Eye Health

1. The Progress of Eye Health
Service in Cambodia
Do Seiha
National PBL & VISION 2020 Coordinator
National Program for Eye Health, M
Ministry of Health
1st Congress AOS,
February 19-21, 2014 at Bangkok Convention Centre at
Central World , Bangkok, Thailand.

2. Content of Presentation
I. Country Profile and Indicators
II. Blindness and Visual Impairment
III. Progress on
1. Human Resource Development
2. Facility Development
3. VISION 2020 Disease Control
Cataract, Refractive Errors, Trachoma, Childhood
Blindness, Diabetic Retinopathy
IV. Challenges of Eye Care and Opportunity
V. Conclusion

4. I- Country Profile and
Indicators
mbodia• Population 14,701,717 (July 2011 est.)
• Urban 20 %
• Rural 80 %
• Male Life expectancy 60
• Female Life expectancy 65
• Annual Population Growth Rate 1.8%
• Total Fertility Rate (TFR) 3.31
• Infant Mortality Rate (IMR) 66 per 1,000 live births
• Under 5 Mortality (MMR) 83 per 1,000 live births
• Crude Birth Rate (CBR) 27.7 per 1,000 population
• Access to Clean Water 36 %
• Access to Latrine ( Rural Area ) 34%
• Gross national income per capita (2012) 2,330

5. • Blindness rate* 0.38%
• Causes of Blindness
• Cataract 74.7 %,
• Corneal scars ( of all courses) 8.0 %
• Glaucoma 3.1 %
• Posterior segment diseases 4.9 %
• Refractive errors 2.7 %
• Uncorrected Aphakia 1.8%
• All bilateral blindness in Cambodia
• 90.2% is avoidable
• 79.1% is curable and 11.1% is preventable
II- Blindness and Visual Impairment
in Cambodia
* RAAB- 2007, Source from National Program for Eye Health, MoH

6. • There are approximately 33,359 people are
living with visual impairment and 57,857 of them
are severely visually impaired.
• Severe Visual Impairment (VA <6/60 – 3/60 )
Cataract - 74.9%
Uncorrected Refractive Errors - 16.9%
• Visual impairment( VA <6/18 – 6/60)
Refractive Errors - 52.8%
Cataract - 43.0%
II- Blindness and Visual Impairment
in Cambodia (Cont.)

7. Main Eye Care Human Resources Categories :
1. Ophthalmologist- 4 years training at the UHS supported
by FHF and ECF started since 2007
2. Ophthalmic Nurse Training : 1 year training under started
in 1997. At present the Training run by Kompot Regional
Nursing School in collaborate with Takeo Eye Hospital
3. Refractionist Nurse : 3 month and 6 months Course
started since 1996 organized by NPEH supported by FHF
& BHVI at the KSFH
4. Fellowship in pediatric ophthalmology : 2 years program
at UHS , Preah Ang Doung and KSFH
Progress on :
1- Human Resource Development

8. Formal Training Duration Enrolment Frequency
Ophthalmology
Residency
4 years 3 - 4 Once/ y
Ophthalmic Nurse 1 year 10-15 Once/y
Refraction Nurse
3 to 6 months 10-12 Once/y
SICS 6 weeks 2 Twice/Y
TOT Primary Eye Care 10 days 10-15 Once/
PEC for HCS 5 days 10-15 2-3 Times/y
PEC for NHV 3 days 20-30 2-3 Times/y
TOT
Vision Screening
3 days 20-30 Once/y
Progress on :
1- Human Resource Development (Cont.)

9. Progress on :
1-Human Resource Development ( Cont.)
Category 2000 2007 2013 2020 Gap by 2020
Ophthalmologist 2 18 32 67 35
Sub Specialist on Cornea,
Retina , Pediatric
4 10 6
Eye doctor( Discontinue
Training ) 10 1 11 0 0
BED ( Discontinue Training, )
12 16 13
3 Upgraded
0 0
Ophthalmic /Eye Nurse, and
BEN
37 88 110 250 140
Refractionist Nurse
12 25 33 73 40

10. 1. 1993 - 3 Eye units
2. 1998 - 10 Eye units
3. 2000 15 Eye units
4. 2014 21 Eye Units
A need of establishing 3 more eye unit
by 2020
Strengthening and optimized utilization
the existing facilities is crucial.
Progress on :
2- Facility Development

12. Regional Eye Hospital
Center of Referred in Region
Sub Specialized Clinics
Training Center
Eye Care Service Delivery
Eye Surgery
Eye Screening
Refraction
Outreach Activities
Eye Unit No Eye Doctor Yet
No Eye Doctor / Only have
Ophthalmic Nurse
Basic Eye Treatment &
Counseling
Referred Eye Patient
Outreach Activities Eye
Screening
Functioning Eye Unit
Eye Care Service Delivery
Eye Surgery
Eye Screening
Refraction
Outreach Activities
National Eye Hospital
Apex Center of Referrals
Sub Specialized Clinics
Main Training Center for
Undergraduate and Residency
Central Management & Coordination
of all Eye Care Activities

13. PHNOM PENH

14. Province

15. Province

17. Progress on :
2- VISION 2020 Disease Control
1. Cataract
2. Refractive Errors & Low Vision
3. Trachoma
4. Childhood Blindness
5. Diabetic Retinopathy
6. Glaucoma

18. VISION 2020 Disease Control
1- Cataract
• Estimated 29,300 Blind people and 145,200 eyes
blind due to cataract in Cambodia
• Accounted for 75 % of blindness
• Cataract backlog 80,000
• Annual incidence 20,000
• To eliminate Cataract Blindness at least 29,300
people with bilateral cataract blindness have to be
operated in one eye or CSR need to increase to
3000/million /year

19. Cataract and Eye Operation 2008-2013
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
2008 2009 2010 2011 2012 2013
16,150 16,667
19,738
22,762
23,900
25,09524,463
25,934
29,944 29,278
34,291
39,434
Cataract Eye Operation

20. Cataract Surgical Rate :
2004-2013
463
788 839
933
1145 1182
1409
1614
1707
1800
3000
0
500
1000
1500
2000
2500
3000
3500
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2020

21. Cataract Surgical Rate per Province in
2012-13
3000
2500
2000
1500
1000
500
0

22. VISION 2020 Disease Control
2- Refractive Errors
• Assuming prevalence of RE in Cambodia :
• 5-15 years ( 3,141,177 ) - 3%
• 16-40 years (7,151,137) - 8%
• 40+ years ( 1,730,753 ) - 80%
• Assuming uptake of spectacles between 50-80%
• Over 1,200,000 spectacles required each year
• The prevalence of refractive error in urban schools
was 13.7% and 2.8% in rural schools.

23. Current refractive error
services
Refractive Error Service Provider:
Govt NGO Private Total
Clinics 20 6 150 176
Spec/year 4,400
(1.4%)
50,160
(15.7%)
264,000
(82.9%)
318,560

24. VISION 2020 Disease Control
3- Trachoma
3-Trachoma
To date the SAFE strategy of WHO is implementing
S : Lid Surgery
A : Antibiotic For Active Trachoma
F : Face washing / Hygiene
E : Environmental Change/ Good living Environment
Active Trachoma has been declined for the last 10
years however , Blinding Trachoma still a challenge.
Cambodia is preparing for Trachoma Elimination by
2016
The National Trachoma Survey is underway in 24
provinces supported by USAID and FHI360

25. VISION 2020 Disease Control
4- Childhood Blindness
4- Childhood Blindness
• Estimated Number of Blind Children 7,650 (1.5/1000
children)
• Blind School Survey in 2009
• Main Causes of Childhood Blindness
• Corneal Scar of all causes 55 %
• Congenital Cataract 10 %
• Eye injuries 3%
• Other 32 %
A approximately 10,000 school Children were screened for
refractive errors at schools and in outreach program
across the country in 2013

26. 3,874
688
256
189
659
1,864
38
150
120
367
94
3,293
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500
Children Consultation 2012-13
Consultation

27. VISION 2020 Disease Control
5- Diabetic Retinopathy
• The prevalence of Adult Diabetic is 2.9 % ( M 2.5%, F 3.3%)
• There are an estimated 250,000 diabetics in the country.
• Diabetic Retinopathy accounted for 17 % and blindness due
to DR accounted for 10 % ,which need medical intervention.
• Diabetic Retinopathy Treated by Laser and Avastin Injection
• Challenges :
• More people poor control of diabetic
• Expensive management
• Treatment only available in City
• Additional Training
• Equipment

28. • Blindness due to Glaucoma accounted for 3.1 %
and approximately about 30,000 Cambodian have
Chronic Glaucoma and three times more 90,000 are
glaucoma suspects.
• Approximately 6% of all eye surgery is
Trabeculectomy
• Challenges
• Late presentation of cases
• Un awareness
• Un-diagnosis
• Non compliant for treatment
• No medication
VISION 2020 Disease Control
6- Glaucoma

29. Eye Health Care Financing
Sources
•Government
• International Agencies and Bilateral
•INGOs
• Local NGOs
• Private
•Charities
Annually over 3 million USD is spend for eye
care .

30. • The distribution of HRH is inequitably divided
throughout the country
• Health system governance and management capacity
limited
• Insufficiently reliable information system and reporting
system,
• Eye health is available only in provincial referral
hospitals (21 eye units).
• Depending on support from INGOs/ Agencies
Eye Health Challenges
Supply Side

31. • Low level of utilization
• Inappropriate health practices and health seeking
behavior.
• Poverty issues, education, sanitation, perceptions,
compliance to treatment,
• The referral system of PEC is poor
• The fund for eye care from government is still
limited
Eye Health Challenges
Demand Side

32. • Support from Government/ MoH
• National strategic plan 2008-2015
• Eye health coverage has been improved to OD
• PEC is integrated into PHC ( MPA CPA1, CPA2, CPA3)
• Eye health infrastructure has been developed and
strengthen
• The identification of posts for all residents is effective in
reducing the mal-distribution of HRH.
• HEF and subsidize are effective in reducing the barrier
for eye health service delivery for poor people.
Opportunities

33. 1. Cambodia has made tremendous achievement of Eye
System Development in
• Human Resource,
• Facilities
• Blinding Disease Control
• Fund Mobilization
• Advocacy
2. Scaling up all activities and strengthening existing
strategies along with the National Health Strategic
Plan will ensue long term sustainability
3. Private, National and International Partnership is
crucial for success.
Conclusion

34. International NGO/ Agencies

35. THANK YOU
FOR
YOUR
ATTENTION