % of annual Health Budget.
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2. Disease Control
Cataract How many cataract surgeries were performed in
the public sector in this period? 83
How many cataract surgeries were performed in the private sector in this period?
30
How many cataract surgeries were performed by others in this period (e.g. Cuban initiative, volunteers, etc.)?
10
Total number of cataract surgeries for this period
Are any eye departments in the country utilizing the cataract outcomes monitoring tool available at :
http://www.cehjournal.org/files/s1001.html
No
Glaucoma Is there a national glaucoma IEC (Information, Education, Communication) plan / programme being implemented in your country?
No, just routine patient education from the eye clinic
Are glaucoma eye medications included in the subsidized drug list?
Yes, there is also a list of the glaucoma patients at the ministry of health
Diabetic Retinopathy
Has a Diabetic retinopathy Services situation analysis been conducted in your country?
No
Is early detection (diabetics screening and referral) integrated in the national non-communicable chronic diseases program?
Yes
Is digital photography screening available in a. public sector, b. private sector
No No
Are diabetic patients routinely referred to ophthalmology units for examination?
Yes
Are laser treatment services available in f. public sector b. private sector
a. Yes 10 monthly
Childhood Blindness
Is there any documentation on causes of childhood blindness in the country?
Yes
Is there a national Retinopathy of Prematurity (ROP) prevention policy?
no
Are there ROP screening and treatment services available?
No, visiting surgeons provide services occasionally
How many children were treated for ROP in this period?
6
Is eye care integrated into maternal and child health programs?
No
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Are there any paediatric ophthalmologists and equipment to perform paediatric examinations and treatment?
No paediatric Ophthalmologist. Limited equipments available
Please provide the following information annually: 16. Total number of children examined in out-patients
departments of eye health facilities 17. Total number of paediatric cataract surgeries 18. Total number of other paediatric eye surgeries
950 No paediatric eye surgeries exempt for 4 emergency operations.
Refractive Error
Are there refractive error services available in the public sector?
No
Is there a school screening programme being implemented?
Yes
Are there spectacle labs producing affordable, quality spectacles (Affordable: Price not more than 3 days of salary of a medium income worker)
Yes No
Provide the number of spectacles dispensed per year (from public and not-for-profit sector):
Not available
Are there any programmes for detecting and treating presbyopia? (e.g. access to comprehensive eye examinations and reading glasses for people over 40 years of age)
Yes in the private sector
Low Vision Are Low Vision services available with 16. Trained professional(s), 17. the necessary equipment and 18. Low Vision appliances available?
Please specify if in the public sector, private sector, both or none
Y/N Y/N Y/N
Inclusive Services
Are there any national plans for inclusive education?
Yes no electronic copy
Are there any national plans for rehabilitation / adjustment to blindness?
Yes no electronic copy
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3. Human Resources
Ophthalmologists Total number of ophthalmologists in country
3
Total number of ophthalmologists performing surgery in public sector
2
Total number of ophthalmologists performing surgery in private sector
2
Optometrists Number of Optometrists in public sector
0
Number of Optometrists in private sector
4
Refractionists Total number in country
Ophthalmic nurses Total number in country 0
Ophthalmic assistants
Total number in country 1
Primary Health Care personnel trained in Eye Health
Total number trained in this period: 0
4. Infrastructure
Is a Preventive Maintenance programme implemented in each hospital with an ophthalmology department?
Yes same is presently disrupted
Has an assessment of availability and adequacy of equipment at eye health facilities been carried out in this period?
Yes
5. Qualitative assessment (related to the eye health action plan and/or strategic framework for country) Describe the major achievements in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period: Was able to perform more cataract surgeries Also provided health information by private sponsor Was able to conduct district clinic with an ophthalmologist,(Cuban initiative)
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Outline the major constrains in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period: Lack of existing department building presently Lack of trained staff (doctors and nurses) in ophthalmology Lack of equipments and instruments to perform basic procedures Lack of advocacy due to dysfunctional national prevention of blindness society Lack of specific budgetary allocation towards eye programs
What are the proposed actions to strengthen eye health services and prevention of blindness services in your country? Continue with the national prevention of blindness programs/VISION 2020 national plan Greater involvement and integration of the public/private sector in the national VISION 2020 plans More public awareness and education programs.
What are the proposed actions to strengthen inclusive education services in your country? National education in regards to risk factors. Persons with risk factors (over forty years, family history) should look for an eye exam. i.e. optic disc assessment plus IOP Identify opportunities for adding basic screening methods for chronic diseases. To re-establish an allied health personnel program in ophthalmology.
What are the proposed actions to strengthen rehabilitation / adjustment to blindness services in your country? To reduce the causes of preventable blindness in Grenada through implementing programs of VISION 2020 which comprise of;
Disease control
Human resource development and
The availability of infrastructure and technologies.
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National VISION 2020 Data Country: Guyana
Year of data: 2011 Country Population: 751,223
Source(s) of National V2020 data: Situation Analysis
Approved by VISION 2020 National Committee or MOH: Yes
1. Central Organization, Leadership and Governance Is there a signed National Declaration in support of VISION 2020?
Yes
Did your country celebrate World Sight Day or other eye health related days in this period?
Yes
Is there an active National Vision 2020 Committee
Yes
Was there a National V2020 workshop / meeting / conference organized in the past year?
No – if yes state the focus / theme of the activity
Is there a designated focal person to assist the V2020 Committee and MoH?
Yes Provide contact information: Mr. Baldeo James
Chief Medex
Ministry of Health
Tel: 226- 1560 or 614 7922 Email: bjames@health.gov.gy
Is there a National Vision 2020 strategic framework approved by the Ministry of Health?
Not as yet Provide an electronic copy:
Is your country implementing a National Vision 2020 plan?
No Briefly explain and provide results /progress:
Is eye health included in National health plans, policies and systems?
No Provide reference and electronic copy of relevant policies, plans:
What is the Governments financial contribution to Eye Health?
Provide in local currency (& USD$ official conversion) figures and % of annual Health Budget. G $ 96 Million / US $ 480 Thousand
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2. Disease Control
Cataract How many cataract surgeries were performed in
the public sector in this period? 575 at GPHC and 489 at Port Mourant Hospital by the Cuban team.
How many cataract surgeries were performed in the private sector in this period?
Approximately, 650 cataract operations were performed in the private sector.
How many cataract surgeries were performed by others in this period (e.g. Cuban initiative, volunteers, etc.)?
489 at Port Mourant Hospital by the Cuban team.
Total number of cataract surgeries for this period 1714
Are any eye departments in the country utilizing the cataract outcomes monitoring tool available at :
http://www.cehjournal.org/files/s1001.html
No
Glaucoma Is there a national glaucoma IEC (Information, Education, Communication) plan / programme being implemented in your country?
No
Are glaucoma eye medications included in the subsidized drug list?
Yes All medications are completely free.
Diabetic Retinopathy
Has a Diabetic retinopathy Services situation analysis been conducted in your country?
No
Is early detection (diabetics screening and referral) integrated in the national non-communicable chronic diseases program?
No
Is digital photography screening available in a. public sector, b. private sector
l. No m. No
Are diabetic patients routinely referred to ophthalmology units for examination?
No. Not routine.
Are laser treatment services available in g. public sector b. private sector
a. No b. Yes – (Data not
available)
Childhood Blindness
Is there any documentation on causes of childhood blindness in the country?
No
Is there a national Retinopathy of Prematurity (ROP) prevention policy?
No
Are there ROP screening and treatment services available?
Yes, Only screening.
How many children were treated for ROP in this period?
None
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Is eye care integrated into maternal and child health programs?
Yes.
Are there any paediatric ophthalmologists and equipment to perform paediatric examinations and treatment?
No paediatric ophthalmologists. Paediatric examination equipment is limitedly available.
Please provide the following information annually: 19. Total number of children examined in out-
patients departments of eye health facilities 20. Total number of paediatric cataract surgeries 21. Total number of other paediatric eye surgeries
Data not available
Refractive Error
Are there refractive error services available in the public sector?
Yes, this is done through Eye Care Guyana/ Government.
Is there a school screening programme being implemented?
Yes
Are there spectacle labs producing affordable, quality spectacles (Affordable: Price not more than 3 days of salary of a medium income worker)
Yes. Eye Care Guyana Lab produces spectacles which is priced between G$6,500-10,000
Provide the number of spectacles dispensed per year (from public and not-for-profit sector):
6596 spectacles were
dispense for 2011
Are there any programmes for detecting and treating presbyopia? (e.g. access to comprehensive eye examinations and reading glasses for people over 40 years of age)
Yes
Low Vision Are Low Vision services available with 19. Trained professional(s),
20. the necessary equipment and 21. Low Vision appliances available?
Please specify if in the public sector, private sector, both or none
1. Yes 2. Limited equipment 3. Extremely limited (All public sector)
Inclusive Services
Are there any national plans for inclusive education?
Yes ( Copy of the Document needed)
Are there any national plans for rehabilitation / adjustment to blindness?
No. Services are available but not under any formal regulation.
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3. Human Resources
Ophthalmologists Total number of ophthalmologists in country
13
Total number of ophthalmologists performing surgery in public sector
7
Total number of ophthalmologists performing surgery in private sector
2
Optometrists Number of Optometrists in public sector
2
Number of Optometrists in private sector
13
Refractionists Total number in country 12
Ophthalmic nurses Total number in country 24 ( this figure is for both Ophthalmic nurses/assistants)
Ophthalmic assistants
Total number in country
Primary Health Care personnel trained in Eye Health
Total number trained in this period: 37
This training seeks to
promote Eye health
awareness and screening of
children and adults at the
community level. It will also
develop the ability in the
persons trained to identify
and refer cases.
4. Infrastructure
Is a Preventive Maintenance programme implemented in each hospital with an ophthalmology department?
No
Has an assessment of availability and adequacy of equipment at eye health facilities been carried out in this period?
No
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5. Qualitative assessment (related to the eye health action plan and/or strategic framework for country) Describe the major achievements in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period:
Decrease in cataract surgery load ;
Establishment of Vision Centres in 8 of the 10 administrative regions;
Two medical doctors are on scholarships being trained as Ophthalmologists;
Continuation of the BSc Optometry program started at University of Guyana
Establishment of National Eye Hospital in outlying region.
Outline the major constrains in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period:
Shortage of trained eye care personnel to reach the entire population
Lack of Ophthalmic equipment in hospitals
Lack of financial resources for training and to equip hospitals
Available services are overburdened
Services still not accessible to all
What are the proposed actions to strengthen eye health services and prevention of blindness services in your country?
Train more eye care personnel at all levels;
Need for more outreach activities to make services more accessible to all;
Upgrade GPHC Ophthalmology Department to a tertiary level
Placement of trained eye care personnel at regional centres
What are the proposed actions to strengthen inclusive education services in your country?
Training of teachers
Provision of Learning material and equipment.
What are the proposed actions to strengthen rehabilitation / adjustment to blindness services in your country?
Develop a national plan for rehabilitation services/ adjustment to blindness services
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National VISION 2020 Data Country: Haiti
Year of data: 2012 Country Population: 10 000
Source(s) of National V2020 data: CNPC-Haiti
Approved by VISION 2020 National Committee or MOH: Y Y/N
1. Central Organization, Leadership and Governance Is there a signed National Declaration in support of VISION 2020?
Y 2000
Did your country celebrate World Sight Day or other eye health related days in this period?
Y World Glaucoma day : Television Conference and an open clinic day World Sight day : Interview on radios
Is there an active National Vision 2020 Committee
Y The Committee meets two times a month
Was there a National V2020 workshop / meeting / conference organized in the past year?
N
Is there a designated focal person to assist the V2020 Committee and MoH?
Y/N Provide contact information: Valery Blot (cnpcht@gmail.com, valeryblot@yahoo.fr )
Is there a National Vision 2020 strategic framework approved by the Ministry of Health?
Y/N Provide an electronic copy: we do have one National V2020 plan that has been shared with the MOH, but not officially approved. But now now we have a signed contract with the MOH since June 2012 recognizing our work.
Is your country implementing a National Vision 2020 plan?
Y/N Briefly explain and provide results /progress: Y Human Resources : 6 residents are in ophthalmology, 3 optometrist are in training Infrastructure: 2 hospitals has been provided with equipment
Is eye health included in National health plans, policies and systems?
Y/N Provide reference and electronic copy of relevant policies, plans:
What is the Governments financial contribution to Eye Health?
The MOH does not have a financial contribution particularly for eye care, this year 9% of the budget is allocated to health versus 5% last year. The way the government contributes is
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by paying salary of the ophthalmologists that works in government institutions, and within those institutions they put regular nurses to work in the services. For materials, the service of ophthalmology does a requisition just like other services, and they are given only when available.
2. Disease Control
Cataract How many cataract surgeries were performed in
the public sector in this period? 1509
How many cataract surgeries were performed in the private sector in this period?
-
How many cataract surgeries were performed by others in this period ? other here are institution finance by NGO, church
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Total number of cataract surgeries for this period
Are any eye departments in the country utilizing the cataract outcomes monitoring tool available at :
http://www.cehjournal.org/files/s1001.html
Don’t know
Glaucoma Is there a national glaucoma IEC (Information, Education, Communication) plan / programme being implemented in your country?
We do not have a national program, but we do sensitisation on the spot
Are glaucoma eye medications included in the subsidized drug list?
No
Diabetic Retinopathy
Has a Diabetic retinopathy Services situation analysis been conducted in your country?
N.
Is early detection (diabetics screening and referral) integrated in the national non-communicable chronic diseases program?
N
Is digital photography screening available in a. public sector, b. private sector
n. Y/N – state number screened
o. Y/N – state number screened
Are diabetic patients routinely referred to ophthalmology units for examination?
N
Are laser treatment services available in h. public sector (Is non in the public sector, if not
please indicate) b. private sector
1 only in the private sector
Childhood Blindness
Is there any documentation on causes of childhood blindness in the country?
No
Is there a national Retinopathy of Prematurity (ROP) prevention policy?
No
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Are there ROP screening and treatment services available?
No
How many children were treated for ROP in this period?
We do not have that information
Is eye care integrated into maternal and child health programs?
No
Are there any paediatric ophthalmologists and equipment to perform paediatric examinations and treatment?
No
Please provide the following information annually: 22. Total number of children examined in out-patients
departments of eye health facilities 23. Total number of paediatric cataract surgeries 24. Total number of other paediatric eye surgeries
We do not have that information
Refractive Error
Are there refractive error services available in the public sector?
Yes, we have 3 public institutions that provide eye care. They have basic materials to the refraction and prescribe glasses (eye charts, box of glass)
Is there a school screening programme being implemented?
Y A school screening program was happening in form of a project by a partner (Iris Mundial in one locality) but there is not yet a government program for that.
Are there spectacle labs producing affordable, quality spectacles (Affordable: Price not more than 3 days of salary of a medium income worker)
No we do not have one, but we plan to have one at SHAA
Provide the number of spectacles dispensed per year (from public and not-for-profit sector):
No available
Are there any programmes for detecting and treating presbyopia? (e.g. access to comprehensive eye examinations and reading glasses for people over 40 years of age)
Y/N
Low Vision Are Low Vision services available with 22. Trained professional(s),
N
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23. the necessary equipment and 24. Low Vision appliances available?
Please specify if in the public sector, private sector, both or none
N N
Inclusive Services
Are there any national plans for inclusive education?
Yes there is a plan with the Ministry of education 2011-2016
Are there any national plans for rehabilitation / adjustment to blindness?
No, all the activity in that sector are within a project with NGOS
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3. Human Resources
Ophthalmologists Total number of ophthalmologists in country
58
Total number of ophthalmologists performing surgery in public sector
5
Total number of ophthalmologists performing surgery in private sector
58
Optometrists Number of Optometrists in public sector
0
Number of Optometrists in private sector
3
Refractionists Total number in country 3
Ophthalmic nurses Total number in country 0
Ophthalmic assistants
Total number in country 0
Primary Health Care personnel trained in Eye Health
Total number trained in this period: 50
They trained in simple eye care for the community.
4. Infrastructure
Is a Preventive Maintenance programme implemented in each hospital with an ophthalmology department?
N
Has an assessment of availability and adequacy of equipment at eye health facilities been carried out in this period?
Y Lack of equipment, ancient equipments
5. Qualitative assessment (related to the eye health action plan and/or strategic framework for country) Describe the major achievements in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period:
- Signed document with the MOH in July 2012 - Participation in putting primary eye care in the curricula of health agents
Outline the major constrains in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period:
- Not enough advocacy with all actors on the field to understand the concept of blindness prevention.
- Lack of financial autonomy for CNPC - Lack of message of education for the population
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What are the proposed actions to strengthen eye health services and prevention of blindness services in your country?
- Increase Communication - Increase the pool of persons working in eye care
What are the proposed actions to strengthen inclusive education services in your country? - Training of teachers - Training school in education skills for different subject as maths... - Utilization of new logistics for education - Reinforcing education by providing more adapted equipment
What are the proposed actions to strengthen rehabilitation / adjustment to blindness services in your country?
- Integrating activities to do screening with various institutions (e.g. HUEH, with CNPC when we do mobile clinic)
- Supervision and Evaluation RFO on a regularly basis to reinforce the work.
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National VISION 2020 Data Country: Jamaica
Date: September, 2012 Country Population: 2.706,300 (STATIN, 2011)1
Source(s) of National V2020 data: MOH
Approved by VISION 2020 National Committee or MOH: Y/N
1. Central Organization, Leadership and Governance Is there a signed National Declaration in support of VISION 2020?
Y/N - If yes, give date signed and name of Signatory
Did your country celebrate World Sight Day or other eye health related days in this period?
Y/N – if yes include a brief summary of activities Celebration 2012 to include Press release (PAHO/MOH)& local displays on diabetic eye disease
Is there an active National Vision 2020 Committee
Y/N – if yes how frequently does the Committee meet? “Small groupings” of persons, each grouping (subcommittee) working on a specific strategic direction. Expect in the coming months to launch an overarching Committee, to facilitate monitoring, coordination etc. MOH actively seeking a Chairman
Was there a National V2020 workshop / meeting / conference organized in the past year?
Y/N – if yes state the focus / theme of the activity No major workshop/meeting this year. Smaller group meetings held.
Is there a designated focal person to assist the V2020 Committee and MoH?
Y/N Provide contact information: In the MOH, the current focal is Dr. Yasmin Williams( williamsy@moh.gov.jm)
Is there a National Vision 2020 strategic framework approved by the Ministry of Health?
Y/N Provide an electronic copy: Draft Strategic Plan for finalization
Is your country implementing a National Vision 2020 plan?
Y/N Briefly explain and provide results /progress: Yes. 1) Development of policyguidelines for management of: a)Retinopathy of Prematurity
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b) Programs for detecting refractive errors in Children 2) Development of a pilot project targeting diabetic retinopathy/diabetic eye disease
Is eye health included in National health plans, policies and systems?
Y/N Provide reference and electronic copy of relevant policies, plans: Dialogue ongoing for inclusion of eye health in adolescent strategic plan (refractive error in school children), safe motherhood (ROP) and PAHO/MOH Improvement of Health Information System
What is the Governments financial contribution to Eye Health?
Provide in local currency (& USD$ official conversion) figures and % of annual Health Budget. No specific budget for “EYE Health”, integrated in budget for primary and secondary health care service delivery
104
2. Disease Control
Cataract How many cataract surgeries were performed in
the public sector in this period? All data from regional public hospitals not currently available. Data only available for patients admitted as inpatients at the Regional Hospitals (as per table attached)
How many cataract surgeries were performed in the private sector in this period?
Not known
How many cataract surgeries were performed by others in this period (e.g. Cuban initiative, volunteers, etc.)?
For data from Cuba/ Jamaica Program, see table attached to this form
Total number of cataract surgeries for this period Unable to say right now
Are any eye departments in the country utilizing the cataract outcomes monitoring tool available at :
http://www.cehjournal.org/files/s1001.html
Y/N
Glaucoma Is there a national glaucoma IEC (Information, Education, Communication) plan / programme being implemented in your country?
Y/N – if yes provide a brief description
Are glaucoma eye medications included in the subsidized drug list?
Y/N – if yes provide a brief explanation Glaucoma medication available from the public health facilities. Additionally all citizens can access subsidized glaucoma medications through the Government’s NHF programme which supports persons with chronic diseases for access medication
Diabetic Retinopathy
Has a Diabetic retinopathy Services situation analysis been conducted in your country?
Y/N – if yes state when the analysis was carried out.
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Is early detection (diabetics screening and referral) integrated in the national non-communicable chronic diseases program?
Y/N
Is digital photography screening available in a. public sector, Not yet b. private sector, Yes
p. Y/N – state number screened
q. Y/N – state number screened Unable to state
Are diabetic patients routinely referred to ophthalmology units for examination?
Y/N – state number referred
Are laser treatment services available in i. public sector . Yes b. private sector Yes
a. Y/N – state number treated # only currently available for Cuba Jamaica Program
b. Y/N – state number treated
Unable to state #s Treated
Childhood Blindness
Is there any documentation on causes of childhood blindness in the country? None known
Y/N – if yes provide electronic copy
Is there a national Retinopathy of Prematurity (ROP) prevention policy? Yes
Y/N – please provide electronic copy
Are there ROP screening and treatment services available? Yes
Y/N
How many children were treated for ROP in this period? Data only available for Bustamante Hospital
See attached table
Is eye care integrated into maternal and child health programs?
Y/N – if yes, how? To some extent as part of neonatal care
Are there any paediatric ophthalmologists and equipment to perform paediatric examinations and treatment?
Y/N No pediatric ophthalmologist but equipment at Bustamante Children Hospital
Please provide the following information annually: 25. Total number of children examined in out-patients
departments of eye health facilities 26. Total number of paediatric cataract surgeries 27. Total number of other paediatric eye surgeries
See attached table
Refractive Error
Are there refractive error services available in the public sector?
Y/N – if yes provide a brief description No specific programme thrust in
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the public sector where refraction would be done as part of routine eye exam as needed
Is there a school screening programme being implemented?
Y/N – if yes provide a brief description Support ongoing by NGOs. Needing coordination, Monitoring and support
Are there spectacle labs producing affordable, quality spectacles (Affordable: Price not more than 3 days of salary of a medium income worker)
Y/N Definition of medium income worker unclear. Subsidy available for children through NGO (Lions Club)
Provide the number of spectacles dispensed per year (from public and not-for-profit sector):
Data not available
Are there any programmes for detecting and treating presbyopia? (e.g. access to comprehensive eye examinations and reading glasses for people over 40 years of age)
Y/N No specific programme
Low Vision Are Low Vision services available with 25. Trained professional(s), 26. the necessary equipment and 27. Low Vision appliances available?
Please specify if in the public sector, private sector, both or none
Y/N Y/N Y/N Limited access nationally.
Inclusive Services
Are there any national plans for inclusive education?
Y/N – please provide electronic copy(s) Included in draft plan
Are there any national plans for rehabilitation / adjustment to blindness?
Y/N – please provide electronic copy(s) Included in draft plan
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3. Human Resources
Ophthalmologists Total number of ophthalmologists in country
Listing of 34 0phthalmologists practising to be verified & categorized by the Jamaica Ophthalmology Association
Total number of ophthalmologists performing surgery in public sector
-----
Total number of ophthalmologists performing surgery in private sector
-----
Optometrists Number of Optometrists in public sector
Listing of 15 optometrists to be verified by the Optometrists’ Association
Number of Optometrists in private sector
-----
Refractionists Total number in country -----
Ophthalmic nurses Total number in country Data unavailable
Ophthalmic assistants
Total number in country -----
Primary Health Care personnel trained in Eye Health
Total number trained in this period: No specific primary care focused training this year. Previously, nurses in nurseries and on the ophthalmology service trained re guidelines for the prevention and management of ROP
Brief description of training activity(s)
4. Infrastructure
Is a Preventive Maintenance programme implemented in each hospital with an ophthalmology department?
Y/N
Has an assessment of availability and adequacy of equipment at eye health facilities been carried out in this period?
Y/N – if yes what are the findings
5. Qualitative assessment (related to the eye health action plan and/or strategic framework for country) Describe the major achievements in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period: Development of a Pilot Teleophthalmology Program for Diabetic Retinopathy
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Outline the major constrains in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period:
- Personnel - Money
What are the proposed actions to strengthen eye health services and prevention of blindness services in your country? The development of a productive intersectoral National Vision 20/20 Committee
What are the proposed actions to strengthen inclusive education services in your country? The mobilization of an effective Low Vision Subcommittee chaired by the Jamaica Society for the Blind
What are the proposed actions to strengthen rehabilitation / adjustment to blindness services in your country? The mobilization of an effective Low Vision Subcommittee chaired by the Jamaica Society for the Blind
ATTACHMENTS;
1) CUBA – JAMAICA PROGRAMME DATA
Year #
Screened
Total persons
selected with
cataract,
DR,
pyterygium
# Persons
diagnosed
with
Cataract
#
Cataract
Surgery
Done
Total persons
diagnosed
with diabetic
retinopathy
# persons
who had
laser
therapy for
diabetic
retinopathy
2012 2092 876 730 420 107 196
2011 8366 3706 1751 913 1603 315
2010 3887 1460 701 590 321 235
2) DATA FROM THE BUSTAMANTE HOSPITAL FOR CHILDREN
ITEM Year: 2010 Year: 2011
Diagnosed Retinopathy of
Prematurity (ROP)
362 479
Total persons seen in Eye
Outpatient Department
3142 3780
Total persons having Eye
Surgery
88 60
109
3) DISCHARGE SUMMARY DATA : Inpatients for cataract surgery
REGIONAL
HOSP
2007 2008 2009 2010*provisional
Kingston
Public
Hospital
138 78 6
Cornwall
Regional
Hospital
55 78 14 18
Mandeville
Regional
0 2 5 1
Reference
1) Statistical Institute of Jamaica, http:statinja.gov.jm/Demo_socialpopulation.aspx
(as of May 17th
2012)
110
National VISION 2020 Data Country: ST.KITTS AND NEVIS Year of data: 2011
Country Population: (40,120 + 12,530) 52,650 Source(s) of National V2020 data: Annual reports
Approved by VISION 2020 National Committee or MOH: Y/N
1. Central Organization, Leadership and Governance Is there a signed National Declaration in support of VISION 2020?
Y/N - If yes, give date signed and name of Signatory
Did your country celebrate World Sight Day or other eye health related days in this period?
Y/N – if yes include a brief summary of activities: A World Sight Day March and Ophthalmic Screening of Elderly at Cardin Home
Is there an active National Vision 2020 Committee
Y/N – if yes how frequently does the Committee meet?
Was there a National V2020 workshop / meeting / conference organized in the past year?
Y/N – if yes state the focus / theme of the activity:
Is there a designated focal person to assist the V2020 Committee and MoH?
Y/N
Provide contact information:
Is there a National Vision 2020 strategic framework approved by the Ministry of Health?
Y/N
Provide an electronic copy:
Is your country i6mplementing a National Vision 2020 plan?
Y/N
Briefly explain and provide results /progress: The Vision 2020 plan is being implemented at the Institutional level only
Is eye health included in National health plans, policies and systems?
Y/N
Provide reference and electronic copy of relevant policies, plans: It is being included in draft policies and plans.
What is the Governments financial contribution to Eye Health?
Provide in local currency (& USD$ official conversion) figures and % of annual Health Budget. Government expenditure is not disaggregated specifically for Programmes, therefore it is difficult to ascertain.
111
2. Disease Control
Cataract How many cataract surgeries were performed in
the public sector in this period? 36 St. Kitts
How many cataract surgeries were performed in the private sector in this period?
Not available
How many cataract surgeries were performed by others in this period (e.g. Cuban initiative, volunteers, etc.) USA
54 (by visiting Ophthalmologist in Nevis)
Total number of cataract surgeries for this period 90
Are any eye departments in the country utilizing the cataract outcomes monitoring tool available at :
http://www.cehjournal.org/files/s1001.html
Y/N
Glaucoma Is there a national glaucoma IEC (Information, Education, Communication) plan / programme being implemented in your country?
Y/N – if yes provide a brief description
Are glaucoma eye medications included in the subsidized drug list?
Y/N – if yes provide a brief explanation Timolol
Diabetic Retinopathy
Has a Diabetic retinopathy Services situation analysis been conducted in your country?
Y/N – if yes state when the analysis was carried out.2011
Is early detection (diabetics screening and referral) integrated in the national non-communicable chronic diseases program?
Y/N
Is digital photography screening available in a. public sector, b. private sector
r. Y/N – state number screened
s. Y/N – state number screened
Are diabetic patients routinely referred to ophthalmology units for examination?
Y/N – state number referred 82
Are laser treatment services available in j. public sector b. private sector
a. Y/N – state 19 number treated
b. Y/N – state number treated
Childhood Blindness
Is there any documentation on causes of childhood blindness in the country?
Y/N – if yes provide electronic copy
Is there a national Retinopathy of Prematurity (ROP) prevention policy
Y/N – please provide electronic copy ? Plans are being developed to screen all premature infants.
Are there ROP screening and treatment services available?
Y/N Children are screened by General
112
Ophthalmologist
How many children were treated for ROP in this period?
01 by General Ophthalmologist
Is eye care integrated into maternal and child health programs?
Y/N – if yes, how?
Are there any paediatric ophthalmologists and equipment to perform paediatric examinations and treatment?
Y/N
Please provide the following information annually: 28. Total number of children examined in out-patients
departments of eye health facilities 29. Total number of paediatric cataract surgeries 30. Total number of other paediatric eye surgeries
320 NONE NONE
Refractive Error
Are there refractive error services available in the public sector?
Y/N – if yes provide a brief description
Is there a school screening programme being implemented?
Y/N – if yes provide a brief description Screening of eight (8) year olds
Are there spectacle labs producing affordable, quality spectacles (Affordable: Price not more than 3 days of salary of a medium income worker)
Y/N
Provide the number of spectacles dispensed per year (from public and not-for-profit sector):
N/A
Are there any programmes for detecting and treating presbyopia? (e.g. access to comprehensive eye examinations and reading glasses for people over 40 years of age)
Y/N Annual Free Eye Screening Programme
Low Vision Are Low Vision services available with 28. Trained professional(s), 29. the necessary equipment and 30. Low Vision appliances available?
Please specify if in the public sector, private sector, both or none
Y/N Y/N Y/N
Inclusive Services
Are there any national plans for inclusive education?
Y/N – please provide electronic copy(s)
Are there any national plans for rehabilitation / adjustment to blindness?
Y/N – please provide electronic copy(s)
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3. Human Resources
Ophthalmologists Total number of ophthalmologists in country
2
Total number of ophthalmologists performing surgery in public sector
1
Total number of ophthalmologists performing surgery in private sector
1
Optometrists Number of Optometrists in public sector
0
Number of Optometrists in private sector
2
Refractionists Total number in country 2
Ophthalmic nurses Total number in country 3
Ophthalmic assistants
Total number in country 0
Primary Health Care personnel trained in Eye Health
Total number trained in this period:
0
Brief description of training activity(s)
4. Infrastructure
Is a Preventive Maintenance programme implemented in each hospital with an ophthalmology department?
Y/N Adequate
Has an assessment of availability and adequacy of equipment at eye health facilities been carried out in this period?
Y/N – if yes what are the findings By corporate partners findings not available
5. Qualitative assessment (related to the eye health action plan and/or strategic framework for country) Describe the major achievements in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period: 1. Positive response to annual free eye screening programme 2. Positive response to World Sight Day March – persons presented for screening. 3. A total of 376 children, 8 year olds screened 4. Increased attendance of persons with diabetes mellitus for screening and follow-up
care
Outline the major constrains in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period:
1. Limited staff – numbers and skills 2. Limited equipment
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What are the proposed actions to strengthen eye health services and prevention of blindness services in your country? 1. Training of personnel in Ophthalmic techniques 2. Lobby for Ophthalmologist trained in ROP/Paediatric Ophthalmology 3. Implementation of a National V2020 plan and establishment of a Nat V2020
Committee 4. Lobby for up-to-date equipment
What are the proposed actions to strengthen inclusive education services in your country? Education/Sensitization programmes, utilizing the media
What are the proposed actions to strengthen rehabilitation / adjustment to blindness services in your country? To improve relationship with Blind Society.
115
National VISION 2020 Data Country: ST. LUCIA
Year of data: November 2011 – OCTOBER 2012 Country Population: 176,000 as of 2011
Source(s) of National V2020 data: SLBWA/MOH
Approved by VISION 2020 National Committee or MOH: Yes
1. Central Organization, Leadership and Governance Is there a signed National Declaration in support of VISION 2020?
Yes – Memorandum of Association between Government of St. Lucia and St. Lucia Blind Welfare Assoc. Signed on 18/10/2004 by the then Minister and Permanent Secretary of the MOH and the President of SLBWA
Did your country celebrate World Sight Day or other eye health related days in this period?
World Sight Day and White Cane Day celebrated with sensitization sessions, free eye screening and examinations and participation in community health fairs
Is there an active National Vision 2020 Committee
Yes – The Committee meets on a quarterly basis
Was there a National V2020 workshop / meeting / conference organized in the past year?
Yes – Four meetings were held in the year where members shared information on activities held. During one of the meetings members were addressed by Officers of the Value Added Tax (VAT) team. VAT is now implemented in St. Lucia. Abuse of the elderly was discussed at the last meeting.
Is there a designated focal person to assist the V2020 Committee and MoH?
Y/N Yes – Nurse Juliette Joseph Assistant Principal Nursing Officer Tel: (758) 452 2301/468 5383 communityhealthp@yahoo.com Nurse Joseph is the Co-chairperson of the Committee
Is there a National Vision 2020 strategic framework approved by the Ministry of Health?
Y/N Yes – Copy of Memorandum between Government of St. Lucia (MOH) and SLBWA attached
116
Is your country implementing a National Vision 2020 plan?
Y/N There is an existing Plan for the period 2010 – 2014 which was updated in January 2011
Is eye health included in National health plans, policies and systems?
Y/N Yes – Eye Health is one of the priority areas under National Strategic Plan for Health 2006 – 2011, soon to be revised
What is the Governments financial contribution to Eye Health?
Annual subvention of EC$76,000.00 plus duty free concessions to SLBWA. Direct percentage not readily available.
2. Disease Control
Cataract How many cataract surgeries were performed in
the public sector in this period? 115 Males, 386 Females and 10 children
How many cataract surgeries were performed in the private sector in this period?
Unknown
How many cataract surgeries were performed by others in this period (e.g. Cuban initiative, volunteers, etc.)?
108 Males, 175 Females and 1 child
Total number of cataract surgeries for this period 223 Males, 561 Females, 11 child
Are any eye departments in the country utilizing the cataract outcomes monitoring tool available at :
http://www.cehjournal.org/files/s1001.html
No
Glaucoma Is there a national glaucoma IEC (Information, Education, Communication) plan / programme being implemented in your country?
The Saint Lucia Glaucoma Association was formed in 2008. Currently there is an ongoing Selective Laser Trabeculoplasty Study measuring repeatability of laser treatments
Are glaucoma eye medications included in the subsidized drug list?
No
Diabetic Retinopathy
Has a Diabetic retinopathy Services situation analysis been conducted in your country?
No
Is early detection (diabetics screening and referral) integrated in the national non-communicable chronic diseases program?
Yes
Is digital photography screening available in a. public sector,
t. No u. Yes – number
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b. private sector unavailable
Are diabetic patients routinely referred to ophthalmology units for examination?
Yes – Approximately 3000
Are laser treatment services available in k. public sector b. private sector
a. Yes – 214 for retina
b. Yes – numbers unknown
Childhood Blindness
Is there any documentation on causes of childhood blindness in the country?
No
Is there a national Retinopathy of Prematurity (ROP) prevention policy?
No
Are there ROP screening and treatment services available?
No
How many children were treated for ROP in this period?
None
Is eye care integrated into maternal and child health programs?
Yes – Eye health is a component of developmental screening and assessment
Are there any paediatric ophthalmologists and equipment to perform paediatric examinations and treatment?
Yes by Locum Ophthalmologists. Phaco emulsification machine and sterilizer available
Please provide the following information annually: 31. Total number of children examined in out-patients
departments of eye health facilities 32. Total number of paediatric cataract surgeries 33. Total number of other paediatric eye surgeries
1. 4,078 2. 10 3. 37
Refractive Error
Are there refractive error services available in the public sector?
SLBWA/ECSL as well as the Cuban Initiative provide refractive error services
Is there a school screening programme being implemented?
Ongoing services provided by SLBWA and Community Health nurses
Are there spectacle labs producing affordable, quality spectacles (Affordable: Price not more than 3 days of salary of a medium income worker)
Yes at SLBWA/ECSL
Provide the number of spectacles dispensed per year (from public and not-for-profit sector):
1,425
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Are there any programmes for detecting and treating presbyopia? (e.g. access to comprehensive eye examinations and reading glasses for people over 40 years of age)
SLBWA/ECSL and elsewhere
Low Vision Are Low Vision services available with 31. Trained professional(s), 32. the necessary equipment and 33. Low Vision appliances available?
Please specify if in the public sector, private sector, both or none
Yes Yes Yes at SLBWA and private sector
Inclusive Services
Are there any national plans for inclusive education?
Yes – extract from Education Sector Development Plan 2000-2005 attached
Are there any national plans for rehabilitation / adjustment to blindness?
No, however extract from SLBWA’s Three Year Plan attached.
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3. Human Resources
Ophthalmologists Total number of ophthalmologists in country
5
Total number of ophthalmologists performing surgery in public sector
5 – all locums
Total number of ophthalmologists performing surgery in private sector
2
Optometrists Number of Optometrists in public sector
2
Number of Optometrists in private sector
7
Refractionists Total number in country 3
Ophthalmic nurses Total number in country 3
Ophthalmic assistants
Total number in country 1
Primary Health Care personnel trained in Eye Health
Total number trained in this period: 25
Nurses and Community Health aides were trained
4. Infrastructure
Is a Preventive Maintenance programme implemented in each hospital with an ophthalmology department?
Yes
Has an assessment of availability and adequacy of equipment at eye health facilities been carried out in this period?
No
5. Qualitative assessment (related to the eye health action plan and/or strategic framework for country) Describe the major achievements in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period: More cataract surgeries performed More persons trained in eye health at primary and tertiary level – increased competency Increased participation in community health fairs – early detection Greater collaboration between Government Ministries/faith based organisations and NGOs Greater access to eye health services such as screening, surgeries, supply of low vision aids etc. Increased sensitization of the public
Outline the major constrains in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period:
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Limited financial and human resources Struggling economy especially with the implementation of Value Added Tax in October 2012
What are the proposed actions to strengthen eye health services and prevention of blindness services in your country? Opening of Vision Centre in the south of the island More training of volunteers Sourcing of funds Eye Health promotional activities Closer collaboration with private sector and other stakeholders
What are the proposed actions to strengthen inclusive education services in your country? Review of existing Education Plan to determine the way forward
What are the proposed actions to strengthen rehabilitation / adjustment to blindness services in your country? Update client database system Strengthen human and financial resources
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National VISION 2020 Data Country: St Vincent and the Grenadines
Year of data: Jan to Oct, 2012 Country Population: 110,000
Source(s) of National V2020 data: Hosp Records
Approved by VISION 2020 National Committee or MOH: N
1. Central Organization, Leadership and Governance Is there a signed National Declaration in support of VISION 2020?
N
Did your country celebrate World Sight Day or other eye health related days in this period?
“N”
Is there an active National Vision 2020 Committee
N
Was there a National V2020 workshop / meeting / conference organized in the past year?
N
Is there a designated focal person to assist the V2020 Committee and MoH?
N
Is there a National Vision 2020 strategic framework approved by the Ministry of Health?
N
Is your country implementing a National Vision 2020 plan?
N
Is eye health included in National health plans, policies and systems?
Y
What is the Governments financial contribution to Eye Health?
???
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2. Disease Control
Cataract How many cataract surgeries were performed in
the public sector in this period? 54
How many cataract surgeries were performed in the private sector in this period?
?
How many cataract surgeries were performed by others in this period (e.g. Cuban initiative, volunteers, etc.)?
37
Total number of cataract surgeries for this period 91
Are any eye departments in the country utilizing the cataract outcomes monitoring tool available at :
http://www.cehjournal.org/files/s1001.html
N
Glaucoma Is there a national glaucoma IEC (Information, Education, Communication) plan / programme being implemented in your country?
N
Are glaucoma eye medications included in the subsidized drug list?
Y (timolol)
Diabetic Retinopathy
Has a Diabetic retinopathy Services situation analysis been conducted in your country?
N
Is early detection (diabetics screening and referral) integrated in the national non-communicable chronic diseases program?
Y
Is digital photography screening available in a. public sector, b. private sector
v. N w. Y (not functional)
Are diabetic patients routinely referred to ophthalmology units for examination?
Y
Are laser treatment services available in l. public sector b. private sector
a. Y –aprox 120 b. N
Childhood Blindness
Is there any documentation on causes of childhood blindness in the country?
N
Is there a national Retinopathy of Prematurity (ROP) prevention policy?
“Y”
Are there ROP screening and treatment services available?
Y
How many children were treated for ROP in this period?
? (1)
Is eye care integrated into maternal and child health programs?
Y
Are there any paediatric ophthalmologists and equipment to perform paediatric examinations and treatment?
N
Please provide the following information annually:
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34. Total number of children examined in out-patients departments of eye health facilities
35. Total number of paediatric cataract surgeries 36. Total number of other paediatric eye surgeries
525 3 14
Refractive Error
Are there refractive error services available in the public sector?
Y
Is there a school screening programme being implemented?
“Y”
Are there spectacle labs producing affordable, quality spectacles (Affordable: Price not more than 3 days of salary of a medium income worker)
N
Provide the number of spectacles dispensed per year (from public and not-for-profit sector):
???
Are there any programmes for detecting and treating presbyopia? (e.g. access to comprehensive eye examinations and reading glasses for people over 40 years of age)
“Y”
Low Vision Are Low Vision services available with 34. Trained professional(s), 35. the necessary equipment and 36. Low Vision appliances available?
Please specify if in the public sector, private sector, both or none
N N N
Inclusive Services
Are there any national plans for inclusive education?
N
Are there any national plans for rehabilitation / adjustment to blindness?
“Y”
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3. Human Resources
Ophthalmologists Total number of ophthalmologists in country
5
Total number of ophthalmologists performing surgery in public sector
2
Total number of ophthalmologists performing surgery in private sector
2
Optometrists Number of Optometrists in public sector
1
Number of Optometrists in private sector
5
Refractionists Total number in country -
Ophthalmic nurses Total number in country “3”
Ophthalmic assistants
Total number in country
Primary Health Care personnel trained in Eye Health
Total number trained in this period: Nil
4. Infrastructure
Is a Preventive Maintenance programme implemented in each hospital with an ophthalmology department?
Y
Has an assessment of availability and adequacy of equipment at eye health facilities been carried out in this period?
Y
5. Qualitative assessment (related to the eye health action plan and/or strategic framework for country) Describe the major achievements in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period: (not implemented)
Outline the major constrains in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period: (lack of resources, lack of initiative at the administrative- MoH level )
What are the proposed actions to strengthen eye health services and prevention of blindness services in your country? (Adequately equip the department, implement ongoing education programs )
125
What are the proposed actions to strengthen inclusive education services in your country? (programs on the public media)
What are the proposed actions to strengthen rehabilitation / adjustment to blindness services in your country? (equipping of the society of the blind with trained personnel and resources)
126
National VISION 2020 Data Country: Suriname
Year of data: 2012 Country Population: 540 000
Source(s) of National V2020 data: MOH Suriname ; Eye Centre Suriname AZP
Approved by VISION 2020 National Committee or MOH: Yes, by MOH
1. Central Organization, Leadership and Governance Is there a signed National Declaration in support of VISION 2020?
NO
Did your country celebrate World Sight Day or other eye health related days in this period?
Yes World Sight Day 13 October 2012 was
celebrated by the institute for the blinds together with the Eye Center Suirname AZP
Glaucoom day 9 maart 2012
Is there an active National Vision 2020 Committee
No Vision 2020 Committee
Was there a National V2020 workshop / meeting / conference organized in the past year?
Yes, organized by the institute for the blinds together with the Eye Centre Suriname AZP
Is there a designated focal person to assist the V2020 Committee and MoH?
NO Provide contact information:
Is there a National Vision 2020 strategic framework approved by the Ministry of Health?
NO Provide an electronic copy:
Is your country implementing a National Vision 2020 plan?
NO Briefly explain and provide results /progress:
Is eye health included in National health plans, policies and systems?
YES Provide reference and electronic copy of relevant policies, plans: NHSP 2012 – 2016 and the OP 2012 - 2016
What is the Governments financial contribution to Eye Health?
Provide in local currency (& USD$ official conversion) figures and % of annual Health Budget. According to the National Health Accounts 2006, the government spent 1.9% of the Total Health Expenditure (3,110,499 US $) for optical services
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2. Disease Control
Cataract How many cataract surgeries were performed in
the public sector in this period? 2011: 3891
How many cataract surgeries were performed in the private sector in this period?
2011 – 2012 NO surgeries in the private sectors
How many cataract surgeries were performed by others in this period (e.g. Cuban initiative, volunteers, etc.)?
2011 – 2012 No surgeries by others
Total number of cataract surgeries for this period 2011: 3892
Are any eye departments in the country utilizing the cataract outcomes monitoring tool available at :
http://www.cehjournal.org/files/s1001.htm
l
No
Glaucoma Is there a national glaucoma IEC (Information, Education, Communication) plan / programme being implemented in your country?
No
Are glaucoma eye medications included in the subsidized drug list?
YES
Diabetic Retinopathy
Has a Diabetic retinopathy Services situation analysis been conducted in your country?
No
Is early detection (diabetics screening and referral) integrated in the national non-communicable chronic diseases program?
YES
Is digital photography screening available in a. public sector, b. private sector
x. YES – 2011: 329 y. NO
Are diabetic patients routinely referred to ophthalmology units for examination?
YES – numbers are not yet available because of the manual patient medical data registry (digital medical data is in progress)
Are laser treatment services available in m. public sector b. private sector
a. YES
Eye Lite Laser: 667
JAG Laser: 653 b. NOT in private sector
Childhood Blindness
Is there any documentation on causes of childhood blindness in the country?
YES
Is there a national Retinopathy of Prematurity (ROP) prevention policy?
No
Are there ROP screening and treatment services available?
YES
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How many children were treated for ROP in this period?
Is eye care integrated into maternal and child health programs?
NO
Are there any paediatric ophthalmologists and equipment to perform paediatric examinations and treatment?
Yes, paediatric ophthalmologists And equipment to perform paediatric examinations and treatment are available
Please provide the following information annually: 37. Total number of children examined in out-
patients departments of eye health facilities 38. Total number of paediatric cataract surgeries 39. Total number of other paediatric eye surgeries
NO children are examined in out-patients departments of eye health facilities Total number of paediatric cataract surgeries : Pending
Total number of other paediatric eye surgeries: pending
Refractive Error
Are there refractive error services available in the public sector?
Yes
Is there a school screening programme being implemented?
Yes , by the school health services and if children have problems they are referred to the GP / Eye specialists
Are there spectacle labs producing affordable, quality spectacles (Affordable: Price not more than 3 days of salary of a medium income worker)
Yes
Provide the number of spectacles dispensed per year (from public and not-for-profit sector):
Estimates were not available
Are there any programmes for detecting and treating presbyopia? (e.g. access to comprehensive eye examinations and reading glasses for people over 40 years of age)
Yes
Low Vision Are Low Vision services available with 37. Trained professional(s), 38. the necessary equipment and 39. Low Vision appliances available?
Please specify if in the public sector, private sector, both or none
Yes Yes Yes
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Inclusive Services
Are there any national plans for inclusive education?
YES
Are there any national plans for rehabilitation / adjustment to blindness?
YES
3. Human Resources
Ophthalmologists Total number of ophthalmologists in country
9
Total number of ophthalmologists performing surgery in public sector
9
Total number of ophthalmologists performing surgery in private sector
0
Optometrists Number of Optometrists in public sector
1
Number of Optometrists in private sector
4 (also performing in public sector)
Refractionists Total number in country 17
Ophthalmic nurses Total number in country 18
Ophthalmic assistants
Total number in country 5
Primary Health Care personnel trained in Eye Health
Total number trained in this period: 0
Brief description of training activity(s)
4. Infrastructure
Is a Preventive Maintenance programme implemented in each hospital with an ophthalmology department?
Yes, annually Sometimes also biannual
Has an assessment of availability and adequacy of equipment at eye health facilities been carried out in this period?
Yes. No problems with the equipment. There is a yearly maintenance program
5. Qualitative assessment (related to the eye health action plan and/or strategic framework for country) Describe the major achievements in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period: Bilateral collaboration with the “Rotterdam Oogziekenhuis” since 2000:
• Training of ophthalmologists • Introduction of new technologies
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• Establishment of EYE CARE CENTER in AZP (24 November 2009) • Expeditions to the rural areas
Bilateral collaboration with Cuba: Milagro Project 2005 – 2009
• Associate member WAEH september 2012 ( World Association of Eye Hospitals )
Outline the major constrains in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period:
- Financing - HCW
o Ophthalmologists o Ophthalmic nurses/assistants o Community Eye Health personnel al trained in Eye Health
- Equipment - Facilities : Mobile Eye clinic with operation theatre
What are the proposed actions to strengthen eye health services and prevention of blindness services in your country?
• Cost effective modern technology • Multidisciplinary well-trained teams
• New building : Eye Hospital / Eye Center • Ground floor : 12 doctors offices , 6 diagnostics rooms, 2 poli-clinical OR’s,
archive, reception • First level : OR complex ( 3 ) , ward with 10 beds , offices, conference
room/auditorium • Scientific research
What are the proposed actions to strengthen inclusive education services in your country? • Public awareness and patient education
What are the proposed actions to strengthen rehabilitation / adjustment to blindness services in your country?
• Decentralized screening to Interior of Suriname, Nickerie , Moengo/albina • Eye bus
• Outreach specialist care
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National VISION 2020 Data Country: Trinidad and Tobago
Year of data: 2012 Country Population: 1.3 Million
Source(s) of National V2020 data: Ministry of Health
Approved by VISION 2020 National Committee or MOH: Yes
1. Central Organization, Leadership and Governance Is there a signed National Declaration in support of VISION 2020?
Yes - If yes, give date signed and
name of Signatory
Did your country celebrate World Sight Day or other eye health related days in this period?
Yes – Activities included public awareness campaign and a walk-a-ton in which the Minister participated
Is there an active National Vision 2020 Committee
No
Was there a National V2020 workshop / meeting / conference organized in the past year?
N/A
Is there a designated focal person to assist the V2020 Committee and MoH?
Yes Ms Carla Ruiz – Research Officer Ministry of Health, 63 park Street, Port of Spain:
Is there a National Vision 2020 strategic framework approved by the Ministry of Health?
No
Is your country implementing a National Vision 2020 plan?
No The Plan has not yet been developed
Is eye health included in National health plans, policies and systems?
Yes Optometry Policy in the final stages of being developed to regulate the practice of Optometry. Vision Plan to be developed.
What is the Governments financial contribution to Eye Health?
The Government provides a global health budget which is not disaggregated by specific areas.
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2. Disease Control
Cataract How many cataract surgeries were performed in
the public sector in this period?
How many cataract surgeries were performed in the private sector in this period?
How many cataract surgeries were performed by others in this period (e.g. Cuban initiative, volunteers, etc.)?
Total number of cataract surgeries for this period
Are any eye departments in the country utilizing the cataract outcomes monitoring tool available at :
http://www.cehjournal.org/files/s1001.html
Yes
Glaucoma Is there a national glaucoma IEC (Information, Education, Communication) plan / programme being implemented in your country?
No
Are glaucoma eye medications included in the subsidized drug list?
Yes. Glaucoma medication is provided through the Chronic Disease Assistance Programme (CDAP)
Diabetic Retinopathy
Has a Diabetic retinopathy Services situation analysis been conducted in your country?
No
Is early detection (diabetics screening and referral) integrated in the national non-communicable chronic diseases program?
Yes
Is digital photography screening available in a. public sector, b. private sector
z. No aa. Y – Data not
available
Are diabetic patients routinely referred to ophthalmology units for examination?
Yes – Data not available
Are laser treatment services available in n. public sector b. private sector
a. Yes – Data not available.
b. Yes – Data not available
Childhood Blindness
Is there any documentation on causes of childhood blindness in the country?
Yes
Is there a national Retinopathy of Prematurity (ROP) prevention policy?
No –
Are there ROP screening and treatment services available?
Yes. This is done through the School Health Programme
How many children were treated for ROP in this period?
Data not available
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Is eye care integrated into maternal and child health programs?
No
Are there any paediatric ophthalmologists and equipment to perform paediatric examinations and treatment?
Y/N
Please provide the following information annually: 40. Total number of children examined in out-patients
departments of eye health facilities 41. Total number of paediatric cataract surgeries 42. Total number of other paediatric eye surgeries
Refractive Error
Are there refractive error services available in the public sector?
Yes
Is there a school screening programme being implemented?
Yes. This is a component of the School Health Programme
Are there spectacle labs producing affordable, quality spectacles (Affordable: Price not more than 3 days of salary of a medium income worker)
Yes. This is done collaboratively by the Ministries of Health and the People and Social Development
Provide the number of spectacles dispensed per year (from public and not-for-profit sector):
Data not available
Are there any programmes for detecting and treating presbyopia? (e.g. access to comprehensive eye examinations and reading glasses for people over 40 years of age)
Yes. This service is provided in both public and private health institutions.
Low Vision Are Low Vision services available with 40. Trained professional(s), 41. the necessary equipment and 42. Low Vision appliances available?
Please specify if in the public sector, private sector, both or none
Yes - Both Yes - Both Yes - Both
Inclusive Services
Are there any national plans for inclusive education?
No
Are there any national plans for rehabilitation / adjustment to blindness?
Yes. This is being done in collaboration with the private and NGO sectors
134
3. Human Resources
Ophthalmologists Total number of ophthalmologists in country
37
Total number of ophthalmologists performing surgery in public sector
18
Total number of ophthalmologists performing surgery in private sector
19
Optometrists Number of Optometrists in public sector
1
Number of Optometrists in private sector
114
Refractionists Total number in country Data not available
Ophthalmic nurses Total number in country Data not available
Ophthalmic assistants
Total number in country Data not available
Primary Health Care personnel trained in Eye Health
Total number trained in this period: Data not available
4. Infrastructure
Is a Preventive Maintenance programme implemented in each hospital with an ophthalmology department?
Yes.
Has an assessment of availability and adequacy of equipment at eye health facilities been carried out in this period?
No
5. Qualitative assessment (related to the eye health action plan and/or strategic framework for country) Describe the major achievements in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period: The decision by the Ministry of Health to conduct a National Eye Survey to guide the development of vision policies and plans for the national population.
Outline the major constrains in implementing the Eye Health/Prevention of Blindness/VISION 2020 National Plan during this period: A shortage of qualified staff in the public health sector. Most of the vision care is currently provided in the private sector.
135
What are the proposed actions to strengthen eye health services and prevention of blindness services in your country?
1. Increase vision screening 2. Increase public health education and health promotion activities focussed on healthy
lifestyles and chronic disease. 3. Recruit additional qualified staff and offer scholarships and bursaries to interested
and qualified nationals
What are the proposed actions to strengthen inclusive education services in your country?
What are the proposed actions to strengthen rehabilitation / adjustment to blindness services in your country? The Ministry of Health is in the process of recruiting a Consultant to conduct a National Eye Survey. The results of this survey will be used to guide the development of vision policies and programmes for the national population.
144
Rapid assessment of avoidable blindness survey methodology
Rapid assessment of avoidable blindness (RAAB) is a rapid survey methodology developed at the International Centre for Eye Health (ICEH). It is a population based survey of visual impairment and eye care services among people aged 50 years and over. RAAB can provide the prevalence of blindness and visual impairment, its main causes, the output and quality of eye care services, barriers, cataract surgical coverage and other indicators of eye care services in a specific geographical area.
What RAAB is not RAAB is not a case-finding exercise: it will not provide a list of names and addresses of
all people who are blind due to (for example) cataract in an area.
RAAB is not a detailed blindness survey: it provides a reasonably accurate estimate of
the prevalence of blindness, and the proportion that is avoidable in a geographic area.
RAAB is not designed to give accurate estimates of the prevalence of specific causes of
blindness and does not measure posterior segment disease in detail.
RAAB focuses on people aged 50 years and above and so it does not give an estimate
of childhood blindness, which is better measured through the Key Informant Method.
RAAB also does not assess the need for refractive error services.
Why carry out a RAAB survey? There are two main reasons to collect RAAB survey data on blindness and visual impairment in a community. 1. To help eye health managers develop intervention programmes for control of blindness
based on a community's needs.
2. To help to monitor existing blindness control programmes and to adjust these
programmes as and when required.
RAAB survey data provides only some of the information needed to plan intervention programmes. A situational analysis document, which can be found at the following link, reviews all the information needed to plan for blindness control programmes at the district level - https://www.iceh.org.uk/download/attachments/13571380/situationanalysis.pdf?version=1&modificationDate=1281948284000
Who can carry out a RAAB survey? The entire process of carrying out a RAAB survey, from planning to the collection of field data, data analysis and report writing, can be conducted by local staff. Three or four teams with transport can cover the usual required sample size in a period of 4-5 weeks, including one week of training. The collection of data can be done by local ophthalmologists, residents in ophthalmology, or experienced ophthalmic assistants, together with an assistant who does not need to be medically trained. Local staff can also enter the data directly into the software package.
145
Want to carry out your own RAAB survey? Good planning and organisation are vital for success Although RAAB has the word "rapid" in its title it is neither easy nor straightforward to undertake. If the RAAB is not undertaken carefully and to a high quality then it will give biased results which will not help with planning or monitoring and will have wasted time and money. RAABs therefore need to be planned and undertaken carefully and we strongly advise you to co-ordinate with an ICEH certified RAAB trainer when planning a RAAB. The trainer can help with the preparations for the RAAB as well as train the staff and monitor the fieldwork during its early stages. Contact details for regional trainers for RAAB are given in this document. All RAAB activities should be organised by a Survey Coordinator who starts work before the actual field survey takes place;
developing the sampling frame for the survey
carrying out a baseline needs assessment
Selecting the clusters to be examined
Recruiting survey personnel
Arranging scheduling and transport & equipment logistics
Organising and ensuring the quality of the staff training
Managing the data - collecting survey records, managing data entry, analysis and report
writing
Top tips for a successful RAAB survey Planning 1. Work with a certified RAAB trainer while planning a RAAB.
2. Do not underestimate the amount of time and effort involved in undertaking a RAAB.
3. Plan a RAAB where the information is needed to plan, monitor and/or advocate for
services, working with local eye care providers.
4. The certified RAAB trainer should ensure that the sampling frame is appropriate for
selecting clusters before the start of the training.
5. Don't leave things until the RAAB starts - make sure sufficient funds in place for all
aspects of the RAAB (training, staff, transport etc) and that relevant authority approvals,
logistics, equipment, printing, office and so on are all ready before the RAAB is started.
Training 1. A RAAB certified trainer should undertake the training for RAAB.
2. The venue for the class room training part should be a simple room that has facilities for
seating, projection and place for practicing vision tests.
3. All members of the survey team should attend all the training sessions.
4. The equipment that will be used in the RAAB survey should always be part of the training
sessions.
5. Pre-training arrangements should include decision on where the IOV exercise and pilot
RAAB survey will be done and be part of the training time table.
146
Fieldwork 1. The RAAB fieldwork should start immediately after the training and should continue
without long gaps.
2. The RAAB protocol should be followed, especially the examination of eligible people in
their own houses.
3. The teams who will undertake the RAAB must commit for the full time duration including
training and a per-diem should be agreed.
4. For team recruitment consider local customs (e.g have female team members in
communities where there is such need) and make sure the team are prepared for long
hours of walking in communities. Fieldwork experience is an advantage.
5. Data should be double-entered as soon as possible after data collection (ideally on the
same day) to correct possible errors. This data should be backed up regularly.
Reporting and service provision 1. "No Survey without Service" should be emphasized. People identified with eye problems
in the survey should be referred to an appropriate service.
2. The results of the RAAB must be written up in a report and presented to the relevant
stakeholders.
3. Stakeholders should be encouraged to use RAAB results to inform planning of services.
4. Advocacy after RAAB on the results to the authorities where RAAB was carried out and
information sharing is absolutely important to build service delivery initiatives.
Download training materials, data analysis software and manuals The RAAB data analysis software package includes RAAB installation software and instruction manual, IOV forms for training the fieldwork team, instructions on how to collect the survey data, RAAB survey forms and further reading.
Download the RAAB package from http://www.cehjournal.org/files/s0701.html
List of regional contacts for training your RAAB trainer Africa: Wanjiku Mathenge (ciku@email.com), Susan Lewallen (slewallen@kcco.net),
Joseph Oye (joye@sightsavers.org)
EMRO: Dr Jadoon (mjadoon@yahoo.com), Mansur Rabiu (mrabiu@emr-iapb.org)
Europe: Hans Limburg (hlimburg@quicknet.nl), Hannah Kuper
(Hannah.kuper@lshtm.ac.uk), Robert Lindfield (Robert.lindfield@lshtm.ac.uk), Sarah
Polack (sarah.polack@lshtm.ac.uk)
South Asia: Dr Shammana (brsham@hotmail.com)
More information For details about ICEH certification for RAAB trainers, please contact Hannah Kuper
(Hannah.kuper@lshtm.ac.uk), Robert Lindfield (Robert.lindfield@lshtm.ac.uk) or Sarah
Polack (sarah.polack@lshtm.ac.uk).
For details of RAABs already carried out, please contact Hans Limburg
(hlimburg@quicknet.nl)
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Introduction to Low Vision
CCB Power Point Presentation
Georgetown, Guyana
Dec 11, 2012
By
Denise Godin
CCB Regional Focal Person for Low Vision
11/22/2012
Low VisionThose persons who cannot
have their sight fully restored.
The majority have some residual vision that can be enhanced or made more useable and utilized for tasks that require vision
When Medical Interventions cannot effect change in
Visual function,
Vision rehabilitation methods and devices can
enhance
Functional vision
148
Definition of Low Vision
Visual Acuity of less than 6/18 (20/70), but equal to or
better than 3/60 (20/400), or a corresponding visual
field loss in the better eye of 20 degrees
World Health Organization
Definition of Visual Acuity
VA Min of Arc WHO Definition 20/20 1 min Normal
20/40 2 min mild LV
20/60 3 min WHO definition LV
20/70 3.5min Mod LV
20/200 10 min Severe LV
20/400 20 min Profound LV
20/1000 50 min Near total blindness
Visual acuity describes the loss of visual resolution (blur)
Contrast is the ratio of light/dark and describes the border of the image
(reduced contrast is often describes as ‘glare’) Functional Definition of Low Vision
- <6/18 to light perception - visual field <20 degrees from fixation - potential to use vision
Bangkok definition: A person with low vision is one who has impairment of visual functioning even after treatment
and/or standard refractive correction and has a visual acuity of less than 6/18 to light perception,
or a visual field less than 10 degrees from the point of fixation, but who uses, or is potentially
able to use vision for the planning and/or execution of a task. (WHO, 1992)
149
Those persons who cannot have their sight fully restored. The majority have
some residual vision that can be enhanced or made more useable and utilized for tasks that require vision.
Benefits of Low Vision
.Visual Environment
-Access
-Increased Awareness
-Control
.Acquisition of incidental visual information
. Increased visual independence
Global Perspective of Blindness Prevalence of blindness .6% in developed countries 1% in developing countries
Prevalence of Low Vision For each blind person there are 3-3.4 with low vision Prevalence of childhood blindness is .1per 1000 – 1.1per 1000
Leading Causes of Blindness in the Caribbean -cataract -Diabetic Retinopathy -Glaucoma -Uncorrected Refractive Error an d Low Vision -Childhood Blindness
Benefits of Low Vision Services -Reduces functional impact of low vision -Facilitates child education and development -Maintains independence -Enhances quality of life -Improves life satisfaction
150
Factors Affecting Low Vision Services -Population Increasing and Ageing -Present Weakness of Eye Care Delivery -Reduction of Government Support for Health Sector/ blindness prevention -Competition of funding
Institutional Landscape -Service Organization for the Blind -Networking -Partnership with Ministries of Health and Education -Referral System -Data Collection and Dissemination -Awareness -Training
National Low Vision Services -Identify a National Focal Person -Network -Set Up Low Vision Clinic -Organize Referral and Follow-Up
Environment Lighting Contrast Size Tactile
Low Vision Assessment -Examination -Refraction -Vision Assessment
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Magnification Calculations Magnification = Dioptic Power ----------- 4 Example: a 20 Diopter lens is equivalent to 5X magnification 20/4) To calculate a patient’s initial starting magnification needs: Starting Magnification: Entering Visual Acuity ------------------------------ Visual Acuity Goal Example: A patient has an entering visual acuity of 20/200 and they need to see 20/50. Initial magnification would be 4X 200/50
Near: Stand Magnifiers -Dome -Bar -Illuminated Stand Hand Magnifiers -Distance from page -Finding the distance -Increase visual field Chest Magnifiers Used for hands-free activities such as crafts, art , and writing
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CCTV/Jordy/Flipper Used for sustained reading activities such as newspapers, writing, and reverse contrast needs I Pad/ I-Pod Used for access to internet(You-Tube, music, etc)
Distance Monocular Telescope Used for reading street signs, bus numbers, spot distance tasks Full field telescopes (spectacle mounted) Place directly at the pupil centre in one eye or both used for sustained distance tasks ie: watching TV, movies. etc Bioptic Spectacle-Mounted Telescope Mobility: Can walk viewing through the carrier lens and stop and view through the telescope to view details (patient views through the carrier and tilts chin down to view through telescope when needed) Distance Electronic Magnifiers Electronic distance device with multiple working distances and magnifications
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