A dispersed population and widening wealth gap pose great difficulties in providing affordable and equitable eye health care for the citizens of Lao People’s Democratic Republic (PDR). The Fred Hollows Foundation has been working in Lao since 2008 to eliminate avoidable blindness.
Lao PDR has a population of only 6.8 million. The small landlocked country faces significant health challenges through poverty, low public spending on health care and a largely rural population with poor access to medical services, many of which are rudimentary and inadequately served with trained eye care personnel.
In the past decade or so, Lao PDR has enjoyed strong economic growth and is now classified as a lower-middle income country by the World Bank. However, the World Health Organization reports that inequality is increasing – more than a quarter of the population lives below the poverty line – as are disparities in access to food, health care and education. The mountainous landscape means many places are difficult to access; approximately one in five people live in areas with no paved roads.
The prevalence of blindness is estimated to be as high as five per cent in some rural or remote areas of the country, where eight in 10 people live. Women account for up to twice as many cases of blindness as men. Cataract is the most common cause, with approximately 10,000 people in need of a relatively straightforward cataract operation to restore their sight.
Thirty years ago, Lao PDR had just one ophthalmologist and three cataract surgeons, and all were based in the capital, Vientiane. Today, there are 16 ophthalmologists – about one per 400,000 people – though many services remain confined to Vientiane, and half the country’s 16 provinces still have no ophthalmologist, and in some cases not even a basic eye doctor. Compare the situation with Australia where it’s estimated there is one ophthalmologist for every 30,000 people.
Since 2008, The Fred Hollows Foundation has been pursuing the goals of delivering eye-care services in remote areas and educating the community about eye health and avoidable blindness, in partnership with the Ministry of Health and provincial health departments.
- Performed 3,344 sight-saving or improving interventions, including 1,167 cataract surgeries
- Screened 62,692 people
- Conducted four outreach eye camps in the country’s remote, mountainous north where hundreds of surgeries and thousands of screenings took place
- Trained 54 clinic support staff and 173 community health workers
- Evaluation of The Foundation’s six-year project in northern Lao PDR found significant increases in cataract surgery rates and strengthening eye service facilities in target areas
- Conducted scoping studies in six new provinces where work will begin in 2014
- Distributed 1,167 pairs of spectacles.
We achieved these results working together with our partners.
About the program
The Foundation has been working in four northern provinces – Oudomxay, Luang Namtha, Bokeo and Phongsaly. Since we began work in Lao PDR in 2008, we have carried out over 10,000 sight-saving operations and treatments, helped to train hundreds of surgeons, medical and support staff and provided important eye care equipment.
A key achievement of Phase 1 of our Sustainable Comprehensive Eye Care project has been construction of a specialist eye unit at Oudomxay Provincial Hospital; it serves as a surgical centre but also a training base for regional eye health workers. Phase 2 of the project will see The Foundation’s work expand into a further six provinces.
The majority of people in remote and rural regions are unaware of eye care and eye disease and fearful of surgery. The Foundation considers that a strong focus on eye health education is an important part of our work. We are training village health volunteers to make their communities aware of eye disease and how to prevent and treat avoidable blindness.
A further barrier to eye health provision in rural areas is cost: most people cannot afford to pay for surgical treatment nor the cost of transport to a health facility which could be several days’ walk from where they live. We are training clinical eye care personnel at the provincial, district and local clinic levels to deliver services in remote areas.
The Foundation’s priorities in Lao PDR include:
- Partnering with 10 provincial governments to establish comprehensive eye care services, including screening, cataract surgeries and dispensing of spectacles
- Supporting the National Ophthalmology Centre to address staffing shortfalls in eye health, especially eye surgeons, eye health nurses and community health workers
- Strengthening our partnership with the Ministry of Education to pilot a School Eye Health Education Project
- Advocating to the Lao PDR government for increased investment in eye health and commitment to the National Prevention of Blindness action plan.
The Foundation will continue to work in Lao PDR to reduce avoidable blindness through improving access to sustainable eye care services and raising the public and political profile of avoidable blindness issues.
Facts and figures
|Number of blind people||56,221|
|National blindness prevalence||1%|
|Main causes of blindness||cataract (60% of blind population), corneal scarring (13%), glaucoma (10%) and childhood blindness (7%)|
|Number of people with cataract blindness (backlog and annual incidence)||backlog is estimated to be 28,500 cases and the annual incidence is estimated to be 5,600 cases annually|
|Number of cataract operations performed annually||4,831|
|Reasons for low cataract surgical rates and backlog||low awareness about eye health care and services, poor distribution of services, a lack of trained staff in remote areas, accessibility and affordability of surgery, a general fear within the community of health treatment and low levels of government investment in eye care.|
|Infant mortality rate (per 1,000 births)||42|
|Children (0-5 years) underweight for age||31%|
|Population living on $1.25 per day||34%|
|Adult literacy rate||73%|
|Number of doctors (per 10,000 people)||3|
Sources: Eye health statistics from 1994, more recent figures not available, CBMI, Lao PDR Ministry of Health, UNDP Human Development Report 2013
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