NATIONAL VISION 2020 ACTION PLAN FOR

LAO P.D.R (July 2009 – December 2013)

NATIONAL BLINDNESS PREVENTION PROGRAMME

MINISTRY OF HEALTH

January 2009

VIENTIANE, LAO P.D.R.

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CONTENTS Page

1. List of Acronyms ii

2. Acknowledgements iii

3. Summary 1

4. Introduction 3

5. Profile of Lao P.D.R. 4

6. Rationale 7

7. Objectives 8

8. Strategies 9

9. Targets and budget 12

10.Information System, Monitoring and Evaluation 15

11.Proposal 17

12.Annexes

12.1 Project planning matrix 2112.2 List of eye care facilities in the province 3212.3 Map of Lao P.D.R. 33

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1. ACRONYMS

GIS Geography Information SystemCBM Christoffel Blind MissionECF Eye Care FoundationHMIS Health Management Information SystemHC Health CentreIAPB International Agency for the Prevention of BlindnessIEC Information, Education and CommunicationIOL Intra-ocular LensLNBPP Lao PDR National Blindness Prevention Programme MCH Mother and Child HealthMIS Management Information SystemMoH Ministry of HealthNCPB National Committee for the Prevention of BlindnessNGDO Non-governmental Development OrganizationNGO Non-governmental OrganizationPBL Prevention of BlindnessPEC Primary Eye Care PECU Primary Eye Care UnitRHB Regional Health BureauSAFE Surgery, Antibiotic, Face washing and Environmental improvementSICS Small Incision Cataract SurgeryTF Trachomatous Inflammation - FollicularTI Trachomatous Inflammation - IntenseTT Trachomatous TrichiasisVVHW Voluntary Village Health WorkerWHO World Health Organization

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2. ACKNOWLEDGEMENT (maximum one page)

Acknowledge persons who took the initiative for the planning workshop.

Acknowledge material support and financial assistance for workshop.

Acknowledge course facilitators, chairpersons, presenters and participants.

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3. SUMMARY (one page)

- Why is the project carried out (= who/what will benefit?)

- What is the project expected to achieve (= number of people benefitting)

- How is the project going to achieve its outputs/results (=strategies used)

- Which external factors are crucial for the success of the Project (= risks and assumptions)

- How can we measure the success (= indicators)

- Where will we find the data required to assess the success (=means of verification).

All this is can be extracted from the project planning matrix. It is advised to write this only when the whole project planning matrix is completed.

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4. INTRODUCTION

According to the latest World Health Organization (WHO) estimates, there are 45 million blind and 135 million visually impaired people in the world. About 90% of all blind people in the world live in developing countries. Around 80% of all blindness can be treated or could have been prevented.

Summary of results from RAAB in 2007A RAAB was conducted in entire Lao PDR in 2007, organised by the Lao PDR National Blindness Prevention Programme with financial support from international NGO’s.The RAAB training was held from December 10 -15, 2006 and the fieldwork was conducted from July to September, 2007. The total sample size was 2,550 people aged 50 year and older. This would provide enough power to detect a prevalence of blindness of 6.0% in people aged 50+ with a variation of 20% and a non-compliance of 5% at 95% probability.

51 clusters were selected from a sampling frame that included all 10,554 census enumeration units throughout Lao PDR which were used during the latest national census from 2005. Each enumeration area was selected with a probability proportional to the size of the population of the village. Within each enumeration area, 50 residents aged 50 years or older (the cluster) were selected using the compact segment sampling method.

Of the 2,550 eligible persons, 2,522 could be examined, giving a coverage of 98.9%. 17 people were not available and 11 refused to be examined.

The age and sex adjusted prevalence of blindness (Best corrected BCVA<3/60 in the better eye) in people aged 50+ found in this RAAB was 1.95% with a variation of 0.61% (36% of the prevalence) at 95% confidence. The non-compliance was 1.1% and the design effect was 1.1. This means that the power of the sample was much lower than anticipated in the design of the study. The main cause is that the prevalence found (1.95%) is much lower that the expected prevalence (6.0%).

In this summary, all data refer to the population of people aged 50 years and older, unless an other age group is specified.

BlindnessThe age and sex adjusted prevalence of blindness (WHO definition: best corrected -BCVA<3/60 in the better eye) in people aged 50+ in Lao PDR is 1.95% (CI 95%: 1.3 – 2.6%), an estimated 12,268 people. The prevalence in males (1.24% - CI95%: 0.5 – 2.0%) is much lower than in females 2.61% - CI95%: 1.6 – 3.6%), but due to the low power of this sample it does not reach significance.If extrapolated to the entire population of Lao PDR in 2005 (5.8 million according to the latest national census) and assuming that 20% of all blindness occurs in people younger than 50, then the prevalence of blindness in the total population can be estimated at 0.27%.

The age and sex adjusted prevalence of blindness with presenting - PVA<3/60 in the better eye, also including refractive errors, in people aged 50+ in Lao PDR is 2.49% (CI 95%: 1.7 – 3.2%), an estimated 15,643 people. The difference in prevalence between males (1.60% - CI95%: 0.8 - 2.4%) and females (3.31% - CI95: 2.2 – 4.4%) is also large but, due to the low power of the sample, not significant.

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Low visionThe adjusted prevalence of low vision (presenting VA<6/18-3/60) due to all causes in Lao PDR is 12.8%, an estimated 80,623 people: 37,240 males (12.3%) and 43,392 females (13.3%). 1.6% of the examined people aged 50 years and older had a BCVA<6/18 in the better eye which was not caused by cataract, refractive error or uncorrected aphakia. Extrapolated to the total number of 629,800 people aged 50+ in Lao PDR, an estimated 10,077 people aged 50+ require low vision services or training.

Causes of blindnessIn people aged 50+, cataract is the most common cause of bilateral blindness with 65.3%, followed by glaucoma (12.5%), surgical complications (6.9%) and other corneal scars (6.9%), phthysis and other posterior segment diseases (both 4.2%). Of all bilateral blindness in Lao PDR 83.3% is considered to be avoidable: 65.3% is curable and 18.1% is preventable.

In patients with severe visual impairment (presenting VA <6/60 – 3/60 in the better eye) cataract is still the major cause (83.6%), followed by other posterior segment or CNS disease (6.8%), In patients with visual impairment (presenting VA <6/18 – 6/60 in the better eye) refractive errors are the major cause (52.1%), followed by cataract (41.5%). Blindness and visual impairment due to corneal scarring also includes pterygium, which is very common in Laos, just like in the neighbouring countries of Vietnam, China and Cambodia.

CataractThe prevalence of bilateral blindness due to cataract is 1.01%, an estimated 6,359 people in entire Lao PDR. Of them 1,277 are males (0.42%) and 5,082 females (1.55%). There are an estimated 39,012 eyes blind due to cataract in Lao PDR (prevalence 3.10%): 12,866 in males (2.13%) and 26,147 in females (4.0%). The prevalence of cataract in females is significantly higher than in males. This means that to eliminate bilateral cataract blindness (BCVA<3/60) in Lao PDR at least 6,359 people with bilateral cataract blindness have to be operated in one eye. If the aim is to operate all cataract blind eyes, then 39,012 cataract blind eyes have to be operated upon.

The RAAB findings above cannot directly be translated into numbers of cataract operations required per year. For this, several assumptions have to be made. Firstly, not all backlog can be finished in one year. A period of 5 years seems more realistic. Secondly, the number of new cases of cataract blindness that occur each year (incidence) should also be estimated and included. We usually estimate the incidence as 20% of the prevalence. Thirdly, not all patients blind from cataract want to be operated. We may assume that 75% of all eligible cases may want to be operated. The required number of cataract operations (CSR) could then be calculated as follows:

Required no. cataract operations / year = (backlog of cataract blind eyes / 5 + incidence) * 75%

Required no. cataract operations / year = ((6,359 / 5) + (6,359 * 20%)) * 75%

Required no. cataract operations / year = 2,543

Required CSR = 2,543 / 5.6 = 454

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In Lao PDR, the estimated number of people blind due to cataract is rather low (6,359). The variation is high (40%), due to the small sample size. The probability is 95% that the real prevalence lies between 0.61% (3,842 people aged 50+) and 1.41% (8,880 aged 50+). There are an estimated 16,502 people with bilateral cataract and a BCVA<6/60 (2.62%) and 67,723 eyes with cataract and BCVA<6/60. If the threshold to qualify for cataract surgery is lowered to BCVA<6/60 then the required CSR will increase from 454 to 1179.It is recommended that all people with cataract and a BCVA<6/60 are also eligible for cataract surgery. It is also recommended to give extra attention to women with cataract, because for every cataract blind man there are 4 cataract blind women.

Cataract Surgical Coverage (CSC)In Lao PDR 39% of all eyes blind due to cataract have been operated upon: 53% in males and 30% in females. That means that for every male eye operated for cataract there is one eye still blind due to cataract and for every female eye operated there are two cataract blind eyes. Of all eyes with a VA<6/60 due to cataract, 27% is operated, of the eyes with a VA<6/18 18%, indicating that most people are operated upon when they have a considerable loss of vision. Of all persons bilaterally blind due to cataract, 60% is operated upon in one or both eyes: in males 79%, in females 47%. This means that for every person operated in one or both eyes for cataract there is another person bilaterally blind due to cataract, not yet operated.

Visual outcome after cataract surgeryOf all eyes operated for cataract 50% can see 6/18 or better and 30% cannot see 6/60. With pinhole the results improve to 67% good outcome and 19% poor outcome. Establishment of good refraction services and individual adjustment of IOL’s are likely to improve the outcome of cataract surgery considerably. Results in patients operated during the last 5 years are better than those operated more than 5 years ago. Of the 112 operated eyes in the survey 99 (88.4%) received an IOL and 13 (11.6%) were operated without IOL. Of all cataract operations, 54% is conducted in a government hospital, 1% in a voluntary or charitable hospital, 5% in a private hospital and 41% in an eye camp or improvised setting.

Barriers to cataract surgeryIn Lao PDR ‘Cannot afford’ is the most common barrier (32%), followed by ‘Old age, no need’ (13%) and ‘No company’ (13%), ‘How to get surgery’ (10%) and ‘Fear of losing sight’ (10%). ‘Cannot afford’ is the main barriers in males and females, but for the other barriers they vary considerable. Knowing these barriers may help to design appropriate health education and promotion strategies to increase the uptake of cataract surgery.

TrachomaRAAB is not designed to provide details on trachoma, because it covers only people aged 50 years and older, while in trachoma the infectious stage mainly affects children aged 0-10 and TT and corneal scarring are usually measured in people aged 35 and older. In the RAAB, no patients aged 50+ were seen with a visual impairment due to trachoma.

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Comparison with neighbouring countriesIn 2007, three RAABs were carried out in Vietnam (16 out of 64 provinces), in Cambodia (national) and in Lao PDR (national). The table below compares the main results of these three surveys.

Table 1. Comparing the main results from RAAB in Viet Nam, Cambodia and Lao PDR Viet Nam Cambodia Lao PDR

Indicator 2007 2007 2007% population 50+ 15.1% 11.1% 11.2%% population 70+ 3.8% 2.1% 2.5%Prevalence BCVA<3/60 3.0% 2.8% 2.0%Prevalence PVA<3/60 3.1% 3.3% 2.5%Prevalence Cataract BCVA<3/60 1.6% 1.9% 1.0%Prevalence Cataract BCVA<6/60 3.0% 3.1% 2.6%CSC eyes <3/60 45% 34% 39%CSC eyes <6/60 38% 27% 27%Outcome % good 51% 62% 50%Outcome % poor 27% 19% 30%% with IOL 84% 89% 88%

Although the population composition in Lao PDR is comparable with Cambodia, the prevalence of blindness and blindness due to cataract is lower in the Lao PDR. The Cataract Surgical Coverage is also comparable with Cambodia.Viet Nam has relatively more elderly people and this may explain the higher prevalence of blindness and blindness due to cataract, because the CSC is only moderately higher compared to Cambodia and Lao PDR.

Prognoses for futureAs in most other countries in South East Asia, the proportion of people aged 50+ is expected to increase from 9.9% in 2007 to 12.2% by 2025. Life expectancy at birth is expected to increase from 55.9 to 62.9 over the same period (prognoses US Census Bureau). This ageing trend is likely to cause an increase of blindness and low vision in Lao PDR. The higher developed a society, the greater the demand for good eyesight. Adequate and effective action is necessary today to control the avoidable blindness in the future.

Looking at the results from the RAAB of 2007, major emphasis should be given to reduction of cataract blindness. Other major causes of blindness are glaucoma, other corneal scars (including pterygium) and phthysis. Refractive errors are the main cause of visual impairment. These are refractive errors in people aged 50+. Further research may be necessary to measure how many school children actually need spectacles.

Trachoma was in the past common in Lao PDR, but in the RAAB no cases of blindness or visual impairment due to trachomatous scarring.

Organisational structure of the Lao PDR National Blindness Prevention Programme (NBPP) Describe the organisational structure of the National Blindness Prevention Programme (NBPP) in Lao PDR. When was it established? Give organogram.

What are the major aims and objectives of the programme?

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What have been its major achievements over the past years?

What is the situation on manpower for eye care in Lao PDR?- ophthalmologists- ophthalmic assistants- eye nurses- optometrists- other eye care staff

What is the situation on eye care infrastructure and equipment?

What are your partner organisations? What do they support?

How were the data collected for the situation analysis?

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5. BACKGROUND INFORMATION (PROFILE OF LAO PDR)

Geography

Climate

Population / Demography

Age and sex composition of population by 5 or 10-year age groups

Socio-economic situation / communication

Health situation / health infrastructure / organisation of health care services- Eye care facilities and resources- Organisation of eye care services - Organogram of structure and functioning of National Blindness Prevention Program - List of member organisations of National Blindness Prevention Program - List of members of NBPP- Data on magnitude of blindness and low vision by cause- Data on human resources by cadre and by district- Data on facilities and equipment by type and by district- Indicate utilisation and capacity of available staff and infrastructure

Figure 1: Map of Lao PDR

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Major Constraints for Eye Care:

Analyse current capacity and utilisation of eye care services List major constraints Poor inter and intra-sectoral collaboration and coordination

Etc.

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6. RATIONALE FOR THIS NATIONAL EYE CARE PLAN

Indicate in which way VISION 2020 will help to reduce the blindness problem in Lao PDR.

For example:

This Plan is expected to contribute to the following:

Improve the profile for eye care issues in Lao PDR.

Increase chances of attracting adequate funds and other resources into eye care services.

Increase awareness and sensitisation of all stakeholders about the need to give eye care

higher priority and consideration when allocating resources.

Have strong commitment from the MOH on the specific policy, leadership and co-ordination

of eye care in the country.

Put in place a clear and relevant set of guidelines for achieving a properly integrated and co-

ordinated eye care system in the country.

Ensure equitable distribution of eye care services in the country.

Develop services that address all the preventive, promotive, curative and rehabilitative

aspects of eye care adequately.

Increase awareness of and demand for eye care services.

Improve accessibility, quantity and quality of eye care.

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7. OBJECTIVES OF THIS PLAN

List the general objective and the specific objectives from the project planning matrix below.

The main objective of the National VISION 2020 Action plan for Lao PDR is to reduce the prevalence of avoidable blindness and severe visual impairment in the country.

Development of eye problemsTable 1 in Chapter 4 compares the eye care indicators of Lao PDR with those of Cambodia and Vietnam. Because the proportion of people aged 50+ and 70+ is relatively low in Laos, there are less people at risk for blindness as compared to Vietnam. Predictions for the next 15 years indicate that the proportion of people aged 50+ is likely to increase from 10% in 2009 to 12.2% in 2025. With this trend also the number of people at risk for blindness will increase. (Figure 2)

Figure 2. Proportion population age 50 years and older in Lao PDR (1995-2025)

Based on data from US Census Bureau: http://www.census.gov/ipc/www/idb/country/laportal.html

Proportion Population aged 50+

0,0%

2,0%

4,0%

6,0%

8,0%

10,0%

12,0%

14,0%

1995

1997

1999

2001

2003

2005

2007

2009

2011

2013

2015

2017

2019

2021

2023

2025

Year

Prop

ortio

n 50

+

Male + Female Males Females

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8. STRATEGIES

List the general and the specific strategies that have been formulated to achieve the above objectives from the project planning matrix below.

Based on the results of the RAAB of 2007, which covered entire Laos, the four main causes of blindness and visual impairment in Lao PDR were identified:

1. cataract2. refractive errors3. corneal injuries and infections, including pterygium4. glaucoma

By focussing on these causes the maximum reduction of blindness and visual impairment can be achieved. At present, cataract intervention is implemented in all provinces in Lao PDR.

CataractCataract is the main cause of blindness (65.3%) and severe visual impairment (83.6%) in Lao PDR. From 2005 till 2008 the number of cataract operations increased from 3,158 to 5,458 per year. With 20 cataract surgeons in 2008, the average number of cataract operations was 225 per cataract surgeon per year. The eye surgeons consider the current capacity for cataract surgery enough to increase the output to 500 cataract operations per eye surgeon per year on average.

The intention is to increase the number of cataract operations by 1000 every year from 2009 to 2013. That can only be achieved through intensified case finding and of training more supporting staff for this purpose. All 17 provincial eye hospitals should be well equipped for adequate diagnosis and treatment of cataract. Instructions will be given to all eye surgeons to consider patients with cataract and a BCVA<6/60 for operation. Eye surgeons with less experience will be given in-service training to enhance their skills. Routine monitoring of visual outcome will be introduced to improve the results of cataract surgery to al least 70% with good and less than 15% with poor outcome. This will require intensified follow-up of operated patients and improved services to provide optimal optical correction after cataract surgery.

Refractive errorsUncorrected refractive errors are the most common cause of visual impairment in people aged 50 years and older (52%). There are no proper data on the prevalence of uncorrected refractive errors in schoolchildren and in young adults aged 15-49.However, refraction services are scarce in Lao PDR and the quality of the spectacles is often poor.Besides that there are cultural barriers against the use of spectacles. Traditionally, people do not read much and the demand for reading glasses is not very high. The intervention strategy will focus on creating more demand for refraction services by examining special groups like military, police, factory workers and civil servants for presbyopia and providing them with reading glasses. Refractionists and adequate optical services should be made available at each provincial hospital. The only data on refractive errors in schoolchildren comes from a study from 1999 which included schoolchildren aged 6-12. Several studies have reported that the prevalence of uncorrected refractive errors in children aged 10-15 is around 4 times higher compared to children aged 6-10. The meeting decided to conduct a detailed pilot study on refractive errors in 5000 school children aged 10-15 (2500 in rural and 2500 in urban area). If the prevalence of uncorrected refractive errors in this group is 5% of more it may be cost-effective to start regular vision screening in children aged 10-15 year. Only when this age group is well covered with services it is recommended to expand services to younger age groups as well.

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Eye injuries and infectionPhthisis (4.2%) and other corneal scars (6.9%) are a major cause of bilateral blindness in Lao PDR. The prevalence is even higher in eyes. Pterygium is very common in Lao PDR and in the RAAB this is classified as ‘other corneal scar’. However, the number of patients blind due to pterygium is limited as it only rarely grows over the entire pupil. The main cause is corneal injury, especially in the agricultural sector. But the widespread practice of self-medication with eye drops containing corticosteroids is also considered a common cause for secondary infection.The main strategy is health education to reduce self-medication with corticosteroids. Also the treatment facilities will be improved to ensure a better outcome after treatment for corneal injuries. These activities will be concentrated in 1 district in 5 provinces (Luangprabang, Xekong, Huaphanh, Luangnamtha, Vientiane Capital) and will be expanded to cover 3 districts in each province by 2013. The aim is to reduce blindness due to corneal trauma and infection from 11.1% in 2008 to less than 8% by 2013.

GlaucomaWith 12.5% glaucoma is the second major cause of blindness in Lao PDR. These people, however, are incurable blind and their sight cannot be restored. But this high prevalence indicates that glaucoma is a very common disease and efforts should be made that patients with glaucoma are checked regularly and provided with treatment to prevent them losing their sight.

The proposed strategy is to establish glaucoma services in 10 selected provincial hospitals, to provide necessary equipment for diagnosis and treatment and to provide additional training to ophthalmologists and BEDs. They will measure routinely IOP, visual fields, cup/disk ration and conduct gonioscopy on all patients at risk for glaucoma: people aged 40+ and relatives from known glaucoma patients. In 4 provincial hospitals (Savannaket, Champasak, Luangprabang and Oudomxay) perimetry will be made available. The aim is to reduce blindness due to glaucoma in these 10 provinces by increasing the total number of patients on regular treatment from 500 in 2008 to 1000 in 2013.

National VISION 2020 CommitteeAt this moment the involvement of the Ministry of Health in the prevention of blindness activities is limited. For better advocacy on the eye care programme and to get more support from the Ministry of Health, NGOs and other partners an active National VISION 2020 Committee can be very useful.

Monitoring and evaluationIn order to monitor whether the activities and sub-activities under this action plan are implemented in time and whether they are successful to reduce blindness a good Health Management Information System is essential. This can also help to evaluate activities supported by NGO’s and to provide data to convince the government to provide (more) support to the eye care programme (advocacy).

See also chapter 10.

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9. TARGETS AND BUDGET

Population: 5.8 millionBlindness PrevalenceNumber Blind

No Activities Targets Physical plan by year Financial plan by year (local currency x 1000)

2009 2010 2011 2012 2013 2009 2010 2011 2012 20131 Diseases control

and prevention1.1 Cataract1.2 Trachoma TT Surgery

Active trachoma Rx Community Sensitisation and Mobilization for F&E

1.3 Childhood BlindnessRefractive Errors (among 12-18 years olds) – ScreeningSpectacles ProvisionVitamin A caps. Distribution (EPI+ )

1.4 LEPD Production1.5 Production and

distribution of aphakic (+10,+11), and reading glasses

1.6 Production and Distribution of IEC Materials

1.7 Research/Survey1.8 Program Review

with District Leadership

1.9 Supervision of Zones/DistrictsSub-Total: Disease control

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No Activities Targets Physical plan by year Financial plan by year (local currency x 1000)

2 HRD - Training 2009 2010 2011 2012 2013 2009 2010 2011 2012 20132.1 Ophthalmologist

2.2 Cataract surgeon 2.3 Ophthalmic Nurse 2.4 Regional PBL.

coordinator (6 month CEH Training)

2.5 TT lid surgeon(IECW)

2.6 Equipment technician

2.7 Optometry technician

2.8 LEPD technician2.9 Spectacle

technician2.10

Low vision Technician

2.11

Regional workshops/seminars for General Health Care Workers on PEC (x2/yr)Sub-Total: HRD

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No Activities Targets Physical plan by year Financial plan by year (local currency x 1000)

3 Infrastructure and equipment development

2009 2010 2011 2012 2009 2010 2011 2012

3.1 PEC Units (strengthening)Out-reach (temporary) PECU Secondary eye care units

3.2 Permanent (up-grade existing secondary eye care units by equipment)Cataract out-reach (temporary) ECUs

3.3 Equipment/ Instruments

Basic Instrument Package for PEC Units

Basic Instrument Package for Secondary Eye Care Unit**

3.4 Strengthening of the PBL. Co-ordination Office at RHB: Stationary etc.

3.4.1

Desk top Computer and Printer for the Regional PBL co-coordinator

3.4.2

Lap top Computer for the Regional PBL co-coordinator

3.4.3

Photocopy machine for the Regional PBL co-coordinator

3.4.4

Vehicle station wagon for out-reach services of the secondary care eye unit

3.4.5

Fuel for 3 Vehicles

3.4.6

Motorcycles

Subtotalinfrastructure and equipment development Grand Total

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10. INFORMATION SYSTEMS, MONITORING AND EVALUATION

Describe the present Health Management Information system.

Is it adequate? If not, what are the constraints and how can it be improved?

Which indicators should be collected in the province to monitor and evaluate the proposed action plan?

At present, no detailed Health Management Information System (HMIS) exists for eye care services in Lao PDR. Usually, the provincial eye surgeons send in a report by the end of the year to the Ophthalmology Centre and their reports are there merged into an annual country report. That means that if there are any shortages in manpower, equipment or supplies that will affect the output of the provincial eye unit, this may only be known at the end of the year and precious time may be lost.

Ideally, the HMIS for eye care services should have quarterly reports from all 17 provincial eye units to the central unit, the Ophthalmology Centre in Vientiane. These reports should then be entered into a central computer system and provide a good overview of the situation in the entire country. If there are no e-mail or internet connections in the provinces the quarterly provincial reports to the centre can be paper reports using a standardised format. If internet connections are available then it may be possible to send electronic reports as e-mail attachments or even to use internet-based MIS systems.

Indicators to be used to measure performance of the activities and sub-activities in this plan:Per eye health unit per quarter:

- ophthalmic manpower- ophthalmic equipment- ophthalmic drugs and supplies

Per province per quarter:- ophthalmic manpower

o new staff trained- ophthalmic equipment- ophthalmic drugs and supplies- Eye OPD

o No. of eye patients seeno No. of patients with cataracto No. of patients with refractive errors

- Cataracto No. of cataract operations doneo Details of cataract operations

Male / Female Age IOL / no IOL Visual outcome at discharge an at 4 weeks post op. or more

- Refractive errors o No. of patients screenedo No. of spectacles provided

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o No. of schoolchildren screenedo No. of schoolchildren unable to see 6/12o No. of spectacles provided to schoolchildren

- Glaucomao No. of glaucoma patients operatedo No. of glaucoma patients under regular controlo No. of new glaucoma patients on register

- Corneal injuries and infectionso No. of pterygium excisionso No. of people with corneal injuries and infections at OPD

It will be possible to link data to a Geographical Information System (GIS) whereby all data from a certain eye care unit can be shown on a map. In that way it is very easy to visualize the distribution of eye care services in the country.

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11. PROPOSAL

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12. ANNEXES

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12.1 PROJECT PLANNING MATRIX

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12.2 LIST OF EYE CARE FACILITIES IN THE COUNTRY

12.3 MAP OF LAO P.D.R.

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