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SITUATIONANALYSIS:EYE CARE IN INDONESIAEYECAREININDONESIAAllya Alwi,MD

MinistryOfHealthOfIndonesia

Prevalence of Blindness in IndonesiaPrevalenceofBlindnessinIndonesia BasicHealthResearch,MoH 2007

Blindness0.9%(basedonVisualAcuity

Prevalence of Blindness in IndonesiaPrevalenceofBlindnessinIndonesia

EyeandEarNationalHealthSurvey19931996(MoH)y y ( ) PrevalenceofBlindness(VA3/60)1,5%

Cataract(0,78%),Glaucoma(0,20%),RefractiveDisorders(0,14%)

OBJECTIVE1 STRENGTHENADVOCACY TO INCREASEOBJECTIVE1.STRENGTHENADVOCACYTOINCREASEMEMBERSTATESPOLITICAL,FINANCIALANDTECHNICALCOMMITMENT INORDER TOELIMINATEAVOIDABLECOMMITMENTINORDERTOELIMINATEAVOIDABLEBLINDNESSANDVISUALIMPAIRMENT

Current PracticesCurrentPractices DirectorateofBasicHealthEffortsisthedesignatedcoordinatoroftheEyeHealthprogramsintheMinistryofHealth

TheNationalCommitteeofVisualImpairmentandBlindnessPreventionhasbeenformedsince2005byMinisterialDecree,andnowitisintheprocessofbeingrenewandupgradedtoPresidentialDecree TheMemberofthisCommitteeconsistofMoH,CrossSectorsStakeholder,NGOs,andProfessions

E C h b i d l l f H l h S i ( i EyeCarehasbeenintegratedoneverylevelofHealthServices(primary,secondary,tertiary).Thecaregivendependsontheavailabilityofhumanresources,equipmentsandinfrastructures

WSD i b i t i 2005 i th f f f WSDisbeingcommemorateeveryyearsince2005,intheformoffreecataractoperations,communityseminarsandcounselling

OBJECTIVE2 DEVELOPAND STRENGTHENNATIONALOBJECTIVE2.DEVELOPANDSTRENGTHENNATIONALPOLICIES,PLANSANDPROGRAMMESFOREYEHEALTHANDPREVENTIONOFBLINDNESS ANDVISUALANDPREVENTIONOFBLINDNESSANDVISUALIMPAIRMENT

Current PracticesCurrentPractices DevelopmentofNationalPolicies,PlansandPrograms:

ConstitutionofHealth(36;2009) ManagementofvisualimpairmentasoneoftheimplementationofHealthCare ManagementofvisualimpairmentisajoinresponsibilitybetweenGovernment,LocalGovernmentand

Community NationalStrategyPlansforVisualImpairmentandBlindnessPreventiontoAchieveVision2020(2005)

HealthyEye2020 Strategy:

Theformingofthenational,Provincial&DistrictsCommitteetocoordinateresourcesandactivities Increasingcrosssectorsadvocaciesandcommunications Developmentofpartnership Increasingprogrammanagementandserviceinfrastructure IncreasingqualityandquantityofHumanResources Mobilization of support from private sectors community and NGOs Mobilizationofsupportfromprivatesectors,communityandNGOs

NationalCoordinationAnnualMeetingonTheDevelopmentofSensoryHealthPrograms(whichincludethepreventionofavoidableblindnessandvisualimpairmentprograms)

CrossPrograms,CrossSectorsandNGOsannualmeetingE H lth P i t t d ith th H lth P (S h l H lth P EyeHealthProgramsareintegratedwithotherHealthPrograms(SchoolHealthPrograms EarlyDetectionandperiodicmonitoring;WorkForceHealthPrograms WorkForceProtection;Nutritionprograms VitaminASupply)

EyeCareforthepoorisgivenwithGovernmentInsurance(Jamkesmas) Cataract operationsCataractoperations Glassesprescriptions OtherCurativeEyeServices

OBJECTIVE3.INCREASEANDEXPANDRESEARCHFORTHEPREVENTIONOFBLINDNESS ANDVISUALTHEPREVENTIONOFBLINDNESSANDVISUALIMPAIRMENT

Current PracticesCurrentPractices

Researches are very limitedy

Sporadically done by Eye Department of University in Indonesia

Nationally, The Basic Health Research conducted by MoHaccommodate Eye Health Data

OBJECTIVE4 IMPROVECOORDINATIONBETWEENOBJECTIVE4.IMPROVECOORDINATIONBETWEENPARTNERSHIPSANDSTAKEHOLDERSATNATIONALANDINTERNATIONAL LEVELS FORTHEPREVENTIONOFINTERNATIONALLEVELSFORTHEPREVENTIONOFBLINDNESSANDVISUALIMPAIRMENT

Current PracticesCurrentPractices PartnershipwithNGOs:

WHO: FacilitatingsituationanalysisandthemakingofNationalActionPlansonVisualImpairmentandBlindnessPrevention

CBM SupportCataractprograms

HKI VitaminAdistribution

Gapopin Gapopin AdministrationofGlasses

MataHati SupportCataractOperations

BankMata CorneaDonor

Partnershipwithotherstakeholders:Profession (PERDAMI / IOA) : Profession(PERDAMI/IOA): Givinginputtogovernmentinestablishingnationalpolicies Facilitateandresourcepersonintrainingandmeetings

OBJECTIVE5.MONITORPROGRESSINELIMINATIONOFAVOIDABLE BLINDNESS ATNATIONAL REGIONALANDAVOIDABLEBLINDNESSATNATIONAL,REGIONALANDGLOBALLEVELS

Current PracticesCurrentPractices

MonitoringandEvaluationofEyeHealthProgramsisdoneby:g y g y RoutineReportSystem(ProvincialHealthOffice)

Supervision(MoH,ProvinceandDistrictHealthOffice)

B i H lth R h BasicHealthResearch

PeriodicReportstoWHO

EYE CARE INFRASTRUCTUREEYECAREINFRASTRUCTUREPUBLIC HEALTH

EFFORTSINDIVIDUAL HEALTH

EFFORTS

TERTIARYProvincial Health OfficeNational Eye Centre (CicendoHospital); Provincial Hospitals;

Education Hospitals

SECONDARYDistrict Health OfficeCommunity Eye Centre

District HospitalsCommunity Eye Centre

PRIMARYPuskesmas Puskesmas

COMMUNITYGROUPSPosyandu Posyandu

HOUSEHOLDSIndividual Individual

DISTRIBUTIONOFOPHTHALMOLOGISTSININDONESIA

1 3% 1 9%17,3%9,6%

1,9%

0,3%

0,1%

68,5%1,8% 0,5%

Productivity of Ophthalmologists Education InstitutionProductivityofOphthalmologistsEducationInstitution

PRODUCTIVITYINSTITUTION PRODUCTIVITY TOTAL2002 2003 2004 2005 2006 2007 2008 2009

FKUI 7 22 8 13 16 10 10 12 98FK UGM 6 6 7 16 6 4 10 3 58FKUGM 6 6 7 16 6 4 10 3 58FKUNAIR 4 12 2 7 8 7 12 4 56FKUNSRAT 7 12 6 2 6 4 1 2 40FK UNPAD 4 2 2 6 9 7 8 10 48FKUNPAD 4 2 2 6 9 7 8 10 48FKUNDIP 6 7 4 3 3 7 6 5 41FKUSU 2 5 5 10 1 6 3 2 34FKUNSRI 2 5 4 3 6 8 8 8 44FKUNHAS 3 3 3 2 5 6 2 7 31FKUNAND 3 0 3 2 2 3 3 1 17FKUNIBRAW 0 0 0 1 7 0 0 9 17Dr.SpM/year 44 74 44 65 69 62 63 63 484

TRAININGSTRAININGS

Trainingsarelimitedg

MoH istraining2person/province/yearinprogramsmanagementandcasemanagement

Primary Eye Care in PuskesmasPrimaryEyeCareinPuskesmas

IN BUILDING OUT BUILDINGINBUILDING OUTBUILDING

Anamnesis Visual Acuity Test

EarlydetectionofCataract,Refraction Disorders ColorVisual AcuityTest

AnteriorSegmentexaminationsSi ht E i ti

RefractionDisorders,ColorBlindnessinCommunityand SchoolsAd i i t ti f Vit i A SightExaminations

IntraOcularPressureTest ColorBlindnessTest

AdministrationofVitaminA2x/Year onInfants

FirstAidsinEyeEmergencies

CATARACTOPERATIONSNO INSTITUTIONS

CATARACTOPERATIONS

2006 2007 2008 2009 2010*

1 CommunityEye 12.287 11.241 13.294 13.738 10.318Centre

2 Cicendo Hospital 1.833 4.603 4.653

3 PalembangEye 900 1.151 1.248 848g yHospital

4 BaliSensoryHospital

1.333 1.895 888

5 PERDAMI 3.674 3.539 5.415 6.965 5.008

6 CBM 14.561 9.636 9.970 9.138 3.791

7 HKI 875 7907 HKI 875 790

8 YKI Bali 2.089 2.089 2.089

9 HospitalsReports

12.043Reports

TOTAL 30.522 26.191 47.918 39.677 27.595

CHALLENGESINDEVELOPINGEYEHEALTHPROGRAMS

d h d b LimitedHumanResourceswithunevendistribution

Lackofmedicalequipmentandinfrastructure

Expensive cost of operations Expensivecostofoperations

Poordatareportingandrecording

Lackofresearchac o esea c

Lowsocio economicstatusofcommunity

Notenoughfunding(notapriorityprogram)

GeographicConditionsofIndonesia

SUMMARYSUMMARY

The prevalence of blindness in Indonesia is still high TheprevalenceofblindnessinIndonesiaisstillhigh

TheHumanResourcesandInfrastructuresforEyeCarearelimitedwithunevendistribution

Withlimitedfunding,partnershipswithNGOsarestillneeded

TheNationalCommitteeneedtobestrengthen

THANKYOU

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