Appendix 1 – PROPOSALS FOR WORKGROUP DISCUSSION



Appendix 1 – PROPOSALS FOR WORKGROUP DISCUSSION

Specific Disease intervention – Cataract, Refractive Error, Diabetic Eye Disease

HEALTH PROMOTION

|Areas of Concern |Plan of Action |Specific Activities |Issues to Resolve |

| | | | |

|Lack of public awareness on |Increase public awareness through |World Sight Day Observance |Who to organise funding, yearly theme|

|cataract, refractive error and|mass media and related activities | |etc. |

|diabetic eye disease |Produce Health Education Materials | | |

| |Establish a committee to organise and| | |

| |monitor promotional activities | | |

| | | | |

| | |Regular production and Educational materials |Who to take charge of producing |

| | | |educational materials, funding, |

| | | |distribution – how many in a year? |

| | | |What is the cost? |

| | |Radio/TV Talks | |

| | | |Who to organise? |

| | | |What to produce? |

| | | |Who to fund? |

| | | |How often? |

| | | | |

| | | |Suggested outcome |

| | | |- form a subcommittee for health |

| | | |promotion |

| | |Documentary on TV on the 3 diseases | |

| | |Catchy TV advertisements | |

| | |Billboards | |

| | |Newspaper | |

| | | | |

| | |Public Forums | |

| | | | |

| | |Form a subcommittee and have regular | |

| | |meetings. | |

| | | | |

| | |Required: | |

| | |Feedback to Task Force | |

CASE DETECTION

|Areas of Concern |Plan of Action |Specific Activities |Issues to Resolve |

| | | | |

|Inadequate case detection |Increase case detection by |Opportunistic Screening at MCH Clinic to |Training – for discussion |

| |intensifying screening |continue | |

| |programmes/activities | |Policy Change |

| |Improve referral system | | |

| |Monitor and reporting of | |Funding |

| |effectiveness of screening programmes| | |

| | | |Monitoring – sustainability of |

| | | |programme |

| | | | |

| | | |Evaluation |

| | | | |

| | | |Suggested Outcome |

| | | | |

| | | |Form a subcommittee for Primary Eye |

| | | |Care Training |

| | | | |

| | | | |

| | | | |

| | | | |

| | |Review current screening programme for | |

| | |Diabetic Retinopathy and extend pilot project| |

| | |to other KK | |

| | |Involve Optometrists and Opticians in | |

| | |screening for the 3 diseases. – school | |

| | |health, DR Screening | |

| | |Review current screening programmes at the | |

| | |preschool and school health level and suggest| |

| | |improvement/alternative programmes | |

| | | | |

| | |Doktor Muda | |

| | |School Health Club | |

| | |Adopt a school/kindergarten programme | |

| | |Reactivate Ophthal. Soc. Home Vision | |

| | |Screening Activity | |

| | | | |

| | |Annual Vision screening programme by | |

| | | | |

| | |NGOs | |

| | |Village Volunteers where applicable | |

| | | | |

| | |What else? | |

Training

|Areas of Concern |Plan of Action |Specific Activities |Issues to Resolve |

| | | | |

|A. Lack of awareness on eye |Provide training to primary health |Review Curriculum of JM,SN, MA, Medical |Implementation issues |

|care among primary healthcare |care providers |Students | |

|providers both in the public |Provide materials for training | | |

|and private sectors |Evaluate and monitor effectiveness of| | |

| |primary eye care training programmes | | |

| | | | |

| | |Refresher Courses | |

| | | | |

| | |Extend 3 day eye care courses to private, | |

| | |industrial and estate healthcare providers | |

| | | | |

| | |Reactivate Ophthalmological Soc. of MMA | |

| | |training to GPs on Diabetic Retinopathy. | |

| | | | |

| | |Review and develop teaching tools and kits | |

| | | | |

|B. Lack of awareness on eye |Provide knowledge on Public Health |Review curriculum and allocate more time for | |

|care among medical officers |Ophthalmology |PEC in Public Health training module | |

| |Enhance the current eye care training| | |

| |module for medical students | | |

| | | | |

| | |Review curriculum and train medical students | |

| | |to enable them to carry out their role in PEC| |

| | |upon graduation. | |

| | | | |

| | | | |

| | | | |

| | | | |

|C. Unsatisfactory product of |Improve the training programme of |Review curriculum and training needs based on| |

|Ophthalmologist Training |Ophthalmologist |role upon completion of gazettement as a | |

|programme – training |Improve the facilities for training |specialist. | |

|objectives not met |especially in the open system | | |

| |Emphasise importance of management | | |

| |and PHO in eye care delivery | | |

| | | | |

| | |Recognise the need for higher surgical | |

| | |training for Ophthalmologist to improve | |

| | |quality of patient care and initiate the | |

| | |formulation and implementation of HST | |

| | |programme. | |

| | | | |

| | |Include management course in training | |

| | |programmes. | |

| | | | |

| | |Include PHO in training programmes. | |

| | | | |

| | |Review role/effectiveness of Specialty | |

| | |Conjoint board as a coordinating body | |

| | | | |

| | |Alternatively suggest/pass over role of | |

| | |coordinating body to Academy of Medicine’s | |

| | |Specialty Board | |

| | | | |

| | |Monitoring of Training Programmes by | |

| | |coordinating body | |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

|Areas of Concern |Plan of Action |Specific Activities |Issues to Resolve |

| | | | |

|D. Inadequate number of |Increase the pool of teachers through|Regional Training Programmes rather than | |

|experienced teachers in the |collaboration with other governmental|duplicating programmes | |

|Ophthalmologist Training |or private centres | | |

|programme |Increase the number of subspecialists| | |

| |and subspecialty centres | | |

| | | | |

| | |Improve access to distant learning using ICT | |

| | |Sign MOU with private institutions or | |

| | |universities including neighbouring countries| |

| | |Increase number of subspecialists in the | |

| | |various subspecialties | |

| | |Establish subspecialty centres in stages to | |

| | |improve care as well as training | |

| | | | |

| | | | |

|E. Inadequate Research in Eye |Facilitate research in Eye Care |Form an Eye Research Interest Group | |

|Diseases and Eye Care Delivery|Monitor research activities | | |

|System | | | |

| | | | |

| | |Conduct Research in Refractive Error, Low | |

| | |Vision, DR, ARMD, Glaucoma and Cataract | |

| | | | |

| | |Provide Funds for Research | |

| | | | |

| | |Provide incentives for researchers | |

SERVICE DELIVERY

|Areas of Concern |Plan of Action |Specific Activities |Issues to Resolve |

| | | | |

|A. Unsatisfactory Cataract |1. Increase CSR |Outreach programmes | |

|Surgical rate | | | |

| | | | |

| | |Efficient use of available resources in | |

| | |public hospitals | |

| | | | |

| | |Improve facilities in public hospitals | |

| | | | |

| | |Improve standard of care – CPGs, SOP workshop| |

| | | | |

| | |Day Care surgery | |

| | | | |

|B. High cost of cataract |To make cataract surgery affordable |To promote use of good quality but low cost | |

|surgery |and accessible |IOL | |

| |Promote small incision cataract | | |

| |surgery | | |

| | | | |

| | |IOL subsidy schemes | |

| | | | |

|C. Refractive Error a major |To make basic Optometry services |Community services by private optometrist |drugs to be used by Optometrists |

|cause of visual impairment |available to all | |Proposal – partnership with |

| |To improve accessibility by shifting | |Ophthalmologists to facilitate use of|

| |some responsibility to Opticians and | |cycloplegics |

| |Optometrists | | |

| |Facilitate Optometrist to provide the| | |

| |desired level of care | | |

| | |Free spectacles programmes – improve access | |

| | |Used spectacles programmes | |

| | |Post optometrists to district | |

| | |hospitals/visiting optometrists | |

| | |Equip public hospitals with basic equipments | |

| | |Evaluate and Improve school health programmes| |

|D. Increasing incidence, late |Improve early detection through | | |

|presentation and inadequate |screening programmes |Screening programmes as above | |

|facilities in the management |Upgrade facilities and improve | | |

|of Diabetic eye Disease |standard of care at secondary | | |

| |centres to ensure there is no | | |

| |discontinuity of laser and | | |

| |Vitreoretinal services | | |

| |Monitor and evaluate laser and | | |

| |Diabetic vitrectomy services | | |

| | | | |

| | |Ensure supply, replacement and maintenance of| |

| | |laser and vitrectomy machines etc. | |

| | | | |

| | |SOP workshop, review CPG | |

| | | | |

| | |Conduct studies on clinical outcomes | |

| | | | |

EYE HEALTH INFORMATION SYSTEM

|Areas of Concern |Plan of Action |Specific Activities |Issues to Resolve |

| | | | |

|Lack of a complete Eye Health |To establish a national Eye Health |Sustain NCSR – participation by private | |

|Information System essential |Information system |sectors necessary | |

|for planning and research |To integrate such a system with the | | |

| |currently available system in MOH | | |

| | | | |

| | |Develop and sustain VISION 2020 web site | |

| | | | |

| | |ICD 10 | |

| | |4. Conduct NES in 2006 | |

| | |5. Low vision registry | |

| | | | |

| | |6. Blindness registry | |

REHABILITATION

|Areas of Concern |Plan of Action |Specific Activities |Issues to Resolve |

|1. Very small number of blind|A) Improve early detection, |i) Public awareness of importance of such |Ministries of Information, Health, |

|& low vision children |intervention, and referral |services |and Education |

|receiving education |services |ii) Train all categories of workers & persons |Ministries of Health, |

| | |who come into touch with babies & young |Social Welfare, and Education |

| |B) Increase enrolment level to |children, especially those below 3 years old | |

| |that of national average |Provide training for all in-service teachers in| |

| | |special needs education of VIPs |Ministry of Education & NGOs |

| | |ii) Ensure that the above training is also | |

| |C) Accelerate expansion of |built into the curriculum of all teacher |Ministry of Education |

| |Inclusive Education “Schools |training colleges | |

| |for All” | | |

| |D) Assist Residential Special | | |

| |schools to convert to Resource | | |

| |Centres | | |

|2. Equally small number of VI|A) Improve identification & | | |

|youths and adults, who are |referral systems | | |

|blind or have LV, being |B) Improve, expand and | | |

|trained & rehabilitated |decentralise Training | | |

| |programmes | | |

|3. Even more limited training |A) Establish &/or improve | | |

|& employment/income generation|Placement services. | | |

|opportunities | | | |

4. Lack of CBR and referral system

Appendix 2

VISION/ MISSION / OBJECTIVES AND STRTEGIES FOR THE NATIONAL PERVENTION OF BLINDNESS PROGRAMME - VISION 2020 MALAYSIA- THE RIGHT TO SIGHT

VISION

All Malaysians shall enjoy eye health resulting from equal, affordable and timely access to quality ophthalmic services at all levels of care by the year 2020.

MISSION

VISION 2020 Malaysia is committed to the elimination of avoidable blindness and low vision through:

1. The provision of accessible quality eye care using appropriate technology at an affordable cost

2. The promotion of the preventive aspects of ocular health, with emphasis on public education and the participation of each individual in his/her own care.

3. The training of all categories of eye care providers

4. The provision of appropriate and effective education, training and rehabilitation of the irrevocably blind and refracted low vision with special needs.

5. The quest for better understanding of local disease patterns, to enable healthcare related strategies to be more effectively planned and evaluated

GENERAL OBJECTIVE

To prevent and control major avoidable blindness and to make essential eye care available to all

SPECIFIC OBJECTIVES

BY 2020:

1. To reduce the prevalence of blindness from 0.29% to 0.15%

2. To consolidate/strengthen the existing programme for cataract intervention and increase the Cataract Surgical Rate to 5000 per million population per year

3. To initiate and sustain a workable intervention programme for low vision and reduce its prevalence rate from 2.4% to 1%

4. To increase awareness on and strengthen services to manage Diabetic Retinopathy

5. To train adequate numbers of appropriate health personnel to provide eye care

6. To develop an eye health information system

7. To promote community participation in the prevention of blindness

8. To ensure intersectoral collaboration in eye care

STRATEGIES

1. To determine the extent of visual impairment among the Malaysian population and identify the major causes of blindness and low vision

2. To initiate and propagate effective intervention aimed at primary, secondary and tertiary prevention of visual impairment

3. To create intersectoral collaboration to foster a joint effort towards the accomplishment of VISION 2020 Malaysia

4. To maintain an ongoing human resource development programme in response to the local needs

5. To initiate a Center for Eye Care Research, focusing on essential research areas for eye health and eye care service delivery.

To maintain a regular evaluation programme on the delivery of eye care services and training programme, including an effective feedback mechanism to the program manager and the public

Reading Material for the Prevention of Blindness Workshop

1. The prevalence of blindness and low vision in Malaysian population: results from the National Eye Survey 1966. M Zainal, SM Ismail, AR Ropialh, H Elais, D Alias, J Fathilah, T O Lim, L M Ding, PP Goh. Br J Ophthamol 2002;86, 951-956

2. Articles form Journal of Community Eye Health ( available at : jceh.co.uk)

1. A Global Initiative for the Elimination of Avoidable Blindness. Vol. 11 issue 25,1998

2. Cataract Surgical Coverage: An Indicator to Measure the Impact of Cataract Intervention Programmes. Vol. 11 Issue 25, 1998

3. The Role of Patient Counsellors in Increasing the Uptake of Cataract Surgeries and IOLs Vol. 11 Issue 25, 1998

4. Community Participation -‘Putting the Community into Community Eye Health’. Vol. 12 issue 31,1999

5. Health Promotion and Community Participation in Eye Care Services. Vol. 12 Issue 31, 1999

6. People Who Do Not Sue Eye Service: ’Making the Invisible Visible’. Vol. 12 issue 31,1999

7. National Prevention of Blindness Program and VISION 2020. Vol. 13, Issue 36 2000

8. National Prevention of Blindness Programmes, Vol. 13 Issue 36, 2000

9. Cambodia’s National Eye Care Programme and VISION 2020: The Right to Sight. Vol. 13 Issue 36, 2000

10. Importance of Affordable Eye Care. Vol. 14 Issue 37 ,2001

11. Cost Containment in Eye Care. Vol. 14 Issue 37 ,2001

12. Financial Sustainability. Vol. 14 Issue 37 ,2001

13. New Issues In Childhood Blindness. Vol. 14 Issue 40 ,2001

14. Guidelines for Setting Up a Low Vision Programme for Children. Vol. 14 Issue 40 ,2001

15. Training Ophthalmologists for Children’s Eye Care Centres. Vol. 14 Issue 40 ,2001

16. Evaluation of Training. Vol. 14 Issue 40 ,2001

17. How Can We Improve Patient Care? Vol. 15 Issue 41, 2002

18. The Patients View: How Can We Improve Patient Care? Vol. 15 Issue 41, 2002

19. Patients’ Perspective: An Important Factor in Assessing Patient Satisfaction. Vol. 15 Issue 41, 2002

20. Teaching Resources: Be Prepared! Vol. 15 issue 41, 2002

21. Technology for VISION 2020. Vol. 15 Issue 42, 2002.

22. The role of optometry in vision 2020 vol 15 issue 43, 2002

23. Case Finding for Refractive Errors: Assessment of Refractive Error and Visual Impairment in Children. vol 15 issue 43, 2002

3. Action ‘urgently needed’ to avert crisis in Canadian ophthalmic health care, warns study-An article from Eurotimes –A European outlook of the world of Ophthalmology vol 8,issue 2. February 2003

4. Report of a WHO/IAPB Scientific Meeting on ‘Preventing blindness in children’ , publication from World Health Organization and International Agency for the Prevention of Blindness ( hard copy )

5. Asia Pacific Regional Low Vision Workshop, Hong Kong, 28-30 May 2001, publication from World Health Organization and International Agency for the Prevention of Blindness (hard copy)

6. Breaking Down Barrier –A Practical Guide for Eye Units in Developing countries by Geert Vanneste, a publication of Christoffel – Blindenmission (hard copy)

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