VISION 2020 PHILIPPINES “THE RIGHT TO SIGHT” _A PROPOSAL FOR THE

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					                  VISION 2020 PHILIPPINES
                    “THE RIGHT TO SIGHT”

   (A PROPOSAL FOR THE ELIMINATION OF
 AVOIDABLE BLINDNESS IN THE PHILIPPINES)




Results of the WORKSHOP ON VISION 2020 conducted by the Department of Health
on July 26 to 28, 2000 at the SEAMEO-INNOTECH.
                                    SITUATIONER

DEMOGRAPHIC DATA:

    As of 1999, the population of the Philippines was estimated at 76 million. The
growth rate for the previous 5 years (1990-1995) was 2.32%. Life expectancy was
65.58 years for males and 70.83 years for females. Per capita income was P17,000.00.
Thirty one (31) % of all families were considered “poor”.

HEALTH RESOURCES:

   Data for 1997 showed that there were at least 616 public hospitals and 1,097 private
hospitals, with a total bed capacity of 80,000. There were 13,096 village health stations
and 2,405 rural health units. There were at least 2,600 government doctors, 1,400
dentists, 4,000 nurses and 13,000 midwives.

BLINDNESS PROBLEM WORLDWIDE

     There are 50 million blind worldwide, most of them living in the underdeveloped and
developing countries of Africa and Asia. Of this, 25 million are blind because of cataract.
It is estimated that, if no steps are taken in the next 20 years, the blind will number 75
million by year 2020.

    The WHO has determined that almost 80% of world blindness is due to cataract,
error of refraction, VAD, trachoma, onchocerciasis—eye conditions that are either
preventable or remediable. The rest is due to glaucoma and retinal diseases including
degenerative eye problems, eye conditions which are difficult to screen, diagnose and
treat.

BLINDNESS PROBLEM IN THE PHILIPPINES

   The most recent survey of blindness (1995) in the Philippines showed that the
prevalence of blindness is 0.7%. Applying this to 1999 population, we have at least
500,000 blind Filipinos (who are unable to count fingers at a distance of 3 meters with
their better eye); prevalence of low vision is 2.4%, or about 1.7 million Filipinos who
cannot count fingers at 6 meter distance with their better eye. The most common
causes of blindness and low vision are cataract, (77% of blind) error of refraction,
Vitamin A deficiency, glaucoma, and retinal diseases.


CATARACT PROBLEM

    Cataract accounts for almost 400,000 blind and 1.1 million low vision Filipinos. The
incidence of blinding cataract is 80,000 per year. As of 1999, we have a backlog of
more than 3 million operable eyes (blind and low vision) with cataracts. At least 160,000
operable eyes are added to this number each year.

   The cataract problem is being addressed to some extent by the Visual Health
Program of the Department of Health and by a number of international as well as local
non-government organizations.

CATARACT SURGICAL RATE

    Cataract Surgical Rate (CSR) is a factor that has been adopted by the WHO to
monitor the performance of countries re Blindness Prevention Programs. The CSR is
the number of cataract surgeries per one million population. This ranges from 6000 in
the developed countries (UK and USA) to less than a thousand in the underdeveloped
and developing countries (Asia, Africa). The World Health Organization recommends
that , to eliminate avoidable blindness which is mostly due to cataract, the CSR must at
least be 3000 in the next five years or by year 2020.

     The CSR in the Philippines is about 600 (50,000 surgeries for a population of 76
million ). Of the 50,000 surgeries annually, only about 15,000 come from the indigent
population. To attain a CSR of 3000, the country must perform at least 200,000
cataract surgeries a year, or at least 60,000 cataract surgeries among the indigent
population.

ERROR OF REFRACTION

   There are at least 7.3 million Filipinos with one or more kinds of error of refraction
with a visual acuity of less than 20/40 in the better eye. About 30,000 are blind from
EOR. There is no government program to address the problem of error of refraction.
Some non-government organizations are helping schoolchildren who need eyeglasses.

VITAMIN A DEFICIENCY

   While the problem of vitamin A deficiency among children 11 to 59 months of age is
being adequately addressed by the Department of Health, the prevalence of VAD
among pregnant mothers is still high at 10% (with night blindness). The “Sangkap
Pinoy” program which distributes Vitamin A Capsules twice a year is now being
continued through the “Garantisadong Pambata” program.

OTHER CAUSES OF BLINDNESS

    The other causes of blindness like glaucoma, diabetic retinopathy, macular
degeneration, etc, are no less important but they are few compared to cataract, EOR,
and VAD; in addition, they are difficult to control and treat and are therefore not usually
included in national blindness prevention programs due to very costly interventions that
are necessary to diagnose and treat them.
OPHTHALMIC RESOURCES FOR THE BLIND AND LOW VISION

     There are one thousand (1000) ophthalmologists and more than 4,000 optometrists
in the country as of 1999. Of the ophthalmologists, 400 are in the NCR. 152 in the other
major cities, and the rest (324) in the provinces.

    Around 60 of the 76 provinces of the country have a government ophthalmologist,
either on a full-time or part-time basis. Most of them (43) are graduates of the Modified
Residency Training Program (MRTP), a                 project to increase government
ophthalmologists, and collaborated by the DOH, the UP Manila and the Christoffel
Blindenmission.

NATIONAL COMMITTEE FOR SIGHT PRESERVATION (NCSP)

   In 1996, a group of government and non-government agencies which were working
on blindness prevention programs, started meeting regularly to discuss their respective
projects and to thresh out issues like maximization of resources and definition of “turfs”.
This group became officially incorporated in 1998 and the NCSP was registered as a
non-profit organization with the main function of coordinating efforts towards blindness
prevention in the country. This group has been behind all sight-saving activities in the
country. Its current chair, Dr. Evangeline Olivar-Santos, is a technical consultant of the
DOH, a university researcher of the UP Manila’s Institute of Ophthalmology, and
program manager of the Modified Residency Training Program in Ophthalmology. Other
members come from the DOH, DECS, PIA, CBM, LIONS, HKI, PBM, EHSF/IPAO.

VISION 2020

    VISION 2020 THE RIGHT TO SIGHT is a global initiative for the elimination of
avoidable blindness. It is the off-shoot of consultations held by the WHO Programme for
the Prevention of Blindness and Deafness at the request of, and with support from, the
Task Force of the Partnership Committee of Nongovernmentatl Development
Organizations. The global plan is documented by the WHO.

    The global plan has three essential elements: disease control strategies; human
resource needs and development, infrastructure/technology needs and development.
                            VISION 2020 PHILIPPINES

GOAL

   The goal of the project is to achieve a prevalence of blindness rate equal to or lower
than 0.5% with no community having a prevalence of more than 1%, by year 2020 if not
earlier.

VISION

   To give all Filipinos particularly the poor and the needlessly blind, the Right to Sight.

MISSION

To form partnerships among government and non-government organizations which will
work together to address the main causes of avoidable blindness, in particular
cataract and errors of refraction.


POLICIES/GUIDELINES

1. The Philippine version of Vision 2020 will have its own mission, vision statement
   based on the WHO Global Initiative for the elimination of blindness and the HEALTH
   SECTOR REFORM AGENDA of the Department of Health.

2. Vision 2020: PHILIPPINES shall prioritize the major causes of blindness which are
   cataract, errors of refraction and Vitamin A deficiency.

3. The project shall adopt the primary health care system as enunciated by WHO.

4. Vision 2020: PHILIPPINES shall have a functional organizational chart where over-
   all direction is vested on an EXECUTIVE COMMITTEE composed of the Secretary
   of Health and the health undersecretaries and given mandate by an Executive Order
   (from the President of the Philippines)

5. The project will have a Project Management Committee created through a
   Department Order which shall have the functions of management, monitoring,
   facilitation of the project among others. This committee will be headed by the
   Undersecretary for Public Health Services as chair, the Director, Center for Disease
   Control Cluster, DOH and the Chairman of the National Committee for Sight
   Preservation (NCSP) as vice-chairs, and the NCSP members as members.

6. The project will be implemented by task forces to be organized in 4 zones, three of
   which correspond to the region of the country not covered by the Visual Health
   Program cluster, and one zone corresponds to the area covered by the Visual
   Health Program cluster (Regions 6,7,8). Each zonal task force will be composed of
   the Regional Health Office Director as chair, the zonal coordinator as co-chair, and
   members of other NGOs and GOs in the region as members.

7. An NGO in each region will be “deputized” by the DOH as a zonal coordinator, the
   functions and tasks of which are clearly spelled out, until such time when the DOH
   can identify DOH zonal coordinators or, when evaluated, performance of these
   NGO coordinators is unsatisfactory. As zonal coordinator, the NGO will enter into a
   memorandum of agreement with the DOH to receive, manage, account for
   government funds allotted for Vision 2020 in his area of responsibility (see functional
   chart).

8. For efficiency, implementation will be by million population (for example, the task
   force in the region will determine the number of cataract patients needing surgery in
   every million population of that region and plan accordingly)

9. A government Appropriations Act shall be recommended for approval by Congress
   to fund Vision 2020: Philippines. Initially, this should amount to at least P60 million,
   for the purchase of equipment and supplies for cataract surgery and eyeglasses for
   indigent blind/low vision, for the first year of program implementation (year 2001).
   Subsequently, it is hoped that no less than P50 Million yearly will be appropriated by
   the government for the program. The rest of the funds needed to attain the targets of
   year 1 of the program will be sourced from the NGOs, LGUs and the community
   (including patients) which will be tapped for the implementation of the project. The
   latter is expected to raise at least P100 million for the first year and equal to or more
   than that amount in subsequent years.

10. Issues that are pertinent to the implementation of the program will be addressed
   and existing policies modified for the efficient and successful implementation of the
   program. These issues include the following:

   a. The roles of the different non-government agencies will be agreed upon with the
      Project Management Committee particularly which zones they should serve.

   b. The current policy of “pooling” doctors’ (particularly the ophthalmologists in the
      government hospitals) PhilHealth claims to be distributed equally among hospital
      personnel should be reviewed and revised. It is recommended that the
      ophthalmogists’ fees should be divided only between the ophthalmologists (50%)
      and the ophthalmology department (50%), the latter to be used for improvement,
      maintenance, or procurement of ophthalmic equipment and/or the salary of
      assistant nurses/aides who are hired for Vision 2020.

   c. Policies regarding surgical missions will be formulated.

   d. Program beneficiaries will be defined. Who will be considered “indigent?”
11. The project will design and maintain registries for the blind and for cataract
    patients initially, and other eye diseases that will be addressed later on.

12. A national survey of blindness and low vision shall be conducted every
   five years as an evaluation tool of the project’s success

13. Vision 2020: Philippines shall have the following components:

•   Policy development
•   Service delivery
•   Human resource development
•   Advocacy
•   Monitoring and evaluation
•   Research
•   Results management and dissemination

STRATEGIES

1. Seek endorsement of the project from the Department of Health Executive
    Committee who, in turn, will seek support and commitment of the government for
    Vision 2020.
2. Drafting, finalization, and signing of Memoranda of Agreement between DOH and
    zonal coordinator (NGO) agency
3. Creation of task forces in each region
4. Assessment of available resources (manpower, facilities, funding sources ) in each
    province
5. Advocacy campaign to / national launching of the project/ social marketing of project
6. Identification of priority areas for project implementation
7. Fund generation campaign – presentation of project to funding bodies, both in
    government and in private sector
8. Preparation of identified hospitals for volume cataract surgeries – resourcing of
    equipment, supplies
9. Identification of ophthalmogist groups to service priority areas
10. Preparation of timetables, targets, budget requirements per zone
11. Conduct of third national survey of blindness (to serve as evaluation tool as well as
    to create awareness about the project)


(see attached detailed implementation plan)
           VISION 2020 PHILIPPINES FUNCTIONAL CHART


 ADVISORY COMMITTEE                                      EXECUTIVE COMMITTEE
World Health Organization                                 Chair: Secretary of Health
University of the Philippines Mla                        Members: Undersecretaries of Health
Phil. Health Insurance Comm
Dept of Social Welfare and Devt.
Dept.of Interior and Local Govt.
Philippine Hospital Association

                                              PROGRAM MANAGEMENT COMMITTEE
                                         Chair: Undersec. of Health for Public Health Services,DOH
                                         Co-chairs: Director, Center for Disease Control Cluster, DOH
                                            Chair, National Committee for Sight Preservation (NCSP)
                                         Members: NCSP member Gos and NGOs




                                         zzzz zzzzzzzzzzKKKKzZZZ
                                                          ZONAL TASK FORCES
                                          ZZZ Regional Field Health
                                          Chair: ZZZZZZZZZZP Office Director
                                          Co-chair: Zonal Coordinator (Non-government Organization)
                                                     zzz
                                          Members: Chapter presidents of Professional groups in
                                                    Ophthalmology, Optometry, Pediatrics
                                                    Representatives from GOs and NGOs in the region


                                    ZONAL COORDINATORS (NGO)
       ZONE A                         ZONE B                     ZONE C                     ZONE D
     Reg. 1 Sukob                    Reg. 4 PBM                 Regions 6,7,8              Reg. 9 Lions
     Reg. 2 Ephpheta                 Reg. 5 Ofphil                Cataract                 Reg. 10 Lions
     Reg. 3 RBI                      NCR PBM                      Foundation               Reg. 11 Lions
     CAR Project Luke                                             Inc. (CFI)               Reg. 12 IDS
                                                                                           CARAGA DJF
                                                                                           ARRM UCCP

                      EXECUTIVE DIRECTOR/PRESIDENT/ADMINISTRATOR

Sukob          Mr. Tomas Arroyo                           Cataract Foundation Inc. Mr. Eusebio Po
Ephpheta       Fr. Jesus Fernandez                        Lions Sight First Mr. Rodolfo See
Resources for the Blind: Mr. Randy Weisser                 Integrated Development Services
Project Luke Dr. Ronaldo Paraan                           Davao Jubilee Foundation Miss Evelyn Cabigon
Philippine Band of Mercy Mr. Jesus Cardenas               United Church of Christ Philippines Miss Rachel Lim
Ofphil          Mrs. Cosette Realica
                                    COMMITTEES

ADVISORY COMMITTEE

Advises on issues that cannot be resolved at a lower level and where national interest is
at stake.

EXECUTIVE COMMITTEE

1. Provides general direction to the project.
2. Meets on a regular basis to discuss project issues and   progress.
3. Works for appropriation of funds for Vision 2020.

PROJECT MANAGEMENT COMMITTEE

1. Oversees over-all implementation of the project.
2. Prepares national goals and targets.
3. Collects and collates reports from the zonal coordinators.
4. Prepares a country project report on a regular basis.
5. Accountable for project funds to the DOH and to the NGOs which are supporting the
   project.
6. Meets with zonal coordinators regularly to discuss project issues and progress.
7. Evaluates performance of the zonal coordinators on a yearly basis.
8. Advocates for the support of the project to the EXECOM and other relevant bodies.

ZONAL TASK FORCE

COMPOSITION
Regional Health Office Director, Zonal coordinator(NGO), regional VHP coordinator,
Ophthalmology, Optometry, and Pediatric Society Chapter presidents, DECS Regional
Director, representatives of other NGOS in the respective zones

OVER-ALL GOALS/TASKS
1. Prepare a zonal project proposal that will address the vision/mission of Vision 2020 to
   be submitted to the DOH (and NGOs) for funding.
2. Increase by the Cataract Surgical Rate (No. of cataract surgeries per million
   population) in the Region every year until a CSR of 3000 is achieved over the next 5
   years.
3. Reduce significantly low vision particularly those due to errors of refraction.
4. Undertake Information, Education and Communication campaigns
5. Social mobilization and advocacy
6. Generate local funds to support the project
ZONAL COORDINATORS(NGO):

1. After consultation with task force, write up the project proposal for their respective
    zones and submit same to the Project Management Committee.
2. Schedule regular/emergency meetings with his task force members to discuss project
    progress, issues, etc.
3. In consultation with members, prepare a yearly budget for Vision 2020 activities in
    their respective zones.
4. Administer and manage the funds allotted to the project in his zone.
5. Prepare regular project reports (quarterly and annual) including financial reports and
    submit same to the Project Management Committee.
6. Monitor and evaluate region performances relative to Vision 2020 targets.
7. Responsible for purchase of equipment, supplies, etc, needed by the project, and do
    so according to accepted government (for DOH funds) or the partner NGO’s mother
    office guidelines.
8. Responsible for cataract finding, screening for indigency, and referring patients to the
    cataract teams in their respective zones.
9. Coordinate missions in their respective zones and see to it that resources are used
    effectively, efficiently, and maximally.
10. Collect and collate cataract surgical forms and submit same to identified information
    centers (ICD10 centers for cataract and other reportable eye disease?)
11. Responsible for updating registries of the project (in diskettes as well as in log books)

REGIONAL VHP COORDINATORS

1. Responsible for the effective and efficient implementation of the project in their
   respective regions.
2. Responsible for orienting provincial officials, health workers, etc. about the Vision
   2020.
3. Assess and submit to zonal coordinator updated reports on the available resources
   for the project in her /his respective region (manpower, materials, equipment and
   money).
4. Together with zonal coordinator, prepare a yearly budget for their respective regions.
5. Prepare requests for equipment, supplies, etc to zonal coordinator.
6. Responsible for training activities in their respective regions.
7. Responsible for the equipment given to them by the project.
8. Schedule missions in coordination with zonal coordinator.
9. Prepare reports or inputs into zonal reports as requested by zonal coordinator.
YEAR 2000

1. Creation of task forces (zonal and subzonal). Submit names and areas of
    responsibility to PMC.
2 . Assessment of the resources in the different zones
   (manpower, infrastructure, sources of funding)
2. Preparation of project proposals (budget vis a vis activity) for funding
3. Program advocacy campaign.
4. Submission of national project proposal to the Secretary of Health.
5. Preparation of prototype registry forms, report monitoring forms, etc. to be used by
    the project.
6. Launching nationwide (October 12, 2000 – WORLD SIGHT
   DAY)

YEAR 2001

1. Upgrading of facilities where cataract surgeries will be performed on a regular and
   volume basis.
2. Purchase of supplies.
3. Conduct of Third National Survey of Blindness and Study on the Value of Pre-op
   medical check-up for routine cataract surgery.
4. Piloting of project in areas identified by zones (if funding is not adequate for the whole
   country)
5. Allotment of funds.

YEAR 2002 -
Full implementation

                          Mid term Goal for the whole country

     YEAR             EST. POPN            CSR           CATARACT           EOR CASES
                         (M)                             SURGERIES           HELPED
     2001                 71               1,000           70,000             50,000
     2002                 72               1500            100,000            100,000
     2003                 73               2000            150,000            250,000
     2004                 73               2500            200,000            350,000
     2005                 74               3000            220,000            500,000
                BUDGET(In Million Pesos)

YEAR       FOR         FOR EOR         Equipment     TOTAL
        CATARACT       (glasses)     Instruments &
         surgeries                    Administratn
2001        70            15               115         200
2002       100            30                70         240
2003       150            75                10         235
2004       200           105                10         315
2005       220           150                10         380
Total     P740M         P375M            P215M       P 1,370M

				
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