Indonesia

Lead Agency
CBM

Name of Project
Indonesia Eye Care Programme

Name of Partner/ Implementing Organisation
CBM through the respective Departments of Health

Location
West and East Java

Support for Christian Blind Mission (CBM/CBMI) in Indonesia covers two areas; the work through the BKMMs (community eye centres) in East and West Java. The information is appropriately marked.

BRIEF DESCRIPTION

CBM’s partners are lead agencies in V2020 implementation in West and East Java and are active members of the provincial forum for prevention of blindness and V2020. Approximately 21,000 cataract surgeries, and more than 12,000 other sight preserving treatments and operations will take place between 2004-2007 at the two units and on outreach into the community.

Local Community Eye Health Centres’ (BKMMs) main activities are cataract surgery and refraction services. These are either undertaken directly by the eye care team of the BKMM or in cooperation with other hospitals and eye doctors (with the BKMM supplying the medicines, consumables and subsidies originating from CBM.

Monitoring and coordination will be via CBM’s coordinating office in Jakarta (Mr. Mike Edwards – Manager and Ophthalmic Nurse).

BACKGROUND TO EAST JAVA

The partnership between BKMM East Java and CBM began in 2004, when an agreement was signed between the Provincial Health Office and CBM Germany. The PBL activity is not new; however, the CBM funding has mobilised authorities at district level to be involved in the project, to help people who need cataract surgery. The CBM funding is only partial as it does not cover all costs for providing operations at the Puskesmases (primary health care centres). Other funding comes from the government’s health budget, local government budget or the patients themselves.

East Java has a population of 35 million, with a growth rate of 1.08%, and a productive age group of 68%. 39.7% of the population lives below the poverty line.

Based on 1996 data, the prevalence of bilateral blindness is 1.97%, which translates into an estimated 690,000 blind people, with 54% (372,600) due to cataract. Out of these 690,000, the 40% (276,000) who are living below the poverty line are the main beneficiaries of the project. The BKMM undertakes its eye care programme in co-operation with the province’s network of 928 Puskesmases, of which 249 have operating facilities covering 8,425 villages. There are around 100 ophthalmologists and 1,150 nurses in the province.

CBM supports the work of three projects: the Rural Eye Care Programme at the Airlangga University based in Surabaya (covering the northeast sector), the Eye Care Programme based in Jombang / Mojowarno (covering the south and southwest sectors), and the BKMM based in Surabaya, covering the north, northwest and southeast sectors of the province. BKMM East Java support (under CBM) began in 2004, chiefly for cataract surgical activities.

Almost 2,000 cataract operations per year were performed by ophthalmologists of BKMM East Java in outreach from the Puskesmases and at the BKMM.

BKMM East Java has its own facilities. It was previously funded by the national government, but since decentralisation in 2000, it now falls under the control and funding support of the provincial health services office in the government of the province of East Java.

Project activities at the BKMM East Java are:

• To perform cataract surgeries.
• To train ophthalmic nurses, as part of the strategy to set up centrally located community health centres to serve as referral and surgical centres.
• To train other medical staff and cadres (in Indonesia this term is used to describe community health workers or community based rehabilitation (CBR) fieldworkers) in community ophthalmology.

PROGRESS IN EAST JAVA

CBM advises that surgery is carried out only in Puskesmases identified as surgical centres. In 2004 a selection and observation to identify potential Puskesmases to become surgical centres was carried out. Of four potentials, CBM’s partner has identified two, situated at Panarukan Situbondo and Karangan Trenggalek.

SITUATION IN EAST JAVA

During the 2004 presidential election, there were no political and associated social problems. Project activity went smoothly, although some district’s efforts were slightly delayed because they were busy with the election.

Several districts faced problems from local ophthalmologists who objected to the free / subsidised services being made available to low income people. For instance, local ophthalmologists in Banyuwangi sent complaint letters to the Health Office’s in Perdami and Bupati. The problem was resolved by the District Health Office.

BACKGROUND TO WEST JAVA

West Java is Indonesia’s most populous province with 36 million inhabitants, with 16% or nearly 6 million people living below the poverty line. Population density is high at over 1,000 inhabitants per square kilometer. The province has an average life expectancy of just 68 years.

There have been two national eye surveys in Indonesia, in 1982 and in 1996. The latter showed a prevalence of blindness in Indonesia of 1.5%, which translates into 3million blind people, of which more than 50% is due to cataract.

The West Java BKMM covers 16 districts, 9 cities, 424 sub districts, and 5817 villages. The BKMM operates with three ophthalmologists, however, there are also 45 ophthalmologists at various district hospitals, and 38 at Cicendo Eye Hospital, which is in the same catchment area.

PROGRESS IN WEST JAVA

One of the main activities of the Eye Care Programme in West Java is cataract surgery, which aims to assist all cataract patients who are classified in a low-income group. Most of the work is done in health centres, as they are easier to reach by those who live far from hospitals. In order to run this activity, CBM provides the BKMM with a financial fund, which is used to purchase medicine, consumable supplies, intra ocular lens (IOL’s), spectacles, and provide outreach mission subsidies.

By December 31 2004, 86.7% of patients screened by the BKMM were for cataract extraction using IOL, and 13.3% were cataract cases without IOL. In 2005, BKMM plans that 100% of cataract surgeries use IOL.

SITUATION IN WEST JAVA

As the district administration in West Java has been decentralised, the head of the district has to have made a specific policy decision to pursue blindness prevention in order for prevention to be supported in that district. As the political will in districts can be different, there are districts that have responded well to the programme, but others that have not reacted. In addition, eye care is not a compulsory health programme item, but only an optional item for development in Public Health Centres. Therefore, advocacy with district heads, district health officials and the heads of health centres is constantly necessary in order to secure funding and support.

TIMESCALE

Continuous surgical and medical activities throughout 2004-2007in West Java, and from Oct 04 onwards in East Java

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

US$610,000 (see table below for breakdown)

ESTIMATED NUMBER OF TOTAL BENEFICIARIES

Total output of West and East Java eye units:

• 21,000 cataract patients;
• 12,000 other eye medical/ surgical patients.
• Children will be approximately 5-10 percent of total served.

Information compiled on 20/6/05 by Peter Renew and Katy Dore at SSI, for publication on FundraiseOnline.

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