Eye Care in Indonesia and

World Report on Vision

Aldiana Halim
Kabupaten Pegunungan Arfak, Papua Barat, November 2016
Kabupaten Pegunungan Arfak, Papua Barat, November 2016
Vision loss affects
more than one’s
ability to see the
world clearly
Vision impairment
affect almost every
aspect of a person’s life
QALY LOSS QALY GAINED
http://apps.who.int/uhc/en/
Health System
Health systems approach
Governance Information
Service
delivery systems

Health
personnel Health Medicines,
financing technology
World Health Organization (2013). "Universal eye health: a global action plan 2014-2019."
https://www.iapb.org/advocacy/who-action-plan
"Ensuring that all people have access to
promotive, preventive, curative and rehabilitative
health services, of sufficient
quality to be effective, while
also ensuring that people do
not suffer financial hardship
when paying for these
services."
Principles of Universal Eye Health

Services must
be available to
Services must be
everyone
comprehensive
Principles of Universal Eye Health

Models of care Services must

must be in line be affordable
with the existing
health system
Challenges of Universal Eye Health
Affordable
services
Break down
barriers
Accessible
services
Challenges of Universal Eye Health
Reach rural
and ageing
populations
Outreach
methods
Increase
cataract output
Challenges of Universal Eye Health

Diabetes

Emerging
diseases Glaucoma
Situation of Visual Impairment in Indonesia
Table 1. Extrapolated magnitude of blindness in persons
  Male Female Total
  n % (95% CI) n % (95% CI) n % (95% CI)
North Sumatra 13524 1.3 (0.5 - 2.0) 22076 1.9 (1.0 - 2.7) 35601 1.6 (0.9 - 2.2)
West Sumatra 4736 1.0 (0.3 - 1.7) 8549 1.6 (0.8 - 2.5) 13281 1.4 (0.7 - 2.0)
South Sumatra 16113 2.5 (1.5 - 3.4) 29145 4.4 (3.0 - 5.7) 45253 3.4 (2.4 - 4.4)
Jakarta 7331 1.2 (0.2 - 2.2) 16135 2.6 (1.8 - 3.3) 23464 1.9 (1.3 - 2.5)
West Java 69058 2.1 (1.1 - 3.1) 111605 3.4 (2.4 - 4.4) 180666 2.8 (2.0 - 3.5)
Central Java 66774 2.1 (1.0 - 3.2) 110202 3.2 (2.4 - 4.0) 176977 2.7 (1.9 - 3.4)
East Java 193907 4.7 (2.5 - 6.9) 177687 4.1 (3.0 - 5.2) 371599 4.4 (3.1 - 5.6)
South Kalimantan 4721 1.5 (0.6 - 2.4) 7484 2.3 (1.2 - 3.3) 12205 1.9 (1.1 - 2.7)
NTB 10713 3.3 (1.9 - 4.8) 16283 4.7 (3.5 - 5.9) 27000 4.0 (3.0 - 5.1)
NTT 5577 1.4 (0.6 - 2.2) 10457 2.5 (1.5 - 3.4) 16035 2.0 (1.3 - 2.6)
Bali 58021 1.7 (0.7 - 2.6) 80012 2.2 (1.3 - 3.1) 138028 2.0 (1.1 - 2.8)
North Sulawesi 4729 1.9 (0.9 - 2.8) 3733 1.4 (0.9 - 2.0) 8461 1.7 (1.1 - 2.2)
Maluku 2391 2.0 (0.8 - 3.2) 4065 3.2 (2.2 - 4.2) 6456 2.6 (1.7 - 3.5)
West Papua 1214 2.2 (1.3 - 3.1) 1164 2.5 (1.5 - 3.5) 2379 2.3 (1.7 - 3.0)
Strategi
Katarak
• Meningkatkan jumlah operasi
katarak
• Kebijakan di daerah untuk
penanggulangan katarak dengan
sesuai keadaan demografi dan
prevalensi kebutaan.
• Perkuatan Sistem rujukan
Gangguan Penglihatan Lain
• Kelainan Refraksi Usia Sekolah
• Layanan komprehensif untuk
retinopati diabetik, glaukoma,
dan childhood blindness.
• Rehabilitasi penglihatan yang
komprehensif dan inklusif
 STRUCTURE OF EYE CARE
Research, Education, Difficult Central of
Cases
Excellent 25 mill

g
in
Tertiery Eye

ain

Re
Difficult Cases 10 mill

Tr

fe
Care

rra
nd

l
a
rt
High Volume Cataract

po
Surgeries Su
p
Secondary Eye Care 2.5 mill
Cataract Case Finding by
health Workers
Primary Eye Care 30.000
Visual Impairment Case Community Structures
Findings by Key
(Key Informants/Cadres)
5000
Informants/Cadres
 World Report on
Vision

• WHO’s first ever World Report on

Vision
• Strategic framework: guide action at
national, regional and global level
• Critical moment to inform and
persuade global leaders about the
magnitude and unacceptability of
vision loss globally.
Lack of ACCESS to care

© World Health Organisation 2019. Some rights reserved

Lack of ACCESS to care

© World Health Organisation 2019. Some rights reserved

 Productivity Education Road traffic accidents

Productivity Impact equivalent 30% of those

improves by up to to up to ½ a year involved in RTAs
20-30% additional have vision
schooling impairment
 Eye care interventions
Lack of ACCESS to care
• Effective interventions are available for
health promotion, prevention, treatment
and rehabilitation to address the entire
range of needs associated with eye
conditions and vision impairment across
the life course.
• Some are among the most feasible and
cost-effective of all health care
interventions to implement.
© World Health Organisation 2019. Some rights reserved
 Lack of Integration
Lack of ACCESS
1. Vertical programmes
to care
2. Lack of coordination with the private
sector
3. Uncoordinated and unregulated
workforce
• 8/24 countries do not recognize
optometry as a profession or do not have
educational requirement

4. Eye-care is not part of the health

information system

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National overarching development/strategic plan

AGEING

ANTI-
MENTAL MICROBIAL
HEALTH RESISTENCE

HIV/AIDS NCDs

Health Sector
Strategic Plan
Maternity &
Child Health
Eye
care

If eye care is not part of the health sector strategic plan, it will
not be prioritized

© World Health Organisation 2019. Some rights reserved

Integrated People Centred Eye Care
• Are managed and delivered so that people receive a
continuum of eye care interventions covering promotion,
prevention, treatment and rehabilitation;
• Address the full spectrum of eye conditions according to
their need;
• Are coordinated across the different levels and sites of
care within and beyond the health sector; and
• Recognize people as participants and beneficiaries of
these services, throughout their life course.

© World Health Organisation 2019. Some rights reserved

Strengthen all levels of care

• Workforce

• Equipment &
consumables
• Assistive products

• Infrastructure

$
© World Health Organisation 2019. Some rights reserved
 CHOGM
COUNTRY
RWANDA
LAUNCHES

WORLD
UN FRIENDS OF HEALTH
VISIONS ASSEMBLY
RESOLUTION