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NEPAL REACH PROGRAM

(REFRACTIVE ERROR AMONG CHILDREN)

Executive Summary   

Globally refractive errors are the single largest cause of visual impairment for both adults and children and the most common reason for patients to consult an ophthalmologist.  The problem becomes more complex with children as they do not complain of defective vision and may not even be aware of their problem. In the global initiative “VISION 2020 The Right to Sight,” childhood visual impairment and refractive error are highlighted as a priority area.

Without appropriate optical correction, millions of children are losing educational opportunities and adults are excluded from productive working lives, with severe economic and social consequences. Individuals and families are frequently pushed into a cycle of deepening poverty because of their inability to see well. Almost 13 million children (age 5 to 15) and 45 million working-age adults (age 16 to 49) are affected globally.  Fully 90% of all people with uncorrected refractive errors live in low and middle-income countries.

In the Nepali context, lack of authentic prevalence data specifically for children means that the extent of Childhood Visual Impairment is not known.   Consequently, it is not prioritized in eye care services and it also requires additional resources and expertise which are not readily available.  IAPB data (2010) for Nepal estimate that 4.9% of the population (30 million) have visual impairment and 0.8% are blind. Studies also show that the rate of myopia particularly in urban areas is increasing.

 To address the problem of uncorrected refractive error in children, Orbis India will be working closely with Nepal Netra Jyoti Sangh (NNJS), the central coordinating body for eye care in Nepal, and two associate hospitals (Mechi Eye Hospital, Birtamod and Biratnagar Eye Hospital, Biratnagar) to roll out the REACH programme in Nepal.  Refractive Error Amongst Children (REACH) was developed in India and has been in place for the past 15 months.  Through the implementation of the REACH model, partners will be able to screen and treat children and gather much-needed data on the levels of refractive error on school going children which can then be channelled into advocacy initiatives.  

 Project Goal:

To reduce visual impairment due to uncorrected refractive error by undertaking 500,000 pediatric screenings among school-going children between 6-18 years in two districts in the Eastern Region of Nepal.

Objectives:

  1. To increase access to child eye health by providing comprehensive refractive error services to school-going children.
  2. To improve the quality of child eye health through high-quality refractive error services for school-going children.
  3. To develop an enabling environment to ensure the delivery and sustainability of quality refractive error services for school-going children.

In addition, a standardized IT-enabled data management system, REACHSoft, will be deployed across all project sites (base hospital and all outreach events) to manage data and facilitate smooth project operations.  This unique software was designed as part of the Qatar Creating Vision programme in India (see section on Orbis capacity).  

The project will work collaboratively with Government Health and Education departments to seek permission to do the screenings.  They will also receive regular reports on project progress and be invited to observe project activities.  It will increase their involvement and ownership in eye care programs.  The data generated will form a good evidence base for research which can be used in advocacy initiatives to lobby for improved school eye care services in Nepal. 

Expected Results:

  1. Awareness on Refractive Error improved to support referral of children.
  2. Program visibility improved through targeted communication initiatives.
  3. Refractive error services are ensured with active engagement of stakeholders.

Outputs

Overall Targets - Nepal

Output Indicators

2018

2019

2020

2021

Total

Target

Target

Target

Target

Target

Others Training

862

2,035

2,050

535

5,482

Paramedics and Project Management Staff

42

15

30

15

102

School Teachers and FCHVs

820

2,020

2,020

520

5,380

Screenings/examinations performed on children

70,000

180,000

180,000

70000

500,000

Medical/optical treatments prescribed to children

1,700

4,400

4,400

1,700

12,200

Surgeries performed on children

22

43

41

21

127

People educated on protecting their sight

1,722

4,443

4,441

1,721

12,327

 

Project Sites  

 As indicated in the map, the Orbis-NNJS REACH Project will be implemented in the Eastern region of Nepal.

  1. Biratnagar Eye Hospital, a tertiary level eye care facility, is located in Biratnagar in the Eastern Region of Nepal.
  2. Mechi Eye Hospital is located in Birtamod, a township in the Eastern Region of Nepal.

 These districts were selected keeping the following points in mind:

  • This is a pilot implementation of REACH in Nepal, and hence only one region has been selected.
  • Since this is a pilot, one larger facility (Biratnagar: 56,000 surgeries annually) and one smaller facility (Mechi: 25,000 surgeries annually) have been chosen.
  • As with REACH in India, partners, where there are established pediatric eye care services, have been chosen to ensure that quality services are available to those children  referred from REACH field activities.

 Project Strategy/Approach   

 Orbis Nepal partners will deploy these projects in three phases: Prepare, Deliver and Consolidate. These three phases are chronologically implemented at any one school such that over time within the overall project there will be some schools in the ‘Prepare’ phase, while others will be in the ‘Deliver’ phase and yet others will be in the ‘Consolidate’ phase. The ‘Prepare’ phase includes the formation and training of an eye care team at the hospital, putting the required equipment in place, networking with stakeholders, preparation of a master database of identified schools and enrolled students and developing the plan for conducting activities in schools. The ‘Deliver’ phase is when screening and refraction services for students in schools will be conducted following a standardized protocol. Glasses will be prescribed/ dispensed to all children diagnosed with refractive errors and those from weaker socio-economic sections will be given spectacles free of cost or at a subsidized price. Children identified with other eye conditions will be referred to the base hospital for further diagnosis and treatment to provide comprehensive services to all children who need them.  The ‘Consolidate’ phase comprises compliance checks and follow-up visits. Female Community Health Volunteers (FCHV), School teachers and senior students (Vision Guardians/Ambassadors) will be trained in each of the schools to support in regular screening, follow-up and ensuring compliance to spectacle wear.

 A standardized IT-enabled data management system, REACHSoft, will be used across all project sites (base hospital and all school-based outreach events) to manage data and to facilitate smooth implementation of the project activities. The partners will liaise with government agencies, including the health and education departments, and by sharing project data will create a case for further Government intervention.

 

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