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Scaling up eye care initiatives in Pakistan

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.

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Scaling up eye care initiatives in Pakistan

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  1. Scaling up eye care initiativesin Pakistan Prof . M. Daud Khan IAPB, 9th General Assembly; Hyderabad, India,18.9. 2012

  2. 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

  3. Health care Heritage at birth 1947 Specialists 6 Medical Officers 42 (Mainly in Punjab) Paramedics and nurses negligible number Only two medical colleges in the country, with 80% staff migrating to India

  4. Challenges • Rising population • Aging population • Poverty • Illiteracy • Extremism • Political instability • Regional conflicts

  5. Eye care Services in 1947,before & after • Few Missionary Hospitals • Sir H. Holland and Sons (Quetta & Shikarpur) • Dr. Novel Christy -Taxilla • Mayo Hospital – Lahore • Civil hospital, Karachi • Few family owned cottage Eye Hospitals

  6. APAO conceived, 1957, Approved, 11.9 1958, 18th ICO, Brussels Awarness A P A O 1979 A P A O 1960 The wake up call O S P 1957 1980 W.H.O Consultant ( Prof. Hugh Taylor )

  7. Essential tools used for scaling up • The initial leadership used Five pillars for initiating and scaling up of eye care. Situation Analysis & E.B Goal Setting Awareness & Advocacy Resource Generation & Management Partnership & Collaboration DISTRICT BASED EQUITABLE EYE CARE Program Development & Management

  8. Program Planning, Development& Management Research based Needs Assessment NHRDP Access Relevance NCECP Quality

  9. Incremental & Sequential Scaling up 1st National Survey 1987 -1988 1ST 5yrs Plan 1994-1998 2nd 5yrs plan 1999-2004 2nd national Survey 2002-03

  10. HRD, OPTHALMOLOGISTS (CPSP) 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 • HQ: Karachi • Regional centers;16, 3 overseas • Accredited institutes: 235 • Supervisors: 2100 • PG students: 13,5oo • Number of Subspecialties: 60 • Total outputs: 19,000 • Impact: > 90% of specialist • health care delivery • is through CPSP alumni

  11. HRD, Ophthalmic Allied health Personnel(AHPO) & Nurses 4 +2 centers for training of OAHP

  12. Major HRD & Service Centers in NGO Sector LRBT hospital ISRA EYE INSTITUTE KARACHI Al-Shifa Trust hospital

  13. Disease Control Plan District Comprehensive Eye Care Services (DCECP) Implement Evaluate • Special programs on: • Corneal blindness • Trachoma • Vitamin A deficiency • Refractive Errors • Diabetes • ARMD • cataract • Simple Glaucoma • Horizontal squints • Lids & Adnexa • Trauma • Infections Monitor Primary Eye Care Community Community Community Detect Treat Refer

  14. Partnership & Collaboration GOP OS Professionals P WHO N E C P NGDOS & INGDOS

  15. CENTRE OF EXCELLENCE HRD, CME, CPD, CED Tertiary Eye Care All the three tiers are important for development of National Eye Care Programme Primary Secondary Health Care Complex Service delivery District Comprehensive Eye Care Programme Primary Eye Care Community Community Community Treat Refer Detect

  16. Impact 2.0% National Prevalence of Blindness 2 0.9% 1 2004 1980 0

  17. 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 (CSR) Special programs for: Corneal blindness Trachoma Vitamin A deficiency Diabetes , ARMD and Glaucoma Refractive errors and low vision

  18. Year by year growth/districtCataract Surgery Gender wise Service uptake P. Cartwright, W Van Berkel, J Banzin, Khan, N Jan 2004

  19. Impact International • Afghanistan • Yemen • Iran • Bangladesh • Jordan • Syria • Lebanon • Palestine • Libya • Sri Lanka • Indonesia • China • Nigeria • Kuwait • Egypt • UAE • Iraq • Saudi Arabia

  20. Future Priorities • 3rd 5 yr. program • GOP commits 2.8 billion ( 46 M $ ) • HR for • Sub specialty development • Enhanced focus on • AHP including nurses • CME, CPD & CED • Enhanced focus on R & D Ref. Error & low Vision School H. service CVC Pediatric Eye care Diabetic Eye care ARM

  21. Acknowledgements SSI CBM ICEH AAO FHF IEF LFW WHO Aravind eye care systems IAPB ICO Impact EMR EU ALBASAR Juntedo University LVP Ecww Dr PARA Prof. Allen Foster Prof. Clare Gilbert Prof. Konyama Prof Prowzeski Dr. Gana Rotary International Dr Babar Q. Dr. Aman K Dr.Rubina G Dr.Haroon A Mr Hassan M. Prof. Saleh M Prof. Nasim P Pros AsadAslam

  22. Leaders who Inspired us

  23. Those who offered us unwavering support

  24. APAO LEADERS WITH VISION & Mission

  25. THANK YOU

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