Pakistan

Across Pakistan nearly one in ten people are visually impaired, with more than two million people blind in both eyes. The Foundation has a strong partnership with the Government of Pakistan and is working in all four provinces of the country.

Overview

In Pakistan, hundreds of people go blind every day, often from preventable causes like cataract. People in Western countries have ready access to cataract surgery, but in Pakistan most people don’t.

A refractive error patient at a hospital in Punjab Province. Photo: Hugh RutherfordMost eye care services are only available in Pakistan's major cities. Around two thirds of the country’s population, and most people who are affected, live in remote areas without access to health services.

Most people are unable to travel to get help – many simply can't afford the expense. Traditional women are particularly disadvantaged as they are not expected to travel alone.

"Reaching the population of Pakistan is not easy," says Dr Gillani, The Foundation’s Country Manager. "It is also very hard to change attitudes. The Foundation has come out with a multi-pronged approach. We have trained the doctors, held eye clinics, introduced quality into the recipients and providers perspective. That has been challenging."

"I can confidently claim that The Fred Hollows Foundation has revolutionised eye care in Pakistan" – Dr Rubina Gillani, Country Manager, Pakistan

Since The Foundation started work in Pakistan in 1998, the rate of blindness is down from 1.8% of the population to 0.9%.

Our aim is to build up Pakistan’s existing health systems so that we can bring sustainable eye care services to every corner of the country.

Achievements 2013

Despite a difficult security situation, by working with government and local partners, The Foundation continued to deliver sight-saving work in Pakistan in 2013.

  • Performed 22,248 cataract operations, 834 laser procedures for diabetic retinopathy and 13,851 other sight-saving or improving interventions
  • Trained nine surgeons and 40 clinic support staff to treat childhood blindness and diabetic retinopathy
  • Trained a further 1,809 community health workers and teachers to detect eye disease
  • Screened 237,307 people including 195,605 children across Pakistan, and provided 2,345 children with glasses
  • Supplied $1,022,199 in medical equipment, including fit-outs of seven new eye units to treat childhood blindness and diabetic retinopathy
  • Conducted a trachoma mapping study in nine districts.

About the program

The Foundation has been working in Pakistan since 1998. Since then, we have worked to build local capacity through strong and wide ranging partnership to help the local eye health system become capable of looking after the country’s own eye care needs. We have also worked to develop and support national and provincial coordination systems for effective eye care planning and implementation.

A happy Zehni Chang relaxes at home after sight restoring surgery, Sindh Province. Photo: www.lannonharley.comSince 1998 The Foundation has helped develop 50 comprehensive eye units by training health workers, providing equipment/medical instruments, refurbishing hospitals, supporting systems and running community awareness campaigns.

The Australian Agency for International Development (AusAID) has been the main funder of The Foundation’s work in Pakistan.

AusAID funded The Foundation’s first national program to address cataract, “microsurgical training program for cataract’’, from 1998-2001 across the country. In this process more than 120 eye units were developed for the delivery of cataract services.

From 2002 to 2013 AusAID provided two rounds of funding for “Pakistan Australia District Eye Care Project’’ (PADEC). This was to strengthen the district based eye care systems through the provision of human resource development, equipment, systems development and advocacy campaigns.

The Australian Government is also supporting our work with the Government of Pakistan on a five-year project called the “Pakistan-Australia Sub-specialty Eye Care’’ (PASEC) Project, launched in 2009.

This project has resulted in the establishment of childhood and diabetes related blindness sub-specialty services in existing tertiary eye units at both district and provincial levels across the country, and developed referral mechanisms and community awareness to increase demand for these services. The project has supported the provision of new equipment, training for ophthalmic teams in relevant sub-specialties, infrastructure upgrades and the development of new quality control systems.

The Pakistan program also involves building the capacity of Comprehensive Eye Care (CEC) Cells, through training and support in each province. The CEC Cells are able to support and guide the district community eye care programs. The setting up of these CEC Cells has enabled effective planning, implementation and monitoring of outcomes over time by the partners themselves. A major role for these Cells is supporting district headquarter hospitals by treating common eye diseases and promoting awareness and confidence in district level ophthalmic services.

Through this kind of support The Foundation has helped progress the National Programme for Prevention of Blindness in Pakistan. The National Programme provided the major pieces of equipment to the eye units at the tertiary, secondary and primary level across Pakistan, the provincial governments provides the required human resources, space and running costs and The Foundation has been filling the gaps in terms of infrastructure, equipment and human resource development.

In Pakistan, due to low literacy, many fears and myths surround eye health treatment. In addition to this, women often won’t leave home to seek medical help for religious or cultural reasons. To address this, The Foundation has piloted the concept of female counselors to encourage female patients to seek eye care services for themselves and their children.

The Foundation is currently working across all five provinces in Pakistan.

Dr Rubina Gillani, Country Manager

Dr Rubina Gillani, Pakistan Country Manager speaking at a supporter function in 2009. Photo: Hugh RutherfordDr Rubina Gillani is crucial to The Foundation's program in Pakistan. Without her determination, strength, knowledge and ability to get the job done, the program’s success so far would not have been possible.

Dr Gillani is both a medical doctor and public health specialist. She has been working as The Foundation’s Pakistan Country Manager since 1998.

"To be a Country Manager honestly means that you need to be a negotiator, you need to be a mentor, you need to be an architect, you need to be a fighter and a debater," she says.

"Our biggest challenge is to remain a development organisation which does not just provide charity. As a development organisation we must continue our work towards sustainability within communities. This takes time but…that is the only way it will work.“ Dr Gillani

Dr Gillani sees sustainability as the most important aspect of The Foundation's work in the country she loves.

Facts and figures

Eye health
Number of blind people over 1.7 million (0.9%), with an annual incidence of 1% (120,000 new cases annually with an increasing backlog)
Main causes of blindness cataract (53%), corneal scarring (14%), uncorrected refractive error (12%) and glaucoma (7%)
Number of people with cataract blindness over 0.9 million people
Number of blind children 125,388 (at the rate of 15 children per 10,000 in the poorest communities) with 4 million children suffering from refractive errors 
Number of ophthalmologists 2,200 (both public and private) of which more than 70% are based in urban areas (while 70% of the population live in district and rural areas)
General health
Population 180 million
Life expectancy 65.7 years
Infant mortality rate (per 1,000 births) 70
Population living on less than $1.25 per day 21%
Children (0-5 years) underweight for age 31%
Literacy rate 55%
Urban population 36%   
Number of doctors (per 10,000 people) 8

Sources: UNDP Human Development Report 2013

What we can do

Help keep Fred’s dream alive.

4 out of 5 people who are blind in the developing world don't need to be. Routine treatment costing as little as $25 can restore sight and hope.