Leaving No One Behind: Strengthening Access to Eye Health Programs for People With Disabilities in 6 Low- and Middle-Income Countries

Blindness and Visual Impairment Situation in Indonesia Based on Rapid Assessment of Avoidable Blindness Surveys in 15 Provinces

Purpose: To report the latest data on blindness and visual impairment (VI) in Indonesia.Methods: Rapid Assessment of Avoidable Blindness (RAAB) surveys were done in 15 provinces in Indonesia between 2013 and 2017. The population of the study was people aged 50 +. In each province, the required number of clusters was selected with a probability proportionately to size. A weighted average analysis for prevalence, causes of visual impairment, and cataract surgical coverage (CSC) estimated the values of the country.Results: The prevalence of blindness in East Java was the highest at 4.4% (95% CI: 3.1-5.6%), followed by Nusa Tenggara Barat (NTB) at 4.0% (95% CI: 3.0-5.1%) and South Sumatra at 3.4% (95% CI: 2.4-4.4%). In number, blindness among people aged 50+ in East Java was the highest at 371,599, followed by West Java at 180,666 and Central Java at 176,977. Untreated cataract was the commonest cause of blindness in all provinces (range: 71.7% to 95.5%). CSC_person<3/60 and CSC_person<6/60 in Bali were the highest at 81.3% and 72.4%, respectively. Indonesia countrywide prevalence of blindness was 3.0%. The total number of people with VI (PVA less than 6/18 in the better eye) in Indonesia was 8,019,427, consisting of 1,654,595 of blindness and 6,364,832 of moderate and severe VI.Conclusion: The burden of blindness in Indonesia is high, and untreated cataract contributes the most. There is an urgent need to increase cataract surgical coverage by providing better access to cataract surgery services for all people in need.

Disability-Disaggregated Data Collection: Hospital-Based Application of the Washington Group Questions in an Eye Hospital in Paraguay

Disability-disaggregated data are increasingly considered important to monitor progress in Universal Eye Health Care. Hospital-based data are still elusive because of the cultural ambiguities of the term disability, especially in under-resourced Health Information Systems in low-and middle-income countries. The aim of this study was to estimate the hospital-based rate of disability in patients presenting at an eye department of a rural hospital in Paraguay and to discuss implications for the management of access barriers. Therefore, we introduced two standardized sets of the Washington Group (WG) Questions as a pilot project. In total, 999 patients answered the self-report WG short set (WG-SS) questionnaire with six functional domains, and 501 of these patients answered an extended set, which included additional domains for "anxiety" and "depression" (WG-ES3). Overall, 27.7% (95% Confidence Interval (CI) 24.9-30.3) were categorized as having a disability. A total of 9.6% (95% CI 7.9-11.6) were categorized as having a disability because of communication difficulties, which was second only to visual difficulties. The odds ratio for disability for patients aged 70 years and older was 8.5 (95% CI 5.0-14.4) and for male patients, it was 0.83 (95% CI 0.62-1.1). Of those patients who answered the WG-ES3, 3.4% were categorized as having a disability because of being worried, nervous or anxious and 1.4% because of feeling depressed. An analysis of the questions of the "depression" domain was impeded by a high rate of measurement errors. The results of the different domains can now be used to inform the identification and mitigation of potential access barriers to eye health services for different types of impairments.

Factors Influencing Disability Inclusion in General Eye Health Services in Bandung, Indonesia: A Qualitative Study

The Inclusive System for Effective Eye-care (I-SEE) is a pilot project for disability inclusion in eye health in Bandung district of Indonesia. The aim of this research was to investigate factors influencing the introduction, i.e., adoption, implementation and continuation of I-SEE. A qualitative exploratory study was conducted by interviewing relevant stakeholders (n = 27) and users with disabilities (n = 12). A theoretical framework on the introduction of innovations in health care was used to guide data collection and thematic analysis. Factors related to the characteristics of the innovation (I-SEE) (e.g., infrastructure, equipment, engagement of people with disabilities, inclusive communication), service provider characteristics (e.g., motivation, attitudes, training), organizational characteristics (e.g., supervision, indicators, data), and the socio-political context of I-SEE (policy, motivation of users, family support, costs, transport) were essential for supporting the introduction process. Additionally, stakeholders proposed strategies for enhancing the introduction of I-SEE (e.g., awareness, collaborations). While there are specific disability related factors, most factors influencing the introduction of disability inclusive eye health were similar to introducing any innovation in general health care. Strategies for disability inclusion should be included from the planning phase of an eye health program and are reasonably simple to adapt.

Towards Universal Eye Health: Hospital-based disability-disaggregated data collection in Takeo province, Cambodia

BACKGROUND

Universal access and equity are salient principles of the World Health Organization global action plan 'Towards Universal Eye Health'. However, collection of disability-disaggregated data to measure access to eye hospitals in low- and middle income countries, including referral to rehabilitative services, are not routinely integrated into Health Management Information Systems.

OBJECTIVE

This report presents secondary-data analysis of disability-disaggregated data collection that was introduced at a tertiary eye hospital in a rural province in Cambodia.

METHODS

A modified version of the Washington Group Short Set of Questions was used to count the number of eye patients with self-reported difficulties. The number of referrals of patients with unavoidable visual impairment to low vision services as well as referral to rehabilitative services was also counted.

RESULTS

From 2011 to 2016, out of 182,327 patients overall 4981 (2.7%; 95% CI 2.66-2.81) reported difficulties with hearing, moving or communicating in addition to visual or other eye-related problems. Most of the difficulties were reported in the age group of patients aged 50 years and older (89.8% [95% CI 88.9-90.6]). All together 901 (0.5%; 95% CI 0.46-0.53) patients were treated at the low vision unit and 652 (0.36%; 95% CI 0.33-0.39) patients were referred to rehabilitation services. The number of referrals to rehabilitation declined annually from the year 2013-2016.

CONCLUSIONS

Patients with self-reported impairments constitute a significant proportion of the eye hospital's population. A modified version of the Washington Group Short Set of Questions enabled routine disability-disaggregated data collection but resulted also in possible under-reporting of difficulties.