NATIONAL EYE PLAN
PAPUA NEW GUINEA
2011 - 2015
Prepared by the National Prevention of Blindness Committee
From a draft by Dr Jambi Garap and Dr John Farmer
Based on initial draft prepared by Dr Kerek, Dr Garap, Gerd Schlenther
following a workshop with the ophthalmologists of PNG in 2008
This National Eye Plan was approved by participants at a national workshop
of all stakeholders held in Port Moresby February 2011
April 2011
National Eye Plan 2011 -2015
1
BACKGROUND INFORMATION (COUNTRY PROFILE)
Papua New Guinea, the largest nation in the Pacific, is classified as a low middleincome country with 2,084 US$ GDP per capita (PPP) (2009 Human Development
Report). The mainland and its 600 associated islands, is the largest in the South
Pacific, both in land area and population. It has a total land area of 462,840 square
kilometers. The country’s geographical features are dominated by extensive
mountain ranges, rainforests, coral atolls and river systems. About 50 per cent of the
total land area is mountainous, and as a result many areas of the country are still
inaccessible by road. The country has a population of approximately 6.5 million
people (2007). Close to 87% of the population lives in rural areas. Access to widely
scattered rural communities is often difficult, slow and expensive. Administratively,
the country has 22 provinces and 89 districts. There are large socio cultural
differences between and within provinces. Around 800 languages are spoken in
Papua New Guinea and each language group has a distinct culture. The official
languages are English, Pidgin and Motu.
PNG's relative level of poverty in relation to neighbouring countries is increasing and
it ranks 148th out of 182 countries on the United Nations Human Development Index
(2009). (This indicates a worsening situation compared with 132nd in 2003, and
128th in 1994) Although adult literacy rate has improved to 57.8% (Human
Development Report 2009), still 39.6% of the population has no education
(Demographic Health Survey 2006). Subsistence farmers, fishermen and hunters
constitute the poorest segments of the population. However, an increasing number of
people living in settlements around the cities are disadvantaged with low income and
poor living conditions. Violence against women and achieving gender equality remain
major challenges in Papua New Guinea. The country is a signatory to the Millennium
Development Declaration. The first MDG progress report was published in 2005 and
the second report early in 2010. The reports show the progress being made by the
country towards the attainment of the MDGs, but there is considerable work to be
done if PNG is to come anywhere near attaining these goals.
In recent years, PNG's economic growth has improved, mainly due to high
commodity prices, rising to 6.5% in 2007 and 6.6% in 2008. The Government's
budgetary and management performance has also experienced improvements. The
Government is focusing on a new national development strategy that takes into
account the future windfall from the planned Liquefied Natural Gas project (PNG
LNG). Nevertheless, after over 30 years of political independence and some early
economic and social progress, most of people of PNG remain poor by both regional
and international standards.
(Source: http://www.who.int/countryfocus/cooperation_strategy/ccsbrief_png_en.pdf)
National Eye Plan 2011 -2015
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HEALTH AND DEVELOPMENT
The major health problems have remained largely unchanged in the past fifteen
years, although there are recent indications of an epidemiologic transition beginning
to take effect among some populations. The leading health problems continue to be
communicable diseases; with malaria, tuberculosis, diarrheal diseases and acute
respiratory disease as major causes of morbidity and mortality. PNG has a
generalized HIV epidemic, driven predominantly by heterosexual transmission. Care
and treatment for people living with HIV have improved significantly since 2006.
Although there has been a downward trend in infant and child mortality, the rates are
high compared to other countries in the Asia Pacific region. Maternal mortality
remains very high and the Demographic Health Survey 2006 suggests that it has
increased over the last decade. Addressing effectively MDG 4 & 5 are therefore key
priorities for Papua New Guinea.
Health services are provided by the Government and non-state providers, mainly the
Churches and to lesser degree economic operators and primarily financed by public
funds. To date, a high level of fragmentation in the institutional and financial
relationships between national, provincial and lower levels of government has
contributed to the poor health outcomes. There is an unclear allocation of
responsibilities for service delivery which creates significant barriers to improving
access to services. Improvement of rural health services is perceived as a key to
improve health outcomes and attaining the health related MDGs.
The Opportunities include;
• Improved economic growth and prospects for PNG
• New National Health Plan 2011-2020 focusing on “back to basics” and
improved service delivery for the rural majority and the urban disadvantaged
population
• Government reforms at sub-national level with better clarification of roles and
responsibilities of the different administrative levels in the public sector
• Recognition of partnership in health and non-state providers’ role to improve
service delivery and for extension of public services
• Increasing funding for rural health services
The challenges include;
• High maternal mortality
• Gender based violence and gender inequality
• Increased health security risks from emerging diseases, MDR TB and other
communicable diseases e.g., cholera
• Generalized HIV epidemic affecting about 1% of the population.
• Inadequate access to safe water and sanitation for large part of the
population
• High level of fragmentation in the institutional and financial relationships
between national, provincial and lower levels of government
• Inadequate human resources in particular midwives and medical doctors in
rural areas and an ageing work force
• Dysfunctional medical supply system
(Source: http://www.who.int/countryfocus/cooperation_strategy/ccsbrief_png_en.pdf)
National Eye Plan 2011 -2015
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WORLD HEALTH ORGANISATION (WHO) STATISTICS ON PNG
Total population: est 6,400,000 (2007) growing at 2.7% annually
Gross national income per capita (PPP international $): 1,630
Life expectancy at birth m/f (years): 60/64
Healthy life expectancy at birth m/f (years, 2003): 51/52
Probability of dying under five (per 1 000 live births): 73
Probability of dying between 15 and 60 years m/f (per 1 000 populations): 303/243
Total expenditure on health per capita (Intl $, 2006): 134 (lowest in the Pacific)
Total expenditure on health as % of GDP (2006): 3.2 (lowest in the Pacific)
Population distribution % rural: 87
Adult (15+) literacy rate (2007): 57.3
(Source: WHO: http://www.who.int/countries/png/en/)
(Source: http://www.who.int/countryfocus/cooperation_strategy/ccsbrief_png_en.pdf
NATIONAL HEALTH PLAN PNG 2011 - 2020
The current goal of the national Government is to improve the health of all Papua
New Guineans through its Goal of “strengthened of primary health care for all and
improved service delivery for the rural majority and urban disadvantaged as outlined
in the National Health Plan 2011- 2020. This “Back to Basics” plan is focused on the
development of a health system with a Vision that provides “affordable, accessible,
equitable and quality health services for all citizens”. Its Mission is to “improve,
transform, and provide quality health services through innovative approaches
supporting primary health care and health system development, and good
governance at all levels”.
(Reference - National Health Plan 2011 – 2020 Volume 1 p18).
NATIONAL HEALTH PLAN KEY RESULT AREAS (KRA)
KRA 1 Improve service delivery
KRA 2 Strengthening Partnerships and Co-ordination with Stakeholders
KRA 3 Strengthen Health Systems and Governance
KRA 4 Improve Child Survival
KRA 5 Improve Maternal Health
KRA 6 Reduce the burden of Communicable Diseases
KRA 7 Promote Healthy Lifestyles
KRA 8 Improve Preparedness for Disease Outbreaks and Emerging Population
Health Issues
These can be abbreviated as KRA1 etc, in this document to demonstrate alignment
between the National Eye Plan 2010 - 2015 and the National Health Plan 2011 –
2020.
National Eye Plan 2011 -2015
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HEALTH INFORMATION-NDOH
Eye Care Services is a National Department of Health function, managed under the
Medical Standards Division. The health facilities are classified according to; level of
health care population coverage, availability of investigative facilities, availability of
Medical Specialists and availability of consumables and pharmaceuticals. This
classification of facilities creates a referral system where a case that cannot be
effectively managed at any level is referred to the next level or a higher level.
Table 1: Levels of Government Health Facilities
Level 7(1)
Level 6 (3)
Level 5(4)
Level 4(11)
Madang
Daru
Mt.Hagen
Wewak
Kerema
Nonga
Alotau
Popondetta
Goroka
Mendi
Port Moresby(PMGH) Lae (Angau)
Kundiawa
Vanimo
Lorengau
Kavieng
Kimbe
Buka
Central (proposed)
Major Churches Medical Council Hospitals
Balimo
Tinsley
Kikori
Mingende
Watuluma
Gaubin
Mambisanda
Telefomin
Kudjip,
St Mary’s Vunapope
National Eye Plan 2011 -2015
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NEEDS ANALYSIS
CURRENT MAGNITUDE OF BLINDNESS, LOW VISION AND DISEASE CONTROL
The prevalence of blindness and visual impairment throughout PNG is high. In a
population-based, cross-sectional study (Garap et al, 20061) on patients over the age
of 50, it was found that 29.2% were visually impaired and 8.9% had functional
blindness. This equates to an estimated 146,000 people over 50 with visual
impairment, of whom 44,000 people are bilaterally blind.
The study showed Refractive error (45.7%) and Cataract (35.2%) were the most
frequent causes of vision impairment in eyes examined. “The identification and
treatment of refractive error and cataract need to be priorities for eye health services
in Papua New Guinea if the burden of vision impairment and blindness is to be
diminished.” (Garap et al, 20061). These figures are for 2006 extrapolated on the
2000 census. The figures have increased over the years since and continue to
increase every year. Every single person in PNG will be affected by the need for
glasses and will also develop cataracts with age. Both are treatable.
Eye conditions not only affect people’s quality of life, but have economic implications
for the community and government, through loss of productivity, and eye and health
care costs:
 A person who is visually impaired is twice as likely to suffer falls than those
with normal vision, is four times more like to have hip fractures, three times
more likely to be depressed and has double the risk of early death (McCarty et
al, 2001)
1.
Garap, J.N., et al., Blindness and vision impairment in the elderly of Papua New Guinea. Clinical and Experimental
Ophthalmology, 2006. 34(4): p. 335-341.
National Eye Plan 2011 -2015
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 The health care costs of a person with visual impairment in Australia, are more
than coronary heart disease, stroke, arthritis and depression and those of
diabetes and asthma combined (Taylor, Keefe, Mitchell, 2004)
It is perhaps difficult to comprehend that approximately three quarters of the
blindness and visual impairment in PNG is treatable or preventable. Eye care
interventions are amongst the most straightforward and cost effective health care
interventions (World Bank), as long as eye health professionals have had appropriate
training to provide the interventions. Presently, PNG is extremely under-resourced in
eye health professionals.
BARRIERS TO EYE CARE DELIVERY
Development of eye health infrastructure and service delivery in PNG is hindered by
the factors high-lighted in the three parts of the Vision2020 platform. Vision2020: the
Right to Sight: is an initiative of WHO and IABP (International Agency for the
Prevention of Blindness) whose goal is to eliminate avoidable /preventable blindness
by the year 2020. The three platforms it recommends to address this issues are:
Disease Control; medical supplies (drugs, consumables and glasses) and
inadequately integrated primary health care systems.
Human Resource; a lack of adequately trained nursing and medical staff
and attrition of trained staff, lack of recurrent funding available to eye health services,
inadequate support to enable trained staff to most effectively use their skills,
Infrastructure; insufficient and poorly maintained medical equipment, and
inadequate and/or poor facilities.
This National Eye Plan considers these three areas of the Vision 2020 platform
and the strategies needed in each to collectively make a significant positive impact in
improving the visual welfare of the people of PNG.
National Eye Plan 2011 -2015
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DISEASE CONTROL (consumables and glasses and programs)
(aligns with National Health Plan KRA 1, KRA2, KRA3, KRA 7)
Without stable supply of ophthalmic drugs, consumables for surgery and glasses or
spectacles (both readymade and custom made) it is not possible to deliver effective
eye care.
Within PNG the main eye conditions requiring treatment are Uncorrected refractive
error and Cataract. Following these are Anterior eye condition (such as corneal
infections, pterygium, uveitis), Trauma and now, increasingly, Diabetic eye disease.
Uncorrected refractive error; Ensuring stable glasses supply for the PGDEC
(Ophthalmic Clinical Specialists) and Primary eye care workers is essential for
dealing with this significant problem
Glasses; A national glasses supply of Readymades (RMS) and Custom made
glasses (spectacles) must being developed. These glasses should be readily
available, appropriate and affordable. The NDOH needs to support the provision of
glasses through the Hospital eye clinics (like any other treatment or “medicine”)
Cataract; One of the major barriers to increased cataract surgery rates is poor
consumable supply (Human resources and Infrastructure, particularly - equipment
are also factors). Small Incision Cataract Surgery (SICS) should be the normal
standard technique used. The aim should be to have a national cataract surgery rate
of 1500 – 2000. Programs for cataract surgery should include outreach programs.
Consumables; The appropriate list of Ophthalmic drugs must be included in the
National Medical catalog. Until a stable consumables supply is available through the
PNG Health System an alternative national ophthalmic consumables supply is
needed. This should include; IOL, sutures, and ophthalmic drugs (see appendix 2,
Equipment and consumables)
Spare parts; Similarly there needs to be a supply of spare parts for instruments. This
could be combined with the consumables supply.
Anterior Eye Condition treatment will be assisted greatly by availability of
appropriate ophthalmic drugs as part of the stable national consumables supply
Posterior Eye Conditions; Diabetic eye disease. Treatment includes public
education to reduce the rate of severe diabetes eye complications, and to encourage
compliance with treatment for those diagnosed with the disease. Increased diabetic
patient screening, additional professional training and facilities will be also needed for
treatment of diabetic retinopathy
Childhood blindness congenital cataract, vitamin A deficiency and lime burns.
Other conditions; Glaucoma, Trachoma, and HIV are less common but still
conditions which require appropriate consideration for treatment plans.
Trauma can be reduced by improving health promotion of the potential causes such
as knife wounds, assaults, domestic violence, lime burn, and workplace safety (see
programs below)
National Eye Plan 2011 -2015
8
Programs to help expand the eye care services should include;
(aligns with National Health Plan KRA 4, KRA 6, KRA 7, KRA 8)
Outreach programs both for screening, basic eye care and refraction as well
as surgical outreach will need to be funded and coordinated.
Diabetes program public education, screening, and diabetic retinopathy
treatment centres
Low Vision additional teaching and appropriate low vision aids will need to be
integrated into the existing training courses and the glasses supplies. This will also
require additional courses for eye care professionals
Community Based Rehabilitation for maximizing the potential of those with
untreatable visual impairment.
Eye Health promotion (including warning about the risks of trauma, fights,
domestic violence, and lime burn). Also included in Health Promotion should be
Occupational Health and Safety, specifically about protection of eyes
Eye Bank – The difficult social and cultural situation regarding organ donation
should be monitored looking for opportunities to develop an Eye Bank. Alternative
sources of supply and artificial corneas should also be considered.
Specialty ophthalmology units – As soon as practical, sub-specialty
ophthalmology units should be established to enable treatment of more complex eye
problems
Research – ongoing research should be conducted to enable improved
understanding of eye conditions in PNG and enhance delivery of eye care.
Monitoring and Evaluation, Data Collection/Statistics – Standardised data needs
to be centrally collected on eye diseases and treatments. This will assist with
advocacy, understanding disease patterns and analyzing and monitoring eye care
delivery
National Eye Plan 2011 -2015
9
HUMAN RESOURCE - Development (training and capacity building)
(aligns with National Health Plan KRA 1, KRA 2, KRA 3)
PNG is vastly undersupplied with manpower in eye care. The main focus of the
national eye plan must be on the development of human resources. Funds will be
needed to support this training and capacity building in PNG
Human Resources in Eye Care in PNG
Most of the human resources in eye care are associated with the National Health
System. Some are provided by CBM, Callan Services, Fred Hollows Foundation NZ
(FHFNZ), PNG Eye Care, International Centre for Eyecare Education (ICEE), St John
Association for the Blind, Royal Australian and New Zealand College of
Ophthalmologists (RANZCO), and other visiting teams and the private sectors.
NEED FOR ADDITIONAL HUMAN RESOURCES
One of the greatest barriers to health is the difficulty people have in accessing health
services. Research in PNG and Fiji (Garap et al., 2006 Du Toit et al., 2006), has
found that even those people living within an hour of eye clinics are often unable to
afford the bus fare or the time to travel to such a clinic. Those living further away,
and those living on islands without eye clinics, have almost no access to eye care.
World Health Organisation (WHO) has long advocated that different categories of
health workers are needed to work in and with communities to improve access to
health care.
The number of eye doctors (ophthalmologists) required for comprehensive provision
of eye care for the people of PNG is estimated at 60 (one per 100,000 people);
currently about 14 ophthalmologists are practising in PNG. Training mid-level eye
care personnel (nurses and eye care workers) to provide eye care would augment
current primary care services, and provide support to the ophthalmologists to enable
them to function more efficiently. The ideal number of mid-level eye care personnel is
estimated to be one per 25,000 people. For the population of PNG (est. 6.4 million)
260 eye care workers are required. At present there are about 60 nurses or eye care
workers providing various levels of eye care on a full or part time basis.
National Eye Plan 2011 -2015
10
The following four types of eye care workers are most appropriate to the needs
of PNG.
Ophthalmologists DO, MMeds
Definition; Specialist eye doctors able to diagnose and treat the eye diseases
found in PNG and perform surgery as appropriate 18 Drs (11 Govt Drs, 3 NGO,3
private,1 admin) plus 3 DO level making a Total of 21)
At the end of 2010 are 18 ophthalmologists working in PNG. Based on the current
population estimates and the WHO recommended ratios outlined above,
approximately 60 Ophthalmologists are required. Realistically, ongoing, in-country
training should initially aim to add 4 Doctors per year into the Ophthalmology training
program. These training positions should be funded by the NDoH or the provincial
hospitals at the Diploma in Ophthalmology (DO) level
Ongoing support should include annual meetings such as at the PNG Medical
symposium, as well as International meetings (such as PacEyes, and RANZCO).
Professional membership of these organization and Continuing Professional
Development for all Ophthalmologists should be encouraged.
There is a need for the University of PNG to create a Chair for Ophthalmology.
Appointing an appropriate person to this position will improve supervision with more
emphasis on raising standards for candidates and their pass requirements. It will also
help attract junior doctors to consider ophthalmology as a career.
Sub Specialist training (in country as far as possible) in Ophthalmology should be
considered. A candidate should be identified to train sub-specialist areas every 2
years.
There should be 2 nursing staff working in the eye clinic for each Ophthalmologist
(this is not including any PGDEC (Ophthalmic Clinical Specialists)).
PGDEC Eye Nurses (“Ophthalmic Clinical Specialists”)
Definition; Diagnosis and non-surgical treatment and management of eye
conditions and vision problems as well as the refraction and prescription of glasses
(spectacles).
It is recommended that these Post Graduate Diploma in Eye Care (DWU) graduates
should now be called Ophthalmic Clinical Specialists
At the end of 2010, there are about 23 active PGDEC “Ophthalmic Clinical
Specialists”. WHO recommendations would suggest at least 120 mid level eye care
workers are needed for the PNG population (assuming 120 additional Primary eye
care workers are also trained). It is suggested there be a ratio of 2 “Ophthalmic
Clinical Specialists” for each ophthalmologist, in addition, other “Ophthalmic Clinical
Specialists” should be located in those main and district hospital eye clinics without
ophthalmologists. Training should aim for 10 new graduates per year. Ongoing
support should include annual meetings and workforce support visits.
National Eye Plan 2011 -2015
11
Selected experienced Ophthalmic Clinic Specialists should be sponsored to complete
a Masters in Public Health or Masters in Community Eye Care (possibly Divine Word
University) to increase skill levels and provide teachers for the training programs.
Ophthalmic (theatre) nurses
Definition; Support nurses trained to assist the Ophthalmologists and the
Ophthalmic Clinical Specialists in the eye clinic and the ophthalmic operating theatre
At the end of 2010, it is estimated that there are approximately 20 nurses performing
this role in PNG. It is suggested there be 2 per ophthalmologist (equating to a need
for 120 Ophthalmic (theatre) nurses). A Certificate in Ophthalmic (theatre) Nursing
course is expected to be offered at DWU from 2012. It should aim to train 10
Ophthalmic (theatre) nurses per year. Many nurses will work in eye clinics without
this certificate but it will be a significant advantage to the clinic where the nurses can
have this specific eye training.
Primary Eye Care workers (refraction)
Definition; Basic eye care and spherical refraction. Generally working away
from the main hospital eye clinics, in regional and rural centres
At the end of 2010, there are about 20 Primary Eye Care workers in PNG. It is
estimated that approximately another 120-200 are needed based on current
population estimates. Training should aim to produce 10 per year. A Certificate in
Eye Care (refraction) is expected to be offered at DWU from mid 2011.
It is envisaged the eye clinic Ophthalmologists and Ophthalmic Clinical Specialists
should support the Ophthalmic (theatre) nurses and Primary Eye Care workers in
their clinic and region. The Primary Eye Care workers located throughout the region
would refer to their supporting eye clinic.
Additional Support staff: Biomed personal (Ophthalmic Instrument technicians) and
Ophthalmic Medical technicians should be trained in the main hospitals to support
the eye clinics. These people should be already working in the hospitals and will
require ophthalmic specific training.
Sufficient numbers of BioMed (Ophthalmic Instrument Technicians) personal need to
be trained to maintain and service the ophthalmic instruments throughout PNG. This
will require funds for training and some regular regional visits to the eye clinics
throughout PNG.
Training of Optical Technicians will also be needed as part of the Glasses supply
network.
Basic eye care short courses for health workers are recommended to be funded
and delivered by the Ophthalmic Clinical Specialists to health workers in their
regions.
Basic eye care training should also be included in the curriculum for all health
courses taught in PNG (eg Doctors, Rural Health Doctors, Nurses, CHW).
National Eye Plan 2011 -2015
12
Recommended PNG Eye Care System
Level 7- 4 Hospital
Support
EYE CLINIC
Ophthalmologist
Ophthalmic Clinical Specialist (PGDEC)
Ophthalmic (theatre) nurse
Primary eye care workers (CEC)
Level 3 Hospitals
District Hospitals
Ophthalmic Clinical Specialist (PGDEC)
District Hospitals
Primary eye care workers (CEC)
Health Centres
Primary eye care workers (CEC)
Health workers with Basic Eye Care training
Referral
Community
Health Post
National Eye Plan 2011 -2015
Health workers with Basic Eye Care training
13
OPHTHALMOLOGY
REGISTRAR (DO)
1
-
-
-
-
-
-
1
-
18
TOTAL
-
Wabag L-4
Simbu L-4
-
Mendi L-4
Vanimo L-4
-
Alotau L-5
Central L-4
1
NGO
Daru L-4
1
Kerema L-4
1+
1NGO
Popondetta L-4
1
Buka L-4
1
Kimbe L-4
Wewak L-5
Madang L-5
Rabaul L-6
Mt. Hagen L-6
Goroka L-5
1
NGO
Kavieng L-4
1
Manus L-4
5+
OPHTHALMOLOGIST
3 private
(MMED)
1 admin
Lae L-6
Port Moresby L-7
Existing Eye Care Human Resources in PNG 2010
1
-
1
-
-
-
-
1
-
-
-
-
-
-
-
-
-
-
-
-
3
-
2
1
2
1
4
2
6
-
-
-
2
-
-
-
-
-
1
-
1
22
3
1
4
1
1
4
1
2
-
-
-
1
-
-
-
-
-
-
-
-
18
PRIMARY EYE CARE
WORKER (CEC)
5
1
3
1
2
1
-
-
-
1
2
-
-
-
1
-
1
-
1
1
19
BIOMED
1
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
1
i
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
0
OPHTHALMIC
CLINICAL
SPECIALISTS
(PGDEC)
OPHTHALMIC
(Theatre) NURSE
(COTN)
INSTRUMENT TECHNICIAN
MEDICAL
TECHNOLOGIST
-
-
Table 2: 2010 Human resources in Eye Care in the country
National Eye Plan 2011 -2015
14
WHO Goals
1
1
1
-
1
-
-
-
1
-
23
OPHTHALMOLOGY
REGISTRAR (DO)
3
1
2
1
1
2
1
1
-
-
-
1
-
-
-
-
-
-
1
-
14
4
3
3
3
2
4
3
3
2
2
2
3
2
2
2
2
2
2
3
2
51 120
8
5
6
5
4
6
5
4
-
-
2
4
2
-
2
-
-
-
4
-
57 120
6
3
3
3
3
3
3
3
2
2
3
3
2
2
2
2
2
2
3
2
54 120
1
-
-
-
-
1
-
-
-
-
-
-
-
-
-
-
-
-
-
-
1
20
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
0
20
OPHTHALMIC
CLINICAL
SPECIALISTS
(PGDEC)
OPHTHALMIC
(THEATRE) NURSE
(COTN)
PRIMARY EYE CARE
WORKER (CEC)
Total
-
Wabag L-4
Simbu L-4
-
Mendi L-4
Vanimo L-4
1
Daru L-4
2
Kerema L-4
Central L-4
Popondetta L-4
2
Alotau L-5
1
Buka L-4
Kavieng L-4
2
Kimbe L-4
2
Wewak L-5
2
Rabaul L-6
6
Goroka L-5
OPHTHALMOLOGIST
(MMED)
Lae L-6
Manus L-4
Madang L-5
Mt. Hagen L-6
Port Moresby L-7
Projected Eye Care Human Resources 2015
60
BIOMED
INSTRUMENT
TECHNICIAN
MEDICAL
TECHNOLOGIST
Table 3: Projected human resource in Eye Health Care in the country 2015
National Eye Plan 2011 -2015
15
INFRASTRUCTURE (facilities and equipment)
(aligns with National Health Plan KRA 1)
Facilities
Appropriate amounts of space and facilities for each eye clinic (including a day
theatre where Ophthalmologists are located) are required for the delivery of effective
eye care.
As the tertiary referral eye centre and teaching clinic, Port Moresby General Hospital
the Eye Clinic requires more space and renovation of existing allocated space to
improve working environment and to allow for teaching of Registrars and others.
Many provincial hospitals with trained staff currently lack suitable facilities. Some
provision for eye health treatment should be made at all regional and later at all
district hospitals. (see appendix 1, Facilities)
A new dedicated National Eye Care Training Centre should be constructed.
Equipment
Each eye clinic facility must have the minimum eye equipment for effective eye
care to be provided (see appendix 2, Equipment and consumables). Ensuring the
eye clinics have this equipment will require substantial funding support.
ADVOCACY
A National Prevention of Blindness Committee was formed at a national
planning workshop in February 2011 to advocate for the implementation of this
National Eye plan and coordinate the ongoing development of eye care by NDoH,
Eye Care professionals, Service providers and NGO's working in eye care in PNG.
This advocacy should encompass all three parts of the Vision 2020 platform as
outlined above. It should ensure that the National Eye Plan is integrated with and
complementary to the National Health Plan.
This committee and a secretariat should be funded by the NDoH and work in closely
with the chief ophthalmologist
Gender/Disability/Disadvantaged
The development and delivery of eye care in PNG will advocate for equality of
opportunity and equality of access of both genders, to those with disability and other
disadvantaged individuals and groups.
This should include working with agencies involved with disadvantaged groups.
ANNUAL REVIEW
It is suggested this plan be reviewed each year by the National Prevention of
Blindness committee. This meeting is an important annual event to ensure
cooperation and advancement of eye care in PNG.
A major review should be undertaken in 3 years to prepare new national eye plan.
Summary
This eye care plan supports and aligns with the “Back to Basics” approach of
the National Health Plan 2011 -2020, by advocating training 4 levels of eye care
workers and the provision of consumables and infrastructure to enable them to
provide eye care for people for PNG and particularly “the rural majority and urban
disadvantaged”.
National Eye Plan 2011 -2015
16
Appendices
1
Minimum Facilities for eye clinic
2
Minimum Equipment and Consumables for eye clinic
3
Budget overview
National Eye Plan 2011 -2015
17
National Eye Plan 2011 – 2015 Appendix 1
Minimum facility space
Clinic area requirement
Area
level 7 (1)
Level 6 (3)
Cons. Clinic
6 x 12m
6 x 6m
Investig. Room
6 x4m
6 x4
Refract. Clinic
6 x 4m
Day surgery
level 5 (4)
Level 4 (11)
level 5 (16)
6 x 4m
6 x 4m
6 x 4m
6 x4m
6 x4m
6 x4m
-
8 x 8m
6 x 6m
6 x 4m
6 x 4m
-
Eye ward
30 bed
20 bed
10 bed
10 bed
-
Optical shop
6 x 6m
6 x6m
6 x6m
-
-
Drs. Office
6 x 6m
6 x 4m
St
Std
-
Staff toilet
Std
Std
Std
Std
--
Pts toilet
Std
Std
Std
Std
-
Staff room
6 x 6m
6 x4
6x4
-
-
Resource room
6 x 4m
5 x 4m
4x4
-
-
Eye bank/ lab
6 x 6m
-
-
-
-
National Eye Plan 2011 -2015
18
National Eye Plan 2011 – 2015 Appendix 2
Equipment and
Consumables
Minimum Eye Clinic Equipment list PNG (based on Vision 2020 Guidelines)
Examination and Diagnostic.
items
Essential E/ If funds available IFA
Quantity
Slit lamp and accessories
Video monitor to s/lamp
Keratometer Manual/auto
A Scan/ papers
3 mirror gonioscope
Indirect Ophthalmoscope with
teaching mirror
Lens 20D
Lens 78D
Lens 90D
Direct ophthalmoscope
Visual acuity charts- combined E
and Snellens
Near Reading chart
Occluders/pinhole
Dressing trolley
lensometer
Ishihara color test plate
Amsler chart
Streak retinoscope
Cross cylinder 0.5 and 1.00
Trail lens set
Prism bar set
Trail frame adult
Trail frame paediatric
Surgeons stools
Table mounted light
auto refractor
Visual field analyzer
Fundus camera, angiography
facility
Yag laser
Photocoagulater
Endolaser applicator
Cryomachine
E
IFA
E
E
E
e
10
10
10
10
10
10
e
e
e
e
e
10
10
10
30
40
e
e
e
e
e
e
e
e
e
e
e
e
e
e
IFA
IFA
IFA
10
20
20
10
10
10
10
10 each
10
10
10
10
40
10
10
10
10
IFA
IFA
IFA
IFA
10
10
10
10
item
E/IFA
Quantity
Punctal dilator
Canula flat-tip
Eye lid speculum- adult
Eye lid speculum -child
Retractors Desmarres -medium
Retractors Desmarres-small
Forceps fine non- toothed
E
E
E
E
E
e
e
10
40
20
20
20
20
20
Minor procedures room
National Eye Plan 2011 -2015
19
Bard Parker blade handle #3
Blade 11
Blade 15
Scissors, Westcott, conjunctival
Loupe,2.5 magnification
Instrument sterilizing box/lid
Tonometer, Schiotz/Perkins hand
held
Acuity , E/Snellens combined chart,
Sterilizing drum
Glucometer/dextrostix
IV stand
Scissors heavy duty
Assorted gallipots
Instrument tray with lid
Table mounted light
Sphygmomanometer aneroid
stethoscope
Artificial eyes- assorted eyes
Height and weighing machines
e
e
e
e
e
e
e
20
20
20
10
10
10
10
e
e
e
e
e
e
e
e
e
e
e
e
10
20
10
40
10
60
30
10
10
10
10
10
Re equipping 10 Eye Clinics in the country; 1 level 7, 3 level 6, 6 level 5 hospitals
Operating theatre instruments/equipments.
item
E/IFA
quantity
Autoclave, vacuum type b/top
Operating microscope static
Assistant binocular teaching scope
Spare bulbs for microscope
Portable pneumatic vitrector with
consumables
Disposable sterile vitrector cutters
for above
Bipolar cautery with accessories
Spirit lamp n accessories
Hydraulic operating table
Surgeons stools on castors
Portable surgical light
Dressing trolley
Intravenous infusion stand
Tonometer, hand held
Schiotz/Perkins
Linen trolley
Bowl stands with bowl
Stand by generator
Portable operating microscopespare
Eye pressure reducer
E
E
E
E
E
10
10
10
100
10
e
20
IFA
E
E
E
E
E
E
E
10
10
20
40
20
50
20
10
E
E
E
e
10
20
10
10
e
20
National Eye Plan 2011 -2015
20
Instrument sets
item
E/IFA
Quantity
Cataract surgery sets
ECCE/PCIOL/SICS as appropriate
Lid surgery/trichiasis sets
Minor operations sets
Instrument sterilizing boxes with
lids
Instrument trays with lids
Large tubing for large instruments
and
DCR /lacrimal set
Orbital set
Posterior segment instrument set
E
50
E
E
E
20
20
40
E
E
30
30
IFA
IFA
IFA
10
10
10
Consumables
DCR Intubation sets
Lacrimal intubation sets with
introducer
sutures
10/0 nylon, DA, spatula needle,
30cm
9/0 nylon, DA, spatula needle,
30cm
4/0 silk, SA, cutting edge
5/0 silk SA, cutting edge
7/0 vicryl, DA, spatula needle,
30cm
8/0 vicryl, DA, spatula, 30cm
5/0 chromic, SA, spatula, 40cm
Knives and blade fragments
Crescent knife, fragment angled
bevel up 2.5mm
Slit knife/keratome, fragment
3.mm angled
Implant blunt knife, fragment
5.2mm
MVR 19 gauge, fragment
15 degree stab knife, fragment
Handle for fragment
Knife for single use
Crescent knife angle bevel up
2.5mm
Slit knife/keratome 3.mm angled
Implant blunt tipped knife 5.2mm
15 degree stab knife
MVR 19 gauge
National Eye Plan 2011 -2015
E
E
E
E
E
E
E
E
E
E
e
5,000
E
5,000
e
5,000
e
e
e
5,000
5,000
30
e
1,250
e
e
e
e
1,250
1,250
1,250
1,250
21
Pharmaceuticals and Consumables to be in Medical catalogue
item
Antibiotics
Chloramphenicol 1% eye ointment
Chloramphenicol eye drops
Ciprofloxacin 0.3% eye drops
Co-trimoxazole tablets
400mg/80mg
Gentamycin 0.3%n eye drops
Gentamycin injection 40mg/ml-2ml
Povidone iodine 10% 200mls
Tetracycline 1% eye ointment
Steroid/anti-inflammatory
Dexamethasone 0.1% eye drops
Dexamethasone injection Sodium
phosphate 4mg/ml-1ml
Prednisolone Acetate eye drops 1%
Prednisolone 5mg tablets
Antibiotics/anti-inflammatory
Bethamethasone /neomycin
ointment
Gentamycin 0.3%/dexamethasone
0.1% eye drops
Chloramphenicol 1% +
Dexamethasone 0.1% eye drops
Mydriatics /dilating drops
Adrenaline 1mg/ml-1ml injection
Atropine 1% eye ointment
Atropine sulphate 1% eye drops
Cyclopentolate 1% eye drops
Cyclopentolate 0.5%&
phenylephrene 2.5% eye drops
Tropicamide 1% eye drops
Miotics/glaucoma preparations
Pilocarpine 4% eye drops
Pilocarpine nitrate 0.5% injection
Timolol 0.5% eye drops
5-fluorouracil injection 250mg/5ml
Miochol 1% injection
Brimonidine 0.3%
Antiviral
Acyclovir 3% eye ointment
Acyclovir 200mg tablets
Antifungal
Natamycin 5% suspension
Natamycin 1% eye ointment
Econazole 2%
Anaesthetic agents and drops
Amethocaine 0.5% eye drops
Lignocaine 2% and adrenaline
1:100,000 injection 50ml
Others
Acetazolamide2 50mg tablets
National Eye Plan 2011 -2015
E/IFA
Quantity
E
E
E
E
5,000 tubes
E
E
E
E
E
E
E
6,000 droppers
3,000 ampoules
500 bottles
10,000 tubes
E
E
E
E
E
2,500 droppers
5,000 tablets
2,000 droppers
3,000 ampoules
1,000 tablets
6,000 droppers
10,000 droppers
E
E
E
E
E
E
1,000 ampoules
1,000 tubes
1,000 droppers
500 droppers
500 droppers
E
500 droppers
E
E
E
E
E
E
3,000 droppers
500 ampoules
1,500 droppers
200 ampoules
50 ampoules
E
E
3,000 tubes
5,000 tablets
E
1,000 tubes
E
E
E
500 droppers
1,000 bottles
E
20,000 tablets
22
Fluorescein strip
Hyalurondiase 1,500 IU/ml
injection
Methylcellulose(HPMC) 2ml syringe
Multi-vitamin tablets
Perasafe sterilizing solution
Sodium chromoglycate 2% eye
drops
Zinc sulphate 0.25% eye drops
Ethanol for retrobulbar injection
Vitamin A capsules 200,000IU
Glycerol
Ringers lactate 500mls
Glucometer testing kits
Mannitol 20% infusion
Paracetamol 500mg tablets
Sodium chloride 0.9% infusion
Depo-medrol 40mg/ml
Ketorolac eye drops
Artificial tears (hypromellose)
Intraocular lens implants
PCIOL- 19
PCIOL-20
PCIOL- 21
PCIOL-22
PCIOL-23
PCIOL-24
ACIOL-18
ACIOL-19
ACIOL-20
Retinal implants
Scleral buckles, 2.0, 2.5, 3.0, 3.5mm
Orbit/lacrimal
Orbital implants-sphere 16,18,20mm diameter
Artificial eyes-1/2 moons, left/right
–different sizes
E
E
100 packets
80 packets
E
E
E
E
2,500 packets
10,000 tablets
480 sachets
5,000 droppers
E
E
E
E
E
E
E
E
E
E
E
E
500 droppers
100 bottles
10,000 capsules
100mls
3,000 bottles
300 strips
2500 bottles
10,000 tablets
500 bottles
50 ampoules
Mobile Clinic and Surgery
Item
E/IFA
Quantity
Hand-held slit lamp
Near reading chart
Acuity chart E/Snellens combined
Hand –held Schiotz/Perkins
Tonometer
Ophthalmoscope
Spare bulbs for ophthalmoscope
Retinoscope plus spare bulbs
Trail lens set
Trail frame adult
Trail frame child
Retractors Desmarres-medium
Eyelid speculum-adult
Forceps- jewelers fine
E
E
E
E
10
10
10
10
E
E
E
E
E
E
E
E
E
10
60
10
10
10
10
10
10
10
National Eye Plan 2011 -2015
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Scissors, Westcott conjunctival
Binocular 2.5 loupe
Autoclave portable-nonelectric
Autoclave electric
ECCE/PCIOL instruments and trays
Evisceration/chalazion/tarsorrhaphy
instrument set and trays.
ECCE cataract kits(consumables)
Sterilizing drum
Portable operating microscope and
spare bulbs
Portable power generator
E
e
E
E
E
E
10
10
10
10
30
10
E
E
E
10
30
10
E
10
Ophthalmic Clinical Specialist (PGDEC) - Instruments
item
E/IFA
Quantity
Light source/ pencil torch/batteries
Direct ophthalmoscope/ spare
bulbs
Retinoscope/ spare bulbs
Acuity chart E/Snellens
Acuity chart near
Trail lens set
Trail frame adult
Trail frame child
Eye model
Eye posters x4
BP machine
Weighing machine
Glucotest kit
dextrostix
Instrument tray with lid
Gallipots
Retractors Desmarres adult/child
Barraquer cilia forceps
Forceps fine toothed –FB
calculator
E
E
1
1
E
E
E
E
E
E
E
E
E
E
E
e
E
E
E
E
E
e
1
1
1
1
1
1
1
4
1
1
1
1
1
6
2
2
2
1
Consumables for Ophthalmic Clinical Specialist (PGDEC)
item
E/IFA
Quantity
Amethocaine 0.5% eye drops
Fluorescein strips
Tetracycline 1% eye drops
Vitamin A capsules 200,000 IU
Cotton buds
Cotton wool
Gauze roll
Disposable eye shield
Ready made glasses; simple
spherical for far and near
E
E
E
E
E
E
E
E
E
20
50
100
100
200
2 rolls
1 roll
50
100
National Eye Plan 2011 -2015
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Teaching / Training.
1 Data projector
1 laptop computer
1 White or black board
Administrative. These items are not in the Standard List.
Computer
Monitor
Mouse
UPS (Uninterrupted Power Supply)
Printer
Photocopier
Laptop computer
Filing cabinets, fixtures and furniture
Stabiliser
Telephone access/mobile phone
Internet access desirable
Scanner – when funding allows
National Eye Plan 2011 -2015
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National Eye Plan 2011 – 2015
Budget
Some funding from the NDoH and some through external sources such as AusAid (ABI2)
Annual
Initial
Later years
Disease control
National Glasses Scheme
50,000
200,000
National Consumables Scheme
100,000
500,000
Outreach programs
250,000 (25,000 per outreach x10)
Diabetes program
20,000
80,000
Low Vision
10,000
20,000
CBR
30,000
Eye Health Promotion
25,000
Eye Bank
20,000
Speciality Ophthalmology units
10,000
200,000
Research
10,000
Data collection
5,000
Human Resource Development
Ophthalmology
Training positions x4
Ophthalmology CPD
Chair in Ophthalmology
SISC training
Sub speciality training
Lecturers
400,000
50,000
300,000
50,000
100,000
100,000
Ophthalmic Clinical Specialist (PGDEC)
PGDEC course
Workforce support
Annual Workshop
Masters sponsorship
Certificate in Eye Care
Certificate in Ophthalmic (theatre) Nursing
Biomed training
Basic eye care training for health workers
800,000
400,000
50,000
20,000
200,000
150,000
50,000
20,000
National PBL committee and secretariat
300,000
Facilities
200,000
1 mil
500,000
2.5 mil
200,000
5 mil
POM
Others
Equipment
POM
Lae
Hagen
Rabaul
Alatou
Madang
Wewak
Mendi
Kimbe
500,000
500,000
500,000
300,000
300,000
300,000
300,000
100,000
200,000
300,000
100,000
National Eye Care Training Centre
National Eye Plan 2011 -2015
26