Bangladesh

Lead Agency
Sight Savers International

Name of Projects
Comilla Comprehensive Eye Care
Narsinghdi Comprehensive Eye Care

Name of Partner/ Implementing Organisation
Comilla – Bangladesh Jatiya Andha Kalyan Somiti (BJAKS)
Narsinghdi – Dhaka Progressive Lions Eye Hospital (DPLEH)

Location
Comilla – Comilla, Feni, Brahmanbaria Districts
Narsinghdi – Narsinghdi, Kishoreganj Districts

Annual Report
View 2004 Annual Report

The Standard Chartered Bank Seeing is Believing support in Bangladesh takes place in Narsinghdi and Comilla.

BRIEF DESCRIPTION

Cataract blindness was identified as the major cause of bilateral blindness and low vision
amongst adults in Bangladesh as a result of the national survey into eye health undertaken in 1999-2000.

SSI works with a variety of government and NGO partners in Bangladesh, supporting district eye care programmes whereby patient screening programmes are undertaken within communities to identify those people in need of eye treatment or cataract surgery. Transport is provided where necessary, to take those patients requiring cataract surgery to the partner’s eye hospital. Increasingly, SSI partners are also working in partnership with the Ministry of Health to train government health workers at the community level to identify, treat and/or refer the most common eye conditions. Over the last few years the Bangladesh programme has moved to a position of 100 percent IOL surgeries, unless contra-indicated. The Bangladesh programme is currently looking at overcoming barriers to patient uptake and in particular, trying to promote and improve access to eye care services for women.

Bangladesh Map

Comilla

The catchment population is 9.5 million with an estimated 40,850 cataract blind. SSI
have been supporting the project with BJAKS in Comilla District since the early 1980s. The
partner recently moved into a dedicated 50-bed eye hospital, the construction of which was supported by the Government of Bangladesh. The partner runs a successful eye care
programme reaching poor and underserved communities, with priority on screening and high volume cataract surgeries using small incision surgery, with IOL.

BACKGROUND TO COMILLA

The catchment area for the base hospital in Comilla District has a population of approximately 5.1 million. 44% are considered to be ultra poor, with an average monthly income of less than Taka 1,500 (£12.50). The main sources of income in the area come from agricultural labour, agriculture, and small businesses.

The Sight Savers International (SSI) partner agency is Bangladesh Jatiya Andha Kalyan Samity (BJAKS), which is a registered non-government organisation (NGO) with the Social Welfare & NGO Affairs Bureau. BJAKS was established to assist local eye patients through organised mobile eye camps and increased public awareness, with support from local physicians and social workers. SSI has been supporting the programme since the early 1990s.

BJAKS moved from its rented premises into a new hospital building at the end of the 2003, enabling them to function as a fully fledged eye hospital. BJAKS is a renowned organisation, which successfully targets and reaches under-served areas. They have completed the first and second phases of the Modular Eye Care (MEC) project, supported by SSI. MEC is a comprehensive eye care project comprising of preventive, curative and promotive services at primary and secondary levels, as well as rehabilitative services for irreversibly blind people. In addition, with SSI support, BJAKS successfully implemented and runs an under-5 clinic.

The third phase began in July 2004 under a new funding mechanism between SSI and BJAKS. BJAKS provides cataract surgeries free of charge to the ultra poor population, with SSI reimbursing the costs. For all other patients BJAKS charges standard fees which are used to cover the running costs of the hospital.

BJAKS Comilla hospital is being implemented with a 50-bed hospital, equipping it to perform a high volume of cataract surgeries. At present, 99% of cataract surgeries taking placer are with Intra Ocular Lens (IOL) using the manual small incision cataract surgery (MSICS) technique.

PROGRESS AT COMILLA

Outreach screening programmes are operational in rural areas in the catchment district, where patients are screened and provided with appropriate treatment when possible. Those identified as surgery patients are referred and transported to the base hospital using the hospital vehicle, and transported home afterwards. A range of secondary eye care services is provided at the base hospital, including refraction, minor surgery and cataract surgery.

The Community Based Rehabilitation (CBR) Programme has been expanded into four additional Upazilas (areas). It provides irreversibly blind people with basic training in orientation and mobility and daily living skills, to improve their capacity for independent living. Steps have been taken to identify irreversibly blind children, and refer and enroll them into schoosl offering Integrated Education (IE).

As part of the project's human resource development plan, the following training needs were assessed and training completed:

Three week basic eye care training at Islamia Eye Hospital for one Medical Officer
Four week MSICS training at Islamia Eye Hospital for one surgeon
Three month Paramedics training on Paediatric Ophthalmology at Lions Aravind Institute of Community Ophthalmology (LAICO)
Accounting for two financial & non-financial personnel
Training on time management (two people)
Workshop on revised MIS software for all relevant staff
Basic Foundation Training for all CBR field Staff at Centre for Disability & Development (CDD)
Refresher training on low vision at Chittagong Eye Infirmary Training Centre (CEITC)
Two day workshop on technical protocols for two medical staff
Participatory Rural Appraisal (PRA) Training (six field staff)
Exposure visit to VMA eye hospital in India for programme, medical and finance staff
Local partner exchange / exposure visit for selected staff to Kurigram Eye Hospital

The stated project objectives are:

To reduce reversible blindness through implementing IOL surgery.
Improve livelihoods of Visually Impaired (VI) people through CBR.
To increase take-up of CES by people who are visually impaired.

SITUATION AT COMILLA

There have been significant changes in the project environment (e.g. area covered, beneficiary population, other providers etc.): Six upazilas of Tangail district were included as programme areas from January 2003.

Narsinghdi

The catchment population is over 8.16 million of whom over 35,000 people are
estimated to be cataract blind. SSI has been working with the Dhaka Progressive Lions Eye Hospital (DPLEH) since 2001, funding surgical costs and staff training. The eye care
programme conducts screening, treatment and cataract surgery. The partner has built an 80-bed hospital, of which 30 beds are ‘free beds’ for cataract patients who cannot afford to pay for surgery. DPLEH has a reputation for high quality services and pioneered the use of small incision surgical techniques in Bangladesh. SSI’s support enables them to reach the poorest communities in the district, providing free surgeries where appropriate.

BACKGROUND TO NARSINGHDI

The project is located in Narsinghdi, which is in the North East of Dhaka District. It has a population of 1.9 million.

The partner agency is the highly successful Dhaka Progressive Lions Eye Hospital (DPLEH), Narsinghdi, which was established in 1989 to prevent and cure blindness through treatment and surgery. DPLEH completed its first phase of partnership with SSI in 2004 and started a second phase as the Comprehensive Eye Care (CEC) Project, with an emphasis on full coverage of the district, and providing services for all the major eye diseases/problems recommended by global VISION2020 initiatives.

The project was already well equipped at the start of the SSI partnership. SSI has funded the cost of surgeries to help build up output volume, and has also met 100% of the cost of staff training.

In the new phase of the Comprehensive Eye Care (CEC) programme, SSI's financial support ensures the accessibility of services to all those who cannot afford to pay (financial cost being the most significant barrier to uptake of services).

SSI supports the hospital in providing a full range of eye care, including low vision services, which are to be incorporated in the second year of phase one of the project. This links in with CBR services to promote inclusion of children who are identified as irreversibly blind and/or visually impaired, which are provided by another SSI partner, Assistance for Blind Children (ABC).

During 2004, the project started a sub-centre in the Narayanganj District, which is adjacent to Narsinghdi. The expansion was the result of a situational analysis carried out to identify the need for eye care services in the district. The total population of Narayanganj is 2.17million, of which 1.15million are male and 1.01million female. The literacy rate is about 57%, with about 68% of the population considered to be very poor. The district is composed of 5 upazilas (sub-districts), all within 10km of each other, with good transport links.

The district government has established a number of facilities in order to provide basic health care services for the community, but there is very little investment in eye care. Some private doctors provide eye care services including cataract surgery, but at a very high cost, which is not affordable for the majority of people living in the district.

PROGRESS AT NARSINGHDI

The project has the following objectives:

To reduce reversible blindness by implementing IOL Surgery.
To increase take-up of Comprehensive Eye Care Services (CES) by people with visual impairment.

The majority of cataract surgeries (99%) were carried out using the small incision technique (MSICS) with IOL implantation. Out of all the IOL surgeries carried out, 11% were walk-in patients, 73% were referred by outreach, 15% were identified by CBR, and 1% identified by primary eye care workers.

In the first half of the reporting period, the project was already performing 35% of total cataract surgeries either free or at subsidised rate. During the second half of the year (Jul–Dec 2004), the project started a new phase ensuring availability of services for those who cannot afford to pay. This resulted in a slight increase in the percentage of free surgeries being performed, taking the percentage of free surgeries for the year to 40%.
Situation at Narsinghdi

The training of primary eye care workers at community level will increase demand for and referral to eye care hospitals, and ensure that services are in line with primary health care services.

The project established a full range of services, including treatment, quality IOL cataract surgery, refraction, and surgery patients referred from CBR projects, which will help to increase demand. Local NGOs are working with communities to organise the outreach screening programme.
The project offers reasonably priced services to communities, which are accessible, and offered in areas which have traditionally been underserved.
If we look at the last three years’ achievements against the target of the project, the IOL surgery rates have increased year by year. Increasing volume has the effect of reducing unit costs for surgery, therefore making it affordable for more people, and moving the work further toward sustainability.
The project will need to expand to attract influential clients who pay for services. Strong, effective support and advice from philanthropists as well as the partner's commitment towards expanding services and infrastructure will move the project towards self-sufficiency.

TIMESCALE

June 2004 to December 2006

APPROXIMATE COST (Year 1, 2, 3 & Total)*

US$ calculated at 2004 H1 forecast rate 1.746

USD	2004**	2005	2006	Total
Comilla	16,000	36,000	37,000	89,000
Narsinghdi	13,000	48,000	50,000	111,000
TOTAL	29,000	84,000	87,000	200,000
** budget for entire year * Note all stated costs are provisional figures

ESTIMATED NUMBER OF TOTAL BENEFICIARIES

Cataract Only

	July-Dec 2004	2005	2006	Total
Comilla	2,238	5,000	5,000	12,238
Narsinghdi	2,020	4,500	4,500	11,020
TOTAL	4,258	9,500	9,500	23,258

Total Beneficiaries

	July-Dec 2004	2005	2006	Total
Comilla	26,800	60,000	60,000	146,800
Narsinghdi	24,250	54,000	54,000	132,250
TOTAL	51,050	114,000	114,000	270,050