ࡱ> G .<bjbjَ @8]$,,,,P|l,HH"jjjjjjժתתתתתת$ĬjjjjjjjHj"jjժ,,jժOժjDpPP,,"ilAppendix 1 PROPOSALS FOR WORKGROUP DISCUSSION Specific Disease intervention Cataract, Refractive Error, Diabetic Eye Disease HEALTH PROMOTION Areas of ConcernPlan of ActionSpecific ActivitiesIssues to Resolve Lack of public awareness on cataract, refractive error and diabetic eye disease  Increase public awareness through mass media and related activities Produce Health Education Materials Establish a committee to organise and monitor promotional activities World Sight Day Observance  Who to organise funding, yearly theme etc.  Regular production and Educational materials Who to take charge of producing educational materials, funding, distribution how many in a year? What is the cost? Radio/TV Talks  Who to organise? What to produce? Who to fund? How often? Suggested outcome - form a subcommittee for health promotionDocumentary on TV on the 3 diseases Catchy TV advertisements BillboardsNewspaper Public Forums Form a subcommittee and have regular meetings. Required: Feedback to Task Force  CASE DETECTION Areas of ConcernPlan of ActionSpecific ActivitiesIssues to Resolve Inadequate case detection  Increase case detection by intensifying screening programmes/activities Improve referral system Monitor and reporting of effectiveness of screening programmes Opportunistic Screening at MCH Clinic to continue  Training for discussion Policy Change Funding Monitoring sustainability of programme Evaluation Suggested Outcome Form a subcommittee for Primary Eye Care Training Review current screening programme for Diabetic Retinopathy and extend pilot project to other KK Involve Optometrists and Opticians in screening for the 3 diseases. school health, DR Screening Review current screening programmes at the preschool and school health level and suggest improvement/alternative programmes Doktor Muda School Health Club Adopt a school/kindergarten programme Reactivate Ophthal. Soc. Home Vision Screening Activity Annual Vision screening programme by NGOs Village Volunteers where applicable  What else? Training Areas of ConcernPlan of ActionSpecific ActivitiesIssues to Resolve A. Lack of awareness on eye care among primary healthcare providers both in the public and private sectors  Provide training to primary health care providers Provide materials for training Evaluate and monitor effectiveness of primary eye care training programmes Review Curriculum of JM,SN, MA, Medical Students  Implementation issues  Refresher Courses Extend 3 day eye care courses to private, industrial and estate healthcare providers  Reactivate Ophthalmological Soc. of MMA training to GPs on Diabetic Retinopathy.  Review and develop teaching tools and kits  B. Lack of awareness on eye care among medical officers Provide knowledge on Public Health Ophthalmology Enhance the current eye care training module for medical students Review curriculum and allocate more time for PEC in Public Health training module  Review curriculum and train medical students to enable them to carry out their role in PEC upon graduation.   C. Unsatisfactory product of Ophthalmologist Training programme training objectives not met Improve the training programme of Ophthalmologist Improve the facilities for training especially in the open system Emphasise importance of management and PHO in eye care delivery Review curriculum and training needs based on role upon completion of gazettement as a specialist.  Recognise the need for higher surgical training for Ophthalmologist to improve quality of patient care and initiate the formulation and implementation of HST programme.  Include management course in training programmes.  Include PHO in training programmes.  Review role/effectiveness of Specialty Conjoint board as a coordinating body  Alternatively suggest/pass over role of coordinating body to Academy of Medicines Specialty Board  Monitoring of Training Programmes by coordinating body Areas of ConcernPlan of ActionSpecific ActivitiesIssues to Resolve D. Inadequate number of experienced teachers in the Ophthalmologist Training programme Increase the pool of teachers through collaboration with other governmental or private centres Increase the number of subspecialists and subspecialty centres  Regional Training Programmes rather than duplicating programmes Improve access to distant learning using ICT Sign MOU with private institutions or universities including neighbouring countries Increase number of subspecialists in the various subspecialties Establish subspecialty centres in stages to improve care as well as training  E. Inadequate Research in Eye Diseases and Eye Care Delivery System  Facilitate research in Eye Care Monitor research activities Form an Eye Research Interest Group  Conduct Research in Refractive Error, Low Vision, DR, ARMD, Glaucoma and Cataract  Provide Funds for Research  Provide incentives for researchers  SERVICE DELIVERY Areas of ConcernPlan of ActionSpecific ActivitiesIssues to Resolve A. Unsatisfactory Cataract Surgical rate 1. Increase CSR Outreach programmes  Efficient use of available resources in public hospitals  Improve facilities in public hospitals  Improve standard of care CPGs, SOP workshop  Day Care surgery  B. High cost of cataract surgery To make cataract surgery affordable and accessible Promote small incision cataract surgery To promote use of good quality but low cost IOL  IOL subsidy schemes C. Refractive Error a major cause of visual impairment  To make basic Optometry services available to all To improve accessibility by shifting some responsibility to Opticians and Optometrists Facilitate Optometrist to provide the desired level of care Community services by private optometrist  drugs to be used by Optometrists Proposal partnership with Ophthalmologists to facilitate use of cycloplegicsFree spectacles programmes improve access Used spectacles programmesPost optometrists to district hospitals/visiting optometrists Equip public hospitals with basic equipmentsEvaluate and Improve school health programmes D. Increasing incidence, late presentation and inadequate facilities in the management of Diabetic eye DiseaseImprove early detection through screening programmes Upgrade facilities and improve standard of care at secondary centres to ensure there is no discontinuity of laser and Vitreoretinal services Monitor and evaluate laser and Diabetic vitrectomy services Screening programmes as above  Ensure supply, replacement and maintenance of laser and vitrectomy machines etc.  SOP workshop, review CPG  Conduct studies on clinical outcomes  EYE HEALTH INFORMATION SYSTEM Areas of ConcernPlan of ActionSpecific ActivitiesIssues to Resolve Lack of a complete Eye Health Information System essential for planning and research To establish a national Eye Health Information system To integrate such a system with the currently available system in MOH  Sustain NCSR participation by private sectors necessary  Develop and sustain VISION 2020 web site  ICD 10 4. Conduct NES in 20065. Low vision registry 6. Blindness registry  REHABILITATION Areas of ConcernPlan of ActionSpecific ActivitiesIssues to Resolve1. Very small number of blind & low vision children receiving educationA) Improve early detection, intervention, and referral services B) Increase enrolment level to that of national average C) Accelerate expansion of Inclusive Education Schools for All D) Assist Residential Special schools to convert to Resource Centres i) Public awareness of importance of such services ii) Train all categories of workers & persons who come into touch with babies & young children, especially those below 3 years old Provide training for all in-service teachers in special needs education of VIPs ii) Ensure that the above training is also built into the curriculum of all teacher training colleges Ministries of Information, Health, and Education Ministries of Health, Social Welfare, and Education Ministry of Education & NGOs Ministry of Education2. Equally small number of VI youths and adults, who are blind or have LV, being trained & rehabilitated A) Improve identification & referral systems B) Improve, expand and decentralise Training programmes3. Even more limited training & employment/income generation opportunities A) Establish &/or improve Placement services.4. Lack of CBR and referral system Appendix 2 VISION/ MISSION / OBJECTIVES AND STRTEGIES FOR THE NATIONAL PERVENTION OF BLINDNESS PROGRAMME - VISION 2020 MALAYSIA- THE RIGHT TO SIGHT VISION All Malaysians shall enjoy eye health resulting from equal, affordable and timely access to quality ophthalmic services at all levels of care by the year 2020. MISSION VISION 2020 Malaysia is committed to the elimination of avoidable blindness and low vision through: The provision of accessible quality eye care using appropriate technology at an affordable cost The promotion of the preventive aspects of ocular health, with emphasis on public education and the participation of each individual in his/her own care. The training of all categories of eye care providers The provision of appropriate and effective education, training and rehabilitation of the irrevocably blind and refracted low vision with special needs. The quest for better understanding of local disease patterns, to enable healthcare related strategies to be more effectively planned and evaluated GENERAL OBJECTIVE To prevent and control major avoidable blindness and to make essential eye care available to all SPECIFIC OBJECTIVES BY 2020: To reduce the prevalence of blindness from 0.29% to 0.15% To consolidate/strengthen the existing programme for cataract intervention and increase the Cataract Surgical Rate to 5000 per million population per year To initiate and sustain a workable intervention programme for low vision and reduce its prevalence rate from 2.4% to 1% To increase awareness on and strengthen services to manage Diabetic Retinopathy To train adequate numbers of appropriate health personnel to provide eye care To develop an eye health information system To promote community participation in the prevention of blindness To ensure intersectoral collaboration in eye care STRATEGIES To determine the extent of visual impairment among the Malaysian population and identify the major causes of blindness and low vision To initiate and propagate effective intervention aimed at primary, secondary and tertiary prevention of visual impairment To create intersectoral collaboration to foster a joint effort towards the accomplishment of VISION 2020 Malaysia To maintain an ongoing human resource development programme in response to the local needs To initiate a Center for Eye Care Research, focusing on essential research areas for eye health and eye care service delivery. To maintain a regular evaluation programme on the delivery of eye care services and training programme, including an effective feedback mechanism to the program manager and the public Reading Material for the Prevention of Blindness Workshop The prevalence of blindness and low vision in Malaysian population: results from the National Eye Survey 1966. M Zainal, SM Ismail, AR Ropialh, H Elais, D Alias, J Fathilah, T O Lim, L M Ding, PP Goh. Br J Ophthamol 2002;86, 951-956 Articles form Journal of Community Eye Health ( available at : www. jceh.co.uk) A Global Initiative for the Elimination of Avoidable Blindness. Vol. 11 issue 25,1998 Cataract Surgical Coverage: An Indicator to Measure the Impact of Cataract Intervention Programmes. Vol. 11 Issue 25, 1998 The Role of Patient Counsellors in Increasing the Uptake of Cataract Surgeries and IOLs Vol. 11 Issue 25, 1998 Community Participation -Putting the Community into Community Eye Health. Vol. 12 issue 31,1999 Health Promotion and Community Participation in Eye Care Services. Vol. 12 Issue 31, 1999 People Who Do Not Sue Eye Service: Making the Invisible Visible. Vol. 12 issue 31,1999 National Prevention of Blindness Program and VISION 2020. Vol. 13, Issue 36 2000 National Prevention of Blindness Programmes, Vol. 13 Issue 36, 2000 Cambodias National Eye Care Programme and VISION 2020: The Right to Sight. Vol. 13 Issue 36, 2000 Importance of Affordable Eye Care. Vol. 14 Issue 37 ,2001 Cost Containment in Eye Care. Vol. 14 Issue 37 ,2001 Financial Sustainability. Vol. 14 Issue 37 ,2001 New Issues In Childhood Blindness. Vol. 14 Issue 40 ,2001 Guidelines for Setting Up a Low Vision Programme for Children. Vol. 14 Issue 40 ,2001 Training Ophthalmologists for Childrens Eye Care Centres. Vol. 14 Issue 40 ,2001 Evaluation of Training. Vol. 14 Issue 40 ,2001 How Can We Improve Patient Care? Vol. 15 Issue 41, 2002 The Patients View: How Can We Improve Patient Care? Vol. 15 Issue 41, 2002 Patients Perspective: An Important Factor in Assessing Patient Satisfaction. Vol. 15 Issue 41, 2002 Teaching Resources: Be Prepared! Vol. 15 issue 41, 2002 Technology for VISION 2020. Vol. 15 Issue 42, 2002. The role of optometry in vision 2020 vol 15 issue 43, 2002 Case Finding for Refractive Errors: Assessment of Refractive Error and Visual Impairment in Children. vol 15 issue 43, 2002 3. Action urgently needed to avert crisis in Canadian ophthalmic health care, warns study-An article from Eurotimes A European outlook of the world of Ophthalmology vol 8,issue 2. February 2003 4. Report of a WHO/IAPB Scientific Meeting on Preventing blindness in children , publication from World Health Organization and International Agency for the Prevention of Blindness ( hard copy ) 5. Asia Pacific Regional Low Vision Workshop, Hong Kong, 28-30 May 2001, publication from World Health Organization and International Agency for the Prevention of Blindness (hard copy) 6. 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