By Shana Angela S. Cervania
The World Report on Vision 2019 proposes to put people and communities at the center of health systems instead of diseases through the Integrated People-centered Eye Care (IPCEC), according to the World Health Organization.
“Eye care needs to be [a] better part of health systems… there needs to be someone available that understands eye care,” WHO Deputy Director for the Collaborating Center for Prevention of Blindness Dr. Andreas Mueller said, explaining that eye health care should be integrated even in small communities.
It states that IPCEC reorients the model of healthcare and avoid healthcare fragmentation by coordinating individuals within and across sectors and strategies to align the needs of the people.
Results show that health systems focusing on the health needs and expectations of the people, families and communities are “more effective, cost less, improve health literacy and patient engagement, and are better prepared to respond to health crises.”
Integrated health services ensures “health promotion, disease prevention, diagnosis, treatment, disease management, rehabilitation and palliative care services.”
IPCEC will also aid in attaining WHO’s Universal Health Coverage (UHC) goal and Sustainable Development Goal (SDG) 3 which is to “ensure healthy lives and promote wellbeing for all at all ages” and SDG 3.8 which is to “achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.”
UHC is an objective of WHO in which “all individuals and communities receive the health services they need without suffering financial hardship.”
Likewise, the World Report on Vision recommends to make eye care an essential element of the universal health coverage, to do research complementing existing data for competent eye care, and to observe trends and weigh progress.
The report also states that eye care is a heavier burden for the women, elderly, migrants, indigenous people; those with disabilities, low income, and living in rural areas, from low to middle-class countries.
Furthermore, it said that it would be a challenge to keep pace with the rising population and their current lifestyle; lacking health information systems data which obstructs planning; lacking national health strategic plans; and poorly coordinated workforce specifically for eye care.
Community Eye Health Program
Meanwhile, DOH Program Manager Dr. Maria Rosario Sylvia Uy said that eye care is already integrated into rural health units (RHUs) through the “Community Eye Health Program” where it conducts the “Prevention of Blindness Program.”
However, the program is still a work in progress as “we need our LGUs (Local Government Units) to buy into our program” so that it will be sustained, she said.
Currently, Physicians of RHUs can only treat common eye conditions in the Prevention of Blindness program that do not need eye specialists such as Viral Conjunctivitis or sore eyes and Hordeolum or kuliti, Uy said.
Patients with serious eye conditions still need to be referred by the rural health units to eye specialists in government hospitals
She said that a local ordinance or resolution may be drafted to prevent the program being removed or replaced every time an area changes its local chief executives.
However, Philippine Eye Research Institute (PERI) Director Dr. Leo Cubillan said that non-governmental organizations (NGOs) would still be needed in regional eye centers in need of physicians and consultants.
Dr. Kadil Sinolinding, Secretary of DOH in the Autonomous Region in Muslim Mindanao (DOH-ARMM), said that he supports an established community eye health center as it will provide a “mass base that will support the presence of ophthalmologists.”
He stressed the need for more support from the “ground” such as the LGUs and the communities as there are only few who seek consultations if healthcare volunteers solely rely on walk-ins.
Dr. Mueller also suggested that the government health system should provide more in optical services such as supplying needed eyeglasses and hiring more eye specialists to work in the health sector.
“Optical services are usually outside the health system, so it’s a business, it’s private; and these services are usually not available in a government facility or government hospitals. This is how it works in most countries,” Mueller said.
“Eyeglasses are expensive to poor people… Hopefully, there is some sort of control to keep the cost of the spectacles at lower levels to make sure it’s affordable for everybody,” he said.
“Spectacles are a health issue and it needs to be treated by the health system rather than completely outsourced as a private business luxury item,” he added.
Prevention is Key
Meanwhile, the National Vision Screening Program (NVSP) For Kindergarten Pupils lead by PERI, in collaboration with DOH, and the Department of Education (DepEd), seeks to discern error of refraction (EOR) and amblyopia or lazy eye among all kindergarten pupils.
Amblyopia requires to be treated before a child reaches the age of seven through corrective lenses and/or patching.
President Rodrigo Duterte signed into law the National Vision Screening Act or Republic Act 11358 last August to create the NVSP which will be launched nationwide on January 20, 2020.
One PERI Vision Screening Kit with a manual will be given per school which will be conducted by teachers to schoolchildren.
According to PERI and its collaborating government institutions, that students who fail the screening will sit in the first row of the classroom and will be referred to eye care practitioners for immediate intervention.
They also stated that 10% or four out of 40 pupils have vision problems with the possibility of three of them having EOR and one of them having amblyopia.
Meanwhile, the Department of Education (DepEd) Bureau of Learner Support Services Director and WHO member Dr. Ella Cecilia Naliponguit said that DepEd is presently looking into students having at least two hours of exposure to sunlight per day for both their physical and eye health.
The DepEd recommends for students to have moderate physical activity outside and be exposed outdoors to prevent eye ailments as part of the education curriculum.
She said that the institution is also considering for teachers to have “alternative creative methods” in teaching students for them to acquire their required amount of sunlight per week.
Lack of outdoor space among schools is also a problem, she said.
Naliponguit also said that it’ll be hard for RHUs to refer immediately the students in far-flung areas who failed the eye test to optometrists.
“Even the RHUs, summarized, are not capacitated to handle the referrals to the health centers supposedly for the validation of the assessment and management of the problems,” she said.
Stats
According to WHO, at least 2.2 Billion people have vision impairment or blindness globally. Half of them still do not receive treatment for their conditions such as near and far sightedness, glaucoma, and cataracts.
The most common ailment is EOR which estimates to be US$14.3 Billion in coverage gap costs including cataracts.
Due to glaucoma, diabetic retinopathy, and trachoma, an estimated 11.9 Million people have moderate to severe vision impairment and blindness. These could have been prevented for US$5.8 Billion.
According to Dr. Mueller, vision loss is going to be a more prevalent issue because of population growth and ageing along with technology-induced behavior and lifestyle changes.
In the Philippines, cataract is the major cause of visual impairment affecting 1.06% or 1.112 Million Filipinos, with 0.35% or 333,639 of them requiring surgery. Those who have uncorrected Error of Refraction (EOR) stands at 0.38% or 398,688 Filipinos. A total of 0.27% or 283,287 Filipinos have Glaucoma, and 0.20% or 209,836 of the population have Maculopathy or Diabetic Retinopathy.
For those with no to mild visual impairment, an estimated 3.26% or 3.4 Million Filipinos have uncorrected EOR; 0.69% or 700,000 have Glaucoma, and 0.59% or 600,000 have Maculopathy or Diabetic Retinopathy.
This study is based on the 2018 Philippine National Survey of Blindness and Eye Disease Study Project conducted by the Philippine Eye Research Institute (PERI) of the National Institute for Health in collaboration with the Department of Health (DOH).
The survey also acts as an evaluation tool to assess the effectiveness of the Vision 2020 Philippines Program. The program is part of the World Health Organization (WHO) global initiative to eradicate blindness which can be averted.
Eye conditions such as cataract, trachoma, and EOR which cause vision impairment and blindness are the most distinct focus of prevention and eye care strategies. Dry eyes and conjunctivitis are other causes, too.
Myopia, also one of the most prevalent eye conditions in the country, resulting from genetics and lifestyle, can also be controlled or prevented through exposure to sunlight for 15 hours per week and using blue light filters in technological gadgets, Dr. Cubillan said.
Continuous lack of ophthalmologists; Government lacking efforts, NGOs leading “not a good sign”
The doctors agreed that there is lacking proper healthcare in provinces because of the absence of adequate health facilities, health personnel, political will, and government efforts.
Executive Director from the non-profit organization Eye Hear Foundation Ms. Rebie Relator said that there are no physical presence from government personnel from the health sector whenever her organization goes for outreach in the provinces.
Rather, they communicate with them and gather support from them through logistics and financial means and the LGUs.
Journalist Karen Davila said that NGOs spearheading healthcare services in provinces is “not a good sign” as this reflects the incapacity of the government.
“If you are very poor, free time will not be enough to be able to save you from bad eyesight, right? And it seems to me right now, based on our conversation, that the very poor in the country when it comes to eyesight are very dependent on medical missions and NGO work which is not a good sign,” she said.
The PhilHealth rule of capping the reimbursements to 50 patients per month should be removed, Sinolinding expressed.
According to Uy, PhilHealth won’t remove the capping because of the anomalies where doctors demand for reimbursement for cataract surgeries they did not do but claimed to.
However, Sinolinding said that he’s not getting reimbursed with the patient cap as there are too many patients, along with new cases, in the provinces such as Cotabato.
“Let us be fair to everybody. Those who deserve to be paid… must be paid. In order to encourage more and more people to go to the provinces then serve the underserved. ‘Yun lang naman ‘yung atin eh. We don’t really earn as much because of PhilHealth,” he said.
He also said that healthcare professionals are also reluctant to volunteer because of the presence of armed groups and lack of security in remote provinces, and lack of available facilities, especially as there are only three available ophthalmologists in BARMM.
Meanwhile, Relator also suggested that there should be a law mandating doctors renew their licenses by doing voluntary work so as to treat more patients in distant provinces.
The Forum on World Report on Vision took place at Rizal Park Hotel on November 5.