Scaling up eye care initiatives

in Pakistan

Prof . M. Daud KhanIAPB, 9th General Assembly;

Hyderabad, India,18.9. 2012

Freedom, India Partition & birth of Pakistan, 1947

A Mixture of joys and sorrows. Indo- pak wins freedom but the partition caused death, disease, destruction and displacement of some 20 million people

1947

Specialists 6

Medical Officers 42

(Mainly in Punjab)

Paramedics and nurses negligible number

Only two medical colleges in the country, with 80% staff migrating to India

Health care Heritage at birth

Rising population Aging population Poverty Illiteracy Extremism Political instability Regional conflicts

Challenges

Few Missionary Hospitals Sir H. Holland and Sons (Quetta & Shikarpur)Dr. Novel Christy -TaxillaMayo Hospital – LahoreCivil hospital, KarachiFew family owned cottage Eye Hospitals

Eye care Services in 1947,before &

after

Awarness

OSP1957

APAO1979

1980 W.H.O

Consultant

( Prof. Hugh Taylor )

The wake up call

APAO1960

APAO conceived, 1957,Approved, 11.9 1958,18th ICO, Brussels

The initial leadership used Five pillars for initiating and scaling up of eye care.

Essential tools used for scaling up

Awareness &

Advocacy

SituationAnalysis

&E.B

Goal SettingResource

Generation&

Management

Program Developmen

t&

Management

Partnership&

Collaboration

DISTRICTBASEDEQUITABLEEYE CARE

Program Planning, Development& Management

Relevance

NCECP

NHRDPAccess

Quality

Research based Needs Assessment

1st National Survey 1987 -1988

1ST 5yrs Plan1994-1998

2nd 5yrs plan1999-2004

2nd national Survey2002-03

Incremental & Sequential Scaling up

A major seat of learning, an autonomous institute, governed by an elected council of 20 members Goals & Objectives PGME R&D in biomedics Equitable Specialist health care Collaboration

HRD, OPTHALMOLOGISTS (CPSP)

HQ: KarachiRegional centers;16, 3 overseasAccredited institutes: 235Supervisors: 2100PG students: 13,5oo Number of Subspecialties: 60Total outputs: 19,000Impact: > 90% of specialist health care delivery is through CPSP alumni

HRD, Ophthalmic Allied health Personnel(AHPO) & Nurses

4 +2 centers for training of OAHP

12

Major HRD & Service Centers in NGO Sector

LRBT hospital

Al-Shifa Trust hospital

ISRAEYE

INSTITUTE

KARACHI

Plan

Evaluate

Implement

Monitor

DistrictComprehensiveEye CareServices (DCECP)

Primary Eye Care

Community Community Community

DetectTreat Refer

Disease Control

• cataract• Simple Glaucoma• Horizontal squints• Lids & Adnexa• Trauma• Infections

• Special programs on:• Corneal blindness• Trachoma • Vitamin A deficiency• Refractive Errors• Diabetes • ARMD

WHO OSProfessionals

P

GOP

NECP

Partnership & Collaboration

NGDOS &INGDOS

Primary Secondary Health Care Complex

Service delivery

District ComprehensiveEye Care Programme

Primary Eye Care

Detect Treat Refer

Tertiary Eye Care

CENTRE OF EXCELLENCE

Community Community Community

All the three tiers are important for development of National Eye Care Programme

HRD, CME,

CPD, CED

2.0%

0.9%

0

1

2

19802004

Impact

National Prevalence of Blindness

Outcome and Impact HRD (Eye care team) 1980 2006 Ophthalmologist 80 2000 Comm. ophthalmologist 0 100 MLECP 0 >500

Infrastructure Centers of Excellence 0 7 3ry eye care centers 10 >80 2ry eye care centers 8/64 118/120

Disease control ( 1115/M 2400 ---4000/ M

Special programs for:Corneal blindnessTrachoma Vitamin A deficiency

Diabetes , ARMD and GlaucomaRefractive errors and low vision

(CSR)

Year by year growth/districtCataract Surgery

0

50

100

150

200

250

300

350

400

450

1st year 2nd year 3rd year 4th year 5th year

P. Cartwright, W Van Berkel, J Banzin, Khan, N Jan 2004

828

249

597

791

977

1,239

379

571

79

661

914

1,0771,192

838

456

35-

200

400

600

800

1,000

1,200

1,400

1999 2000 2001 2002 2003 2004 2005 till Sept06

Years

Ge

nd

er

Male Female

Gender wise Serviceuptake

Afghanistan Yemen Iran Bangladesh Jordan Syria Lebanon Palestine Libya

Impact International

Sri Lanka Indonesia China Nigeria Kuwait Egypt UAE Iraq Saudi Arabia

Future Priorities

•HR forSub specialty development•Enhanced focus on AHP including nurses CME, CPD & CEDEnhanced focus on R & D

Pediatric Eye careDiabetic Eye careARM

Ref. Error & low VisionSchool H. serviceCVC

3rd 5 yr. program GOP commits 2.8 billion ( 46 M $ )

Acknowledgements

WHO ICOIAPB

ICEHCBMSSI FHF LFW

EUJuntedo University ALBASAR LVP Ecww

AAO

Rotary International Dr PARAProf. Allen Foster Prof. Clare GilbertProf. KonyamaProf Prowzeski Dr. Gana

IEF

Dr Babar Q.Dr. Aman KDr.Rubina GDr.Haroon AMr Hassan M.

Prof. Saleh MProf. Nasim PPros Asad Aslam

Aravind eye care systems

Impact EMR

Leaders whoInspired us

Those who offered us unwavering support

APAO LEADERS WITH VISION & Mission

THANK YOU