For equitable and holistic eye care services, leadership and governance, health service delivery, access to drugs, health workforce, information system and health financing should be strengthened

Every year World Sight Day is observed on the second Thursday of October. It is coordinated by the International Agency for the Prevention of Blindness (IAPB) in cooperation with the World Health Organisation (WHO). It is a major global event to draw attention on the blindness and vision impairment.

Accordingly, this year the eye health stakeholders observed the day with a rolling theme of “Universal Eye Health” in line with the WHO Action Plan 2014-19. For this year, call to action is “Eye Care Everywhere” with a focus to find the solutions to ensure that everyone everywhere has access to sight.

The IAPB has estimated that 36 million people are blind globally and around 217 million are moderate to severe visually impaired of which more than 75 per cent are due to avoidable causes.

This makes the global prevalence of blindness and vision impairment 3.37 percent (2015) which means nearly four out of every 100 people are either blind or have difficulty in seeing things in strength sufficient to affect normal living. Another tragic fact is that nine out of these 10 visually impaired people live in low and middle income countries and more than half are women.

Eye care service was at its rudimentary stage in Nepal prior to 1981.

The Nepal Blindness Survey 1981 revealed a very high burden of eye diseases (0.84 per cent of blindness in all ages) with only a handful of eye care infrastructure available in the country. This huge gap in demand and supply of eye services drew the attention of national and international eye health stakeholders to the burden of blindness and vision impairment.

The Government of Nepal signed the global initiative of “Vision 2020: The Right to Sight” in 1999 which provides the guidelines, targets and strategies to be taken to reduce the prevalence of blindness in the developing world, for elimination of avoidable blindness by the year 2020.

After a decade of launching this initiative and rigorous efforts to strengthen physical and human infrastructure on eye health from I/NGOs, the situation has significantly improved, making eye care a successful I/NGOs-run programme.

As a result, blindness prevalence has been reduced by 58 per cent from base year 1981 to 0.35 per cent as per WHO definition in 2012 (Epidemiology of Blindness in

Nepal, 2012).

Though progress in eye care has been encouraging, much needs to be done. The percentage of blindness has decreased but the number of the blind remains same as population has doubled. The burden of eye disease is in increasing trend due to longer exposure to gadgets, climate change, air pollution and increased life expectancy.

This year alone, Nepal eliminated trachoma but at the same time chronic eye diseases such as glaucoma, diabetic retinopathy and age-related macular degeneration are increasing.

Though the physical and human resources are much developed (there were 257 ophthalmologists in 2015 (ECSAT report 2015, Nepal Netra Jyoti Sangh), they are inadequate to meet the current demand and are inequitable in distribution.

There is a very minimal presence of government in the eye care (0.02 per cent of overall budget in eye health, ECSAT report 2015, Nepal Netra Jyoti Sangh) and primary eye care is not still integrated into primary health care.

Similarly, sustainable development goal has included neglected tropical disease, trachoma and onchocerciasis, as a direct target to end the epidemic by 2030.

Nepal has made tremendous achievements in eye care with the development of eye care infrastructure and human resources in the last three decades. Nonetheless, the distribution of services is not equitable yet.

For equitable and holistic eye health service provision, the pillars of eye health services including leadership and governance, health service delivery, access to drugs, health workforce, information system and health financing should be strengthened. While moving from centrally operated system to federal one, the different levels of government can learn a lesson from neighbouring countries and their strategy of eye health integration.

The government needs to activate the apex body for eye health to facilitate and coordinate the eye care service providers in the country. Eye care services should be integrated and included in major initiatives and goals as Universal Health Coverage, Sustainable Development Goal.

The changing trend of eye diseases should be addressed in terms of policy, plan, technology, drugs, medicines and human resources. Eye care gaps in rural and remote areas can be fulfilled by retention policy and incentives. Evidence-based eye care programmes should be launched to meet the eye health needs of people at the grassroots level. The obtained data from Health Management Information System should be analysed by disaggregating into its major determinants as sex, age and ethnicity. The growing health insurance and other private health insurance should be inclusive of eye health services. Hopefully, with all these efforts we can reach the unreached, ensuring that everyone can enjoy the right to sight.

Oli is senior research officer, Research Department, Tilganga Institute of Ophthalmology