BLINDNESS IN INDONESIAFarida Sirlan

DefinitionWHO: < 3/60 - 3 m finger counting 6/60 - 6 m finger counting

Blind prevalence (0/0)1996Visual impairment 1.80Severe visual imp. 1.10Blind 1.50

Blind Prevalence (%) Based on Age Group, Gender and EducationContinue

VariablePrevalence (%)TotalAge Group 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-391.5

0.50.20.10.40.60.40.81.2

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Blind Prevalence (%) Due to Area and ProvinceContinue

Blind Prevalence (%) Due to the Cause

Distribution (%) Cause of Blindness

Trend of Blindness 1982-1996Cause of blind 1982InfectionMalnutrition

Cause of blind 1996DegenerationRetinopathy

Why Blindness ?Lack of knowledge of the blind peopleLack of health priority and political will Lack of awareness of the professionalGeographically difficult

Magnitude of Blind1.5 million backlog of cataract blind210.000 new cataract blind per year420.000 people blind of glaucoma300.000 people blind of refractive errors275.000 people blind of retinopathy210.000 people blind of corneal diseases 0.3%ofchildern.. Children blind

Government Policy for BlindnessBlindness problem is under 2 DG MOHPrevention of Blindness Committee, report directly to Minister of HealthInter Ministry CollaborationMOU with NGOsProgram priorityVision 2020, the right to sight

Program Priority due to Blind Cataract blind Refractive errors Glaucoma Retinopathy

Why priority?Cataract blindAvoidableRefractive errors

GlaucomaUnavoidable Retinopathy

Cataract Blind Program in Indonesia Central level Provincial level District level Community level

CENTRAL LEVELMinistry of Health: priority , political will Ministry of Internal Affairs: depend on approachMinistry of Social welfare: depend on approachNGOs: depend on regional country director/regional consultant / adviser

INDONESIAPrevention of Blind Committee National

Forum of cat.blind eradication Province

Forum of cat.blind prevention District

Team of cat.blind screening Sub district

PROVINCIAL LEVEL Teaching hospital / University Provincial Health Office Residency training program Community Eye Care Institution/BKMM Professional Association NGOs role

West Java Forum Eye Camps Affordable cat surgery hospital based surgery $ 20 Cross subsidy

DISTRICT LEVEL District Health Office District Hospital equipment subsidy outreach service eye camp Ophthalmologist awareness skill facility

Cataract Blind- 52% causes of blindness- Starting at productive age Avoidable blind by surgery Cataract surgery is not equitable, available, accessible and affordable yet

Cataract Blind Magnitude0,78% population or 1,5 million cat.backlog1population or 210.000 new cases Cataract Surgical Rate = 350/million/yearTarget of cat.ops = 210.000/yearCoverageup to 2000 = 60.000/year

BarriersLack of- knowledge- awarenessHospital is not available notfamiliar not accessible

PROBLEM SOLUTIONAdvocacyPromotionTrainingScreening 5) Surgery: - Cross subsidy - Hospital base - Eye camps 6) Patient satisfaction7) Monitoring/evaluation

ADVOCACY Ministry of Health increase priority as training center Province/local gov. forum as referral hospital District level forum district as program coordinator Sub district level key person, GP, nurses, health cadres as technical assistance

PROMOTION Leaflet UKMPK Booklet PKKP Books UKS Manual

TRAINING GP Nurses Cadres Funded by : MOH and CBM

GPNursesCadresMOHCBM

SCREENING Eye camps team Health Centers Head of Sub district Cadres

Cross Subsidy 2001 Subsidi dampak BBM/PDPSE JPSBK

GovernmentNon GovernmentLocal Govern.DharmaisCBMRotaryLionsMOHMOADharmais CBMRotaryLions

TRAINING CENTER Eye care management camps Eye care team counseling Microsurgery course High volume, high quality surgery

Cost of Blind

Cicendo Eye HospitalCataract Surgery Cost$ 100 350$ 20cross subsidy (paid)$ 40

Blind due to refractive errors9.5% of blindnessMain cause is amblyopia and high myopia / degenerative myopiaScreening at school age groupProviding affordable glassesTraining for teachers and paramedicalPrimary eye care program

Blind due to Glaucoma13.4% of blindnessIn Indonesia mostly open angle glaucomaUsually come in acute attack stageNeed early detection and screening at the people over 40Need promotion and training for primary eye care program,GP from health centers

Blind due to RetinopathyMostly due to Diabetes MellitusUsually come at DR ll lll stageLack of awareness of the patientsNeed promotion and early detection Need training for GP from health centersNot all hospital provide retinal services and treatment

Children Blindness0.3% blind from children age groupThe most important cause is amblyopia, cataract congenital and retinoblastomaDo not have yet the standard procedure to treat children blindnessStill at low priority of blindnessShould develop pediatric ophthalmology

Xerophthalmia1994 HKI present award for Soeharto1997 monetary crisisMalnutrition and xerophthalmia

Vision 2020, the right to sightReduce blind to 0.5% year 2020

cataract blind : 0.25% from 0.78% other cause of blind: 0.25% from 0.72%

cataract surgical rate and coverage of cataract surgery should increase 3 times as well as effort to reduce the other blindness

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