There is no alternative to ensuring a comprehensive approach in delivering equitable eye care in Bangladesh for attaining universal eye healthy. Currently, we are focusing on WHO Health Systems Strengthening (HSS) Framework and addressing the supply side of eye care services.
The eye care has been traditionally led by philanthropists in Bangladesh to save sights by removing cataract. The NGO eye hospitals and facilities did offer services to walking patients but still depends on the planned drive of collecting patients and screening through camps and school sight testing programmes. In doing so, they have been contributing to avoidable blindness prevention in the country.
The government and NGOs are yet to engage communities to have a sustainable impact on the areas/ population where they have served and could not adequately generate demand for eye care services compared to the disease burden on a particular community.
A responsive referral mechanism could not be established from the community level to at least district levels or referral base eye hospitals of NGOs are not in place or conceived either by these key players in eye health. This has also resulted in delay in generating demand or creating pressure on the key players of eye care to equip and strengthen themselves to develop comprehensive eye care, which could significantly contribute to achieving universal eye health in Bangladesh.
From the demand generation point of view, due to absence of community engagement and empowerment, the expected outcome could not be ensured and the health system strengthening efforts, especially in eye health, has been staggering for long. Our prevalence shows we have a huge backlog of cataract and refractive error (RE), which have increased manifolds over the last few years.
Because of lack of latest data and information about services at the national level, a comprehensive planning process has been compromised. There is enough evidence that key players have been taking initiatives e.g., having an approved separate Operation National Eye Care (NEC) plans and budget under 4th HNPSDP, recognition of PPP approach in the NEC plan addressing eye health issues in a collaborative way by the government, NGOs and private sector to prioritise and address eye health issues.
While delivering eye care services, even the government also adopted the approach of NGOs like organising mega camps which are not effective and sustainable. To offer eye care services, the NGOs have already adapted a community component “Close to Community” by establishing primary eye care centre/Vision Centres which connects the community to their base eye hospitals and developed a referral system. The importance of community engagement and empowerment has been realised by the government and thus the government has created a countrywide Community-based Health Care system, which is expected to create a referral system from Community Clinics of the government to the sub-district or upazila-level hospitals.
The government has also taken the initiative under the NEC plan to set up vision centres at the sub-district-level hospital which has been a bold step to involve communities. However, the development of comprehensive eye care services at the district-level hospitals to respond to the demand of sub-district-level vision centres is still a challenge for NEC to resolve. While the government has been convinced to start eye care at the sub-district level and develop a system of referral care, there is no way that it can do alone and reach out to the communities and hard-to-reach areas.
This needs to be collaborative planning, coordination and support to each other through policy instruments so that NGO and private sector could expand significantly and complement and supplement bridging the gaps and meeting the needs of eye care services to ensure the comprehensiveness of the approach.
In the World Sight Day 2019, World Report on Vision (WRV) was launched with the aim to accelerate the achievement of universal eye health. The report underscored the missing link – the community component to reinforce the health system strengthening framework. The report emphasised the need for an Integrated People-Centred Eye Care (IPCEC) approach along with HSS which would have a combined effect on eye care for all. Fortunately, the International Agency for the Prevention of Blindness (IAPB) regional and Bangladesh leadership and the government pioneered in launching the WRV in January 2020, giving a momentum to the NEC movement in universal eye health in Bangladesh. The health minister, officials of the health directorate, members of Bangladesh Council for the Blind, Ophthalmological Society of Bangladesh and INGO Forum in eye health, experts and journalists were present at the ceremony.
A consultative workshop organised by INGO Forum in eye health came up with actions against each of the IPCEC key components which is a milestone for Bangladesh history in revolutionising the mindset of the key stakeholders and policymakers and planners of the health sector. That later triggered revision of existing NEC OP and also building consensus through a dialogue for integrating eye health into various OPs of 4th HNPSDP – another milestone in the challenging days of COVID-19 pandemic.
During the COVID 19 pandemic, a huge negative impact has been observed. Restrictions on movement impeded service delivery at all levels. Yet few selective emergency eye care services were available. Due to closure of the schools and restrictions on mass gatherings, community-level outreach services of eye hospitals such as eye camps and school screening programmes were stopped. Interesting to note that the community-based primary eye care centres or Vision Centres, which were less known during pre-COVID-19 period, have been found more vibrant in delivering eye care services and making appointments for selective and emergency surgeries, including follow-up, etc, which has been found more utilised by the communities because of their location and active support to patients following all safety measures to prevent viral transmission and getting appropriate eye care services. There were also few attempts made by the Vision Centre staff to organise targeted visit to either institutions (e.g., religious schools or madrasas) or local office premises of development NGOs (e.g. credit group, local community) for secondary screening of listed/identified eye patients, who required diagnosis and referral to their Vision Centre or the eye hospitals. In all cases, Vision Centre staff took protective measures to ensure safe eye care service delivery and that has been helpful for promotion of eye health and demand generation of community-based eye care services centring Vision Centre.
Dr. Munir Ahmed is Country Director of Orbis International and a Public Health Management Specialist.
(To be continued)
