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Scaling up eye care initiatives in Pakistan . Prof . M. Daud Khan IAPB, 9 th General Assembly; Hyderabad, India,18.9. 2012. Freedom, India Partition & birth of Pakistan, 1947. - PowerPoint PPT Presentation
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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 6Medical Officers 42 (Mainly in Punjab) Paramedics and nurses negligible numberOnly 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 ComplexService 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
1980 2004
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
050
100150200250300350400450
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
Gen
der
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