There is acute shortage and maldistribution of ophthalmic personnel, with over 90% of present personnel in the capital, the majority of whom did not have any formal training. The training of eye care personnel is expected to provide a core group of well – trained eye care personnel who can then provide training to other Cambodians.
With the national plan in its 5th year of implementation, a review of the manpower requirements shows that 9 Ophthalmo lo gists, 17 Ophthalmic Nurses, 7 Opto met rists, 28 Basic Eye Doctors, 56 Basic Eye Nurses, 45 Optometry Technicians, 132 Ophthalmic Assistants, 230 Primary Eye Care Trainers and 2215 PEC Workers will need to be trained between now and 2005. This excludes two doctors currently undergoing residency training and 3 nurses who had been trained as Ophthalmic Nurses in Thailand. However, the availability of training centres, trainers and financial resources may preclude the achievement of this very worthwhile objective in the develop ment of eye care in Cambodia.
A 2-year training programme to train Basic Eye Doctors and 9 months training for Basic Eye Nurses have been initiated in the country and supported by NGOs (Help-Age International, Maryknoll/CBM and Mekong Eye Doctors). A total of 12 doctors and 42 nurses have been trained within these training programmes.
An evaluation of these training programmes carried out by Dr Serge Resnikoff of the WHO Programme for Prevention of Blindness and Deafness, in June 1998, concluded that the training was of a high standard and the performance of the candidates was very satisfactory.
Within VISION 2020, emphasis should be placed on the training of mid-level personnel. Efforts should be made to achieve the WHO target for the sub-region for mid-level personnel with the ratio 1:50,000 population. Managers for national prevention of blindness programmes and ophthalmic trainers should also be trained.
Infrastructures and Appropriate Technology
Currently, it is estimated that only 40% of Cambodians have access to eye care services in 10 provinces of the country. The estimated coverage of eye care services is about 25% and the utilization of eye care services was less than 1% in 1999. The number of eye units had increased from 4 in 1993 to 10 by the end of 1998, with more units being set up in 5 provinces in the year 2000. The total number of eye beds in the country has increased to 200 in 1999.
The national plan for eye care development envisages a network of eye care services in each of the provinces of Cambodia, with the development of 5 regional eye centres, including the national eye centre in Phnom Penh for research, training and policy development.
A national workshop to address the issues of sustainability in eye care programmes was organised in 1999 to identify and address the needs, major constraints and challenges for the development of sustainable eye care services in Cambodia. The workshop recommended that cost recovery systems in the eye units should be strengthened, as part of an overall provincial hospital system with some form of autonomy. The accessibility of public services to poor patients should be enhanced through improvement in quality of services, affordable fees, exemption from payment and adequate information to the community.
An essential drug list for the different levels of eye care has been developed. A standard list of equipment, drugs and suppliers is operational and a ‘material and supplies bank’ has been set up by the national PBL committee to assist the eye units in the bulk purchase and procurement of IOLs, sutures, spares and other supplies. This is in addition to that supplied by the Ministry of Health’s central medical stores. In cooperation with NGOs, training programmes in equipment maintenance are planned for technicians and end users in the near future.
Experience in the local production of eye drops (Battambang laboratory) have not been satisfactory due to infrequent production, primarily due to lack of personnel and raw materials for production. Functional low cost optical workshops have been set up in 4 provinces, either singly or to support the existing eye units.
Within VISION 2020, targets should be set for services availability, accessibility, utilisation and coverage. Strengthening of cost recovery systems within the eye units will be required. Development of equipment maintenance systems for eye care, including training of Instrument Mainte nance Technicians, consolidation of bulk purchasing strategies, establishment of facilities for low cost production of drugs and spectacles will be required.
Role of NGOs in VISION 2020 in Cambodia
VISION 2020 aims to establish a global partnership for eye health, which is indispensable to the fundamental ‘Right to Sight’. Various NGOs have been playing an increasingly important role in blind-ness prevention in Cambodia. These include Helen Keller International, CBM, Maryknoll, HelpAge International, IRIS, Mekong Eye Doctors, SEVA Foundation and Asian Eye Care. Voluntary organisations such as Rotary International and the Lions SightFirst programme have also been involved.
The common goal is the elimination of avoidable blindness in Cambodia by the year 2020.
VISION 2020’s mission is to eliminate the main causes of blindness – thus, adequately addressing the eye care problems found in Cambodia. However, the implementation of this ‘Right to Sight’ will require a meaningful partnership and commitment from governments, NGOs, institutions and individuals in achieving these noble objectives. Major efforts will need to be made in the areas of advocacy, resource mobilisation and strengthening national capacities for implementing the main components of VISION 2020.