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National Eye Care Strategy

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National Eye Care Strategy Strategy for National Eye Care for Vision 2020 in Bangladesh Prepared by Dr. A. M. Zakir Hussain Dhaka, August 2014 1 TABLE OF CONTENTS Acronym………………………………………………………………………………………...2 Background……..……………………………………………................................ .........4 The draft 2014-2020 strategic plan………………………...………….….………………..20 Policy statement……………………………………………………….… ……………...20 Results framework………………………………………………………………………........24 2 ACRONYM BBS Bangladesh Bureau of Statistics BCPS Bangladesh College of Physicians and Surgeons BMDC Bangladesh Medical and Dental Council BNSB Bangladesh National Society for the Blind CBHC Community Based Health Care CC Community Clinic CDC Communicable Diseases Control CMSD Central Medical Stores Department DEC District Eye Health Coordinator DEHC District Eye Health Committee DGHS Directorate General Health Services DP Development Partners DSF Demand Side Financing ECHO Eye Care and Health Observatory ESD Essential Services Delivery FY Financial Year GDP Gross Domestic Product GOB Government of Bangladesh HEP Health Education and Promotion HIS-EH Health Information System-E Health HNPSP Health Nutrition and Population Sector Program HPNSDP Health Population and Nutrition Sector Development Program HRM Human Resource Management HSM Hospital Services Management IAPB International Agency for the Prevention of Blindness INGO International Non Governmental Organization JAG Joint Advisory Group KAP Knowledge Attitude and Practice M&E Monitoring and Evaluation MLEP Mid Level Eye Care Personnel MOHFW Ministry of Health and Family Welfare MOLGRDC Ministry of Local Government, Rural Development & Cooperatives NCD Non Communicable Diseases NEC National Eye Care NEH National Eye Health NEHC National Eye Health Committee NES Nursing Education and Services NGO Non Governmental Organization NIO National Institute of Ophthalmology NSAPR National Strategy for Accelerated Poverty Reduction NTDs Neglected Tropical Diseases OSB Ophthalmological Society of Bangladesh OP Operational Plan 3 OT Operation Theatre PHC Primary Health Care PIP Program Implementation Plan PIU Program Implementation Unit PPP Public Private Partnership RAAB Rapid Assessment of Avoidable Blindness SWAp Sector Wide Approach TK Taka UHC Upazila Health Complex USD US Dollar V2020 VISION 2020 WHO World Health Organization 4 BACKGROUND 1. Past activities Vision 2020 – the Right to Sight, was launched by the World Health Organization (WHO) and International Agency for Prevention of Blindness (IAPB) in 1999 in Beijing to eliminate avoidable blindness by the year 2020. The 56th session of the World Health Assembly of WHO, which was chaired by the Honorable Minister, in- charge of the Ministry of Health and Family Welfare, Government of the People's Republic of Bangladesh, adopted the Vision 2020 formally. To facilitate attainment of the Vision 2020 goals in Bangladesh a Bangladesh National Vision 2020 Advisory Committee was formed in 2007 with Director General of Health Services as its chairperson and the line director of the National Eye Care Program as its member secretary. The terms of reference of the Committee includes: 1. Provision of guidance and technical and advisory support to the line director; 2. Identification of national eye care priorities and program/research priorities and their implementation, operationalization of the national eye care plan included in the sector-wide perspective plan of the Ministry of Health & Family Welfare, Government of Bangladesh; 3. Promotion of and support to mobilize resources; 4. Pursuance for the formation of district Vision 2020 coordination committees; 5. Obtaining BNCB endorsement on policy and other issues relevant to attainment of Vision 2020 goals. District Vision 2020 Committees were formed with support from international non- government organizations (INGOs). These committees draw members from upazila level public health officials, i.e., upazila health and family planning officers, Lions and Rotarians, representatives from education and religious sectors, from local bar councils and press clubs, local municipalities, NGOs, international NGOs (INGOs), private hospitals, local philanthropists, local public leaders and other stakeholders. These are headed by the head of the district health department, i.e., civil surgeons. The terms of reference of the District Vision 2020 Committees include: 1. identification of district eye care needs; 2. development of district eye care plans with targets; 3. Development of monitoring and evaluation plans and implementation strategies. 4. Rreviewing progress, achievements, challenges and lessons learnt to advise the district eye care managers; 5. Maintenance of a profile of the district eye care providers; 5 6. Facilitation of coordination to avoid duplications and overlaps; 7. Support for mobilization of resources; 8. Identification of needs and areas to improve infrastructure, human resources development and management, equipment and other supplies. Bangladesh was also the first country in the South-East Asia Region of WHO to develop a plan in 1980 for a national program on prevention of blindness, which triggered a global concept of development of national programs on blindness prevention, supported technically by WHO. The program in Bangladesh was taken up under the aegis of the Bangladesh National Council on Blindness (BNCB), with support from the Royal Commonwealth Society for the Blind (RCSB), now known as the Sightsavers International. This national eye care plan of 1980 was developed immediately after Bangladesh ratified the Vision 2020. This was subsequently incorporated in 2003 in the second sector-wide perspective plan of the Ministry of Health and Family Welfare, widely known as the Health, Nutrition and Population Sector Program (HNPSP) 2003-2011. Some of the activities of this plan were funded by the Sightsavers International. In 2003 BNCB formed a review committee, which assessed eye care service capacity at the base nationally and drafted a new national eye care plan in 2005 (the second national eye care plan), after series of consultations and workshops across the country between 2003-2005 period, participated by the Ministry of Health & Family Welfare staff from national to the most fringe level, by national and international non-government organizations, eye care experts and the relevant auxiliary staff. These activities were supported by the Sightsavers International and ORBIS International. The plan prioritized three eye care problems, namely, cataract, childhood blindness and low vision. Along with these three prioritized areas other problems that were focused were: cornea and retina related problems and glaucoma. This plan was followed by a ground breaking event- creation of a post of line director for National Eye Care in the 2011-2016 sector-wide five year plan of the Ministry of Health & Family Welfare, Government of Bangladesh.The 2005 national plan emphasized on capacity building for secondary care and on strengthening the primary health care infrastructure so that primary prevention and referral of medical cases may be institutionalized. The plan underscored the role of coordination, in particular at the district level. The plan also laid emphasis on public-private partnership including non- government organizations for effective attainment of the Vision 2020 goals. The current sector-wide plan 2011-2016 of the Ministry of Health & Family Welfare, Govt. of Bangladesh, i.e., Health Population and Nutrition Sector Development Program (HPNSDP), has the following NEC relevant key objectives: 1. Awareness on blindness prevention; 2. Control of childhood blindness; 3. Strengthening of coordination between Government-NGO and private eye 6 care providers; 4. Building of capacity of eye care service providers; 5. Voucher scheme for eye care services; 6. increasing the country cataract surgical rate. The 2011-2016 sector-wide plan underscored the importance of ocular trauma, due to agricultural and occupational accidents; ocular growth and malformations. A strategy was drawn for early detection and management of these problems, as these interventions provide appreciable social and economic dividend. A major thrust has been given to improvement of infrastructure and technology at secondary level service centers; establishment of vision centers at upazila level, for correction of refractive errors and identification of cataract and other ophthalmic problems for referral; introduction of child sight testing in primary schools; introduction of subspecialty services at tertiary level; demand side financing; management of information systems; and involvement of primary health care infrastructure for providing eye care. The other areas are: increase in awareness of the people on blindness prevention, strengthening coordination between government, NGOs and the private sector, introduction of vouchers to increase accessibility of the poor, elderly, women and children to cataract surgery. Some of the crucial activities completed under the plan are: SICS guideline; Treatment protocol; Examination protocol; Eye care manual for primary health care workers; Guideline for OT and ward management for nurses and paramedics; Guideline for counseling in eye care; Functioning district vision 2020 in 30 districts; Age and gender specific cataract surgery reports on standard formats sent to IAPB and WHO regularly; Cataract surgical outcome monitoring (CSOM); Earmarking of community clinics as referral point to upazila health complexes (vision centers). The
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