One ophthalmologist for 170,000 people in country. Experts suggest massive thrust in HRD and increase in resource allocation in eye health to achieve Vision 2020. There are only 900 ophthalmologists in the country meaning one ophthalmologist has to work for around 170,000 people.
The information was revealed at a workshop on Vision 2020, which aims to eliminate avoidable blindness by the year 2020, organised on Tuesday at Spectra Convention Centre in Dhaka.
Studies suggest that Bangladesh is far away from attainment of the global benchmark in eye health service. According to the studies, Cataract Surgical Rate (CSR) in the country is around 1,300 per million people, compared to 6,000 in India and 3,845 in Nepal. Number of ophthalmic allied personnel per population is also lower in Bangladesh – 1: 295573.2 against 1: 72474.9 in India and 1: 59091.1 in Nepal.
Eye health experts and other stakeholders suggested at the workshop that Bangladesh needs to largely increase investment in eye health to develop more eye surgeons and allied ophthalmic personnel to achieve Vision 2020 and Universal Eye Health through an efficient eye care service.
According to the eye health indicator set jointly by Word Health Organisation (WHO) and International Agency for the Prevention of Blindness (IAPB), Bangladesh needs to immediately address the issue of inadequate number of ophthalmologists, allied personnel and also health facilities to achieve the global benchmark.
Ophthalmological Society of Bangladesh (OSB) and International NGO Forum working for eye health organised the workshop with the objectives to identify the challenges of eye care service and set forth recommendations crucial to meet the target of Vision 2020.
The eye health experts identified four key areas that require immediate measures to improve eye care services. The areas include increasing the number of cataract surgeons to address the backlog of cataract surgery; increasing the number of mid-level ophthalmic personnel to support ophthalmologists for more productive time for high volume quality cataract surgery and also largely contribute to improving primary eye care; phenomenally increase the resource allocation for eye health to ensure its equitable distribution and introduction of eye health financing scheme for poor; and ensuring quality eye care service across the country.
Health and Family Welfare Ministry Secretary Syed Monjurul Islam spoke at the inaugural session as the chief guest while Asia Pacific Academy of Ophthalmology (APAO) Vice-President Prof Ava Hossain and Director General of Health Services Prof Deen Mohd Noorul Huq remained present as the special guests.
The chief guest said Bangladesh needs to focus more on eye health to be an efficient and skill nation and require identification of priorities in eye care service to attain the Vision 2020 goals.
The secretary praised the INGOs, development organisations and others working for ensuring eye health services and urged them to forge greater partnership with the government in the field. He sought suggestions and technical supports from NGOs and development agencies apart from finance.
DG Health Noorul Huq said eye care services cost less in Bangladesh compared to other countries and urged the doctors and health facilities to cut cataract surgery charges so that more people, especially the poor, can afford the service.
He laid emphasis on cataract surgery training for ophthalmologists and urged the INGOs to develop training centres for that.
OSB President Prof Md Sharfuddin Ahmed and Secretary General Prof AHM Enayet Hussain, Line Director of National Eye Care Prof Golam Mostafa, INGO Chair and Sightsavers Bangladesh Country Director Khondoker Ariful Islam and Orbis International Country Director Dr Munir Ahmed also spoke at the workshop.
According to papers presented at the workshop, presently Bangladesh has only 900 ophthalmologists with population-ophthalmologist ratio being 170,000:1. There is no satisfactory increase in CSR — from 1172/million in 2010 to only 1300/million in 2014.
The papers say there are over 750,000 blind people in Bangladesh, out of which 650,000 are blind due to bilateral cataract accounting for 80 percent of total blindness. Around 130,000 cataract blinds are added every year as new cases and annual performance of cataract surgery is around 200,000, according to the papers.
Experts said at the workshop at least 90 percent of the existing ophthalmologists should have formal training in ophthalmic microsurgery to achieve CSR up to 3000/million, which is necessary to overcome the backlog in cataract surgery. But, they said, currently there is no systematic planning for eye health workforce development and deployment.
The speakers said many practicing ophthalmologists are not performing cataract surgery while ophthalmology residency training programme lacks comprehensive approach including practical component of ophthalmic microsurgery.
Experts said if eye health financing scheme can be introduced in Bangladesh eye health services would be easily accessible to the poor patients living in the rural areas.
A large number of ophthalmologists, high government and NGO officials also attended the workshop.
INGO Forum members are Andheri-Hilfe Bonn, CBM, the Fred Hollows Foundation, Heart to Heart Foundation, Helen Keller International (HKI), Korea International Cooperation Agency (KOICA), Orbis International and Sightsavers.
The experts made a number of recommendations under the four key areas. The key recommendations, among others, are mapping of eye care service for allocation of cataract surgeons in the areas with poor human resources; special training course on micro-surgery for ophthalmologists; and government’s policy to include introduction of reimbursement to ensure subsidised cataract surgery through public and private eye hospitals.