Major Recommendations from the Roundtable
1. Ensure comprehensive eye care service delivery i.e. prevention and promotion, treatment and rehabilitation at all levels to reach the unreached and underserved including remote rural and neglected populations particularly women and children;
2. Build capacities of ophthalmologist, anesthesiologist, eye care providers, rehabilitation professionals, community health workers, and others on eye care services to ensure quality eye care services for all;
3. Assess the gaps in human resource (HR) required for quality comprehensive eye care services and prepare a long-term action plan for human resource in eye health (ophthalmologists, optometrist and Allied Ophthalmic Personnel);
4. Ensure availability of ophthalmologist at district hospitals through government policy;
5. Introduce the health-care financial scheme that allows eye care surgery especially of poor children;
6. GO, I/NGO and media collaboration to raise mass awareness across Bangladesh;
7. Introduction of RoP screening and treatment services in medical college hospitals and district level;
8. Policy for education department to promote students eye screening prior to school enrolment, Tax waiver for spectacles and other eye care equipment;
9. Conduct national survey for evidence creation on blindness;
10. Develop inter-ministerial coordination system (among MoE, MoH and Mof Finance for cross linkages and better planning and delivery of low vision services;
11. Increase number of School Sight Testing Program (SSTP) and covering all schools through GO- NGO collaboration;
12. Improve management information system and ensure district kevel planning in eye health;
13. Creating opportunity in public institutions for mid-level training in Ophthalmology.
The Ministry of Health and Family Welfare
Eyes are one of the most important organs in the human body. But we don't care much about it.
Though Bangladesh has moved far ahead in eye care services, we still have to do a lot, especially for the poor people living in the rural areas. We don't have a sufficient number of paediatric ophthalmologists and modern equipment for eye treatment in the rural areas. We need to put more attention to develop human resources to deliver quality eye care services for all. Government has created posts for ophthalmologists in district hospitals and already equipped district hospitals across the country to reach people in need.
We have around 1000 eye specialists for around 160 million people, which is insufficient for the country. In total 10,000 medical students become doctors every year, but there is less interest to become eye specialists. We should encourage them to get into this field. Bangladesh also lacks sufficient number of teachers in medical colleges and universities though we are setting up more medical universities in Chittagong, Sylhet and Rajshahi.
I would like to thank Orbis International and its partners across Bangladesh for playing a vital role in reducing childhood blindness as well as improving our eye-care system since 1985. They supported National Institute of Ophthalmology & Hospital (NIO&H) for quality eye care services for the children through training doctors, anaesthetists and nurses, supplying modern equipment.
I would like to thank our Prime Minister Sheikh Hasina for increasing health budget to Tk 1.15 lakh crore in 2017-18 FY from Tk 53,000 crore in the previous fiscal year. Let us work together to prevent childhood blindness in Bangladesh through awareness raising, developing more human resources and improving services at rural areas.
Md Habibur Rahman Khan
The Ministry of Health and Family Welfare
The health ministry has to work on health services for all the organs of the human body and that's why sometimes we can't give special attention to a specific organ like the eyes. Eyes are the most valuable organs in the body and the effect of having no vision is more devastating than that of any other organs. So, we should put special emphasis on avoidable blindness, especially for children.
However, it is sometimes not possible to deliver quality eye care services due to shortage of paediatric ophthalmologists and modern equipment. Our ministry has been working tirelessly to address this issue to prevent childhood blindness. At the national level, we have National Institute of Ophthalmology & Hospital (NIO&H) and Sheikh Fazilatunnessa Mujib Eye Hospital and Training Institute in Gopalganj. Still we need more eye institutes across the country. Besides, the capacity of the eye departments in medical colleges, upazila and district hospitals must be expanded further.
We thank Orbis International, Bangladesh Country Program, for their over 30 years of saving sights in Bangladesh and their contribution in reducing avoidable blindness. The government should organize eye camps in rural areas to screen and treat eye diseases to prevent childhood blindness. This can reduce one-third of the preventable blindness from the country.
Prof. AHM Enayet Hussain
Additional Director General (Planning & Development), DGHS
The Ministry of Health and Family Welfare
Children can't tell about the problems with their eyes and parents also can't understand the problems in most of the cases. Due to lack of awareness and delay in treatment, many children lose their normal eyesight. A recent survey shows that child blindness rate has been reduced in Bangladesh.
The prevalence of childhood blindness has come down from 8/1,000 children to 6/1,000 children. The same survey shows that some 20 percent parents do not realise that their children are blind until it's too late while 30 percent parents are aware of the problem, but don't take their children to paediatric ophthalmologists in time.
The country's primary health care system is well-organized and child eye-care is being integrated with the primary healthcare system.
The survey also reported that the rate of curable blindness has increased in Bangladesh like in the developed world and that we need to concentrate on rehabilitation and research, and awareness building of genetic eye diseases. To prevent childhood blindness, earlier identification of children, timely treatment and strong referral system are required.
I would take this opportunity to thank Orbis International for undertaking national childhood blindness reduction program in Bangladesh.
Prof. Dr. Golam Mostafa
National Eye Care (NEC) and
Director cum Professor, NIO&H
The National Eye Care (NEC) Plan pays more importance to issues related childhood blindness and we have some specific plans to prevent this condition. As part of our efforts, our main focus is on the upazila and district level hospitals as many people in the rural areas do not have access to eye care services at rural area. That's why we have to roll out awareness campaigns across the country so that rural people can go to the doctors for treatment of childhood blindness in time.
The National Eye Care is providing training to the ophthalmologist to improve eye care services across Bangladesh. Under new operational plan of NEC, a total of 200 vision centres will be established at the upazila level to help early diagnosis of childhood blindness and refer the patients to district hospitals. According to our five-year plan we will train the appropriate personnel from the Upazila Health Complex to be able to recognize, do refraction and refer to district and tertiary eye hospitals We have already launched our activities in 54 district hospitals, but all are not yet fully functional. We have a plan to make all districts to have a functional District Vision 2020 committee to implement the NEC plan. However, we could not start the operations in all the district hospitals for shortage of ophthalmologists.
I would strongly recommend appointment of at least one ophthalmologist in every district hospital and expect our honourable minister’s support to ensure that the doctor is stationed there for two-three-year tenure. This will help the NEC to effectively implement the NEC and District Vision 2020 plan. We are getting support from all INGOs and more specifically from Orbis in paediatric eye care services in particular.
Director of Programs
Bangladesh Country Program
On behalf of Orbis International, I would like to thank all of you for attending the roundtable. We are here to listen to all of you who work with us for over 30 years. Without your support we will not be able to expand eye care services across Bangladesh.
With more than 30 years of experience as a leading organization in eye care in Bangladesh, Orbis is uniquely qualified to address the problem of preventable sight loss among children. Orbis has already established or strengthened ten children’s eye care centres across Bangladesh. Over the last decade alone, more than one million children have received medical or refractive error treatments, while 50,000 have received sight-restoring or sight-improving surgery. The impact for these children, their families and communities is profound, especially when sight-restoration allows for full integration into social and economic activities.
Around 55 percent of Bangladesh's visual impaired population is women and some 89 percent blindness can be prevented with proper treatment and care. I am glad to inform you that Orbis International has been implementing the world's largest project on Prevention of childhood blindness in Bangladesh, which is inaugurated by Honourable President of Bangladesh in 2013.
Orbis implemented the first community-based Diabetic Retinopathy project in rural areas which has contributed significantly to addressing diabetic related eye diseases. Orbis also supported the establishment of the first in-country training centres in Paediatric Ophthalmology and Cornea sub-specialties. Orbis first started RoP screening services and treatment centre in Bangladesh as well as started a pilot project to provide support to children with type-1 diabetics.
We express our heartfelt thanks to the government, NEC and partners for their continuous guidance, cooperation and support to Orbis International Bangladesh Country Program. We highly appreciate Qatar Fund for Development (QFFD) for their assistance to implement Qatar Creating Vision project.
Md. Iqbal Hossain
Orbis International, Bangladesh Country Program
We have undertaken a project for child eye care named Qatar Creating Vision project. We are implementing the project activities with the help of nine associate organisations. The aim of this project is to improve the entire eye care treatment and to reduce the number of child blindness. Four lakh premature babies are born in the country every year and these children may become infected with low eye vision.
We will bring over million children under our treatment service within the next four years. And we have rendered eye care treatment service to 100,000 children. We have conducted 15 thousand surgeries on children eye for their cataract and cornea complications and 12,000 spectacles have been given to poor children from Orbis International.
Dr. K. Zaman BNSB Eye Hospital, Mymensingh
Mymensingh BNSB Eye Hospital is serving 16 million people of greater Mymensingh division. We are the only centre in the division, to provide comprehensive eye care service for the children. We started RoP screening and treatment services outside Dhaka with support from Qatar Fund for Development.
All preterm neonates born prior to 35 weeks and less than 2000 gm birth weight should be screened in 3-4 weeks of birth by an eye specialist.
A massive awareness program is needed for doctors, nurses, ophthalmologists and community people to address this issue. We need more human resources especially more well trained mid-level ophthalmic personnel to deliver quality eye care services in the rural areas.
Enamul Hoque Chowdhury
The Daily Sun
Eyes are valuable but neglected organ. We never want to give our eyes enough rest and that's why the eyes start afflicting with different problems after a certain period of time. I would like to thank the honourable state minister and other distinguished guests for being here today to discuss this important issue. I am sure the honourable state minister is taking a good note of all the suggestions, recommendations and advice coming up at this roundtable on prevention of childhood blindness in Bangladesh.
I want to call upon the authorities to hold eye camp at every school, which will contribute a lot to the country's public health sector in the long run as because eye diseases are one of the most critical health issues affecting many people, especially the children. For your kind information, I am also an honorary member of the National Human Rights Commission where we have employed a blind girl who has been performing as good as her colleagues.
We know that you are working on awareness building of eye diseases and the Daily Sun stands ready to extend support to this endeavour. I really appreciate the work being done by Orbis International in Bangladesh over the three decades and the Daily Sun is ready to respond to the call of Orbis in future.
Dr. Munir Ahmed
Orbis International, Bangladesh Country Program
Orbis International has been working to prevent childhood blindness in Bangladesh for last 30 years. In celebration of the gracious and auspicious occasion, we, along with the Daily Sun, have arranged this roundtable. We want to listen to your suggestions, recommendations and new ideas. We would also like to have your feedback and suggestions on our efforts because Orbis International wants to strengthen its endeavours in Bangladesh in the days to come.
Orbis aims to transform lives who are needlessly blind and work through partners since 2000 starting with childhood blindness in the country.
Through long term programs, Orbis is improving access to eye care services for children and neonates living in the poorest, most remote areas of the country. We focus on raising community awareness and training health workers so they can deliver quality eye care. Orbis works with local communities, civil society organizations and partners in eye health to promote eye care and quality practices.
We focus on improving practice, knowledge, ensuring access to quality eye care and delivering eye care services through the government and other partners in a coordinated approach. This approach ensures coverage and quality of evidence-based interventions while strengthening the entire health system. We work with the government at a national level to design better health policies. Orbis is also conducting operational research on child eye health issues to inform and strengthen programs in the long-term. Orbis strengthens networking and advocacy with policy makers and International NGOs on different important eye care related issues. This included taking the lead in developing national protocols for paediatric eye care and also provides active support to develop National Eye Care Plan. Orbis seeks innovative ways to quality programming and effectiveness; scale of our approach is recognized by GoB and partners in eye health thus enabling us to expand our coverage through new projects.
We are happy to see that our national Eye care plan has included the formation of a national council or board for accreditation or recognition of the MLOPs which has to be materialized shortly to ensure that we have addressed the huge need of such cadres in eye health to achieve what we are planning for.
Shiabur Rahman Shihab
The daily sun
As a journalist, we need latest information to inform our readers. While writing any news or article on eye health, we have to refer very old statistics, which was conducted a decade ago. I would suggest to conduct a national survey in priority basis.
Besides, a massive social awareness is needed to address the issue and media campaign is needed to address this issue.
Khulna BNSB Eye Hospital, Khulna
Early identification of childhood blindness is very important. I would suggest to start vision screening of children before admission to school. Ministry of education and Ministry of Health & Family Welfare can jointly work to address this issue.
Dr. Khairul Islam
Deep Eye Care Foundation, Rangpur
Many people of the country’s northern region are deprived of eye care services. So, we have taken a project titled ‘Char Vision’ with the help of Orbis International to render eye care treatment to the people of char (river island).
Deep Eye Care Foundation started its journey in 2008 with the aim of bringing underprivileged people under eye care treatment facilities. Our organisation examined the eyes of 2 lakh children in 2015. Of them, 13 percent are char children. To improve awareness among the char people, we began community camps and training Khude Doctor (Little Doctor) of school children so that they can convey the message to their family and society to take care of their eyes. Our organisation also provided eye care treatment to the children who had been suffering from cataract, glaucoma and retina problems.
I would like to recommend to introduce the voucher scheme in char areas, so that the poor children can access to eye care service.
Prof. Dr. Md. Forhad Hossain
Head of Paediatric Unit
National Institute of Ophthalmology & Hospital
National Institute of Ophthalmology & Hospital (NIO&H) has a well-equipped paediatric unit with qualified ophthalmologists. And we treated 62,470 paediatric patients in 2016, who were mainly suffering from cataract, retina problem, low eye vision and glaucoma.
We conduct surgeries for poor paediatric patients but we need more anaesthetists to support us during surgery. The government should give more focus on human resource development and eye health specially anaesthetists and paediatrics eye health surgeons to carry out quality eye care services for the children, who coming across the country.
At the same time, I highly appreciate Orbis International for extending their supporting hands to us for eradicating childhood blindness.
Dr. Mohammad Ariful Alam
Health, Nutrition and Population, BRAC
BRAC has long been working for the improvement of people’s health. But we started work on eye care from 2006. We have seen that people have lack of knowledge about their eye care problems. To increase public awareness, we started community interventions to reach grassroots level people to provide eye screening services.
We already distributed one million spectacles to poor villagers who have been suffering from different types of eye care problems, which costs Tk. 100 per spectacle. We are also implementing Vision Bangladesh program to reduce avoidable blindness.
We thank Orbis for partnering with BRAC and supporting to set up Vision Centre with telemedicine facilities in the community. Integration of eye health into development program, strong community intervention and Tax waiver for spectacles and other related supplies are essential to ensure eye care services at the door steps of the community.
Grameen Health Care Services Ltd.
Grameen Health Care has started its eye care services in 2006 and set up three eye hospitals at Bogra, Barisal and Thakurgaon for rendering eye care treatment to the people living in rural areas. Orbis International supported us to establish paediatric eye care services in our Bogra Eye hospital. We have also started school screening program where doctors go to schools and examine the eyes of school-going children. Those who have low eye vision and other problems are advised to take spectacles or advised to go to doctors.
I would like request to government to allow specialized foreign doctors to come to Bangladesh and treat patients voluntarily, as there is huge shortage of skilled doctors in the rural area. Meanwhile, these doctors can train our doctors and staffs on quality eye care services.
Dr. Mastura Khatun
Senior Consultant & Head of Paediatric
Ispahani Islamia Eye Institute and Hospital, Dhaka
Orbis International is the pioneer organization in eye care sector in Bangladesh. Orbis has a very significant role in developing human resources of eye care services in the country. We have treated 75,000 eye patients last year.
Every day, at least 200 paediatric eye patients are visiting our hospital. Most of them are suffering from low eye vision, cataract and child diabetic retinopathy.
We need more paediatric eye consultants to do quality surgery and we need to pay attention for low vision services as well as increase human resources.
MA Masud Bhuiyan
Mazharul Haque BNSB Eye Hospital, Chandpur
We have started working with Orbis International in 2017 to provide quality eye care treatment to children. I would suggest to add curriculum on primary eye care in the text book of primary and secondary schools. I would also request to add primary eye care in teacher’s training curriculum so that they are able to identify children with eye problems at school.
School screening program is necessary to identify children’s eye problem at early stage. We should make concerted efforts in collaboration with the government in creating more paediatric eye consultants for the improvement of eye care facilities.
Syed Mushahid Ahmed
Honorary General Secretary
Moulvibazar BNSB Eye Hospital
Mentioning the contributions of Orbis, he said that there would have been no Bangladesh if Father of the Nation Bangabandhu Sheikh Mujibur Rahman was not born and then we could not reach at our present stage in the world. Similarly, without support from Orbis, we could not be able to address childhood blindness in our country. Physicians become happy when they see smiles on the faces of parents of blind children who return to their homes after successful treatments.
Although the eye hospitals across the country run with modern facilities and equipment, but still there is shortage of eye specialists. Public private partnership is necessary to address this issue.
Dr. AKM Abdus Selim
Secretary General & CEO
Bangladesh Jatiya Andha Kalyan Samiti (BJAKS), Comilla
BJAKS is serving eye care services for blind children since 1993. On an average, we get 100 to 150 child patients every day. But, we face an acute shortage of paediatric ophthalmologist and specialists in this field. Timely follow-up after surgery is very important.
We need to increase human resource in eye health sector to ensure follow-up of each patients for quality eye care service.
Tarik Hasan Shahriar
Md. Enamul Hassan
Reaz Ahmed Sumon