Current
Status of Thai National Programe for Prevention of Blindness
Nisit
Leelawongs, MD.
Department
of Ophthalmology, St. Louis Hospital
The
Thai programme of blindness prevention took its beginning in
1977. Crash programmes within the Ministry of Public Health
were made with the aim to strengthen eye care at the inter mediary
level. A small group of ophthalmologist from rural service,
calling themselves the "Ophthalmic Cell" met
and took initiative. This action was voluntary and although
receiving no concrete com mitment from the authorities, however
was sup ported by several Eye Institutes. Then the rural eye
units, each of which was staffed by one sur geon and two 6-month-trained
nurses, were orga nized and were soon to increase rapidly in
num bers.
The
situation changed in 1982, when a Na tional Board was first
formulated, and the "Ophthalmic Cell" become the central co-ordinating body of multidisciplinary
composition. Activities in this phase were introducing of primary
eye care into the community levels.
A
nation wide survey, carried out in 1983, identified major
causes of blindness as well as mag nitude of the national problems.
Further expan sion of primary eye care and strengthening of
se condary eye care were made in accordance with other major
activities of the Fifth National 5-year Socio-Economic Development
Plan. Great thank to the successful 'Primary Health
Care" in this country, it facilitated of very
effective and effi cient on the effort of integration primary
eye care into the primary health care scheme. In this phase
a number of significant activities were also introduced. The
institute of Public Health Ophthalmo logy, established at Korat,
provided wider Oppor tunity for training, services and research.
Also various eye sectors made contributions in parallel with
the Institute on the National Programme Specialized eye care
was found already covering over 50 provinces with referral networks
to which outreached communities could have access to cata ract
and glaucoma care. The outlook of Thai programme had never before
held so spectacular and magnificent. The success of primary
eye care gave a huge potential for a great leap foward the phase
to follow.
Common
to many countries in this region, cataract has been identified
as a leading cause of blindness and has had a great concern
to all sectors, and at all levels of health care providers.
However, a strong belief prevailed that, answer must be found
in the primary health care with a strong eye component integrated.
It must be based on the spirit of self-reliance and self-determination,
and avoiding of new inputs and foreign aids as well. With 200,000
cases of blindding cataract, the Ophthalmic Cell has developed
provincial plans to intervene in mass on the premise that, it
is part of primary health care scheme with eye sectors playing
supplementary role.
After
a long preparation, three provinces Buri ram, Korat and Tak
were selected for a pilot study in 1986. A district of 100,000
population in each province, was chosen and carried out with
their own plan. However, it consisted of collecting base-line
data. Mass screening and referral were carried out at the primary
level. Surgery was sub sequently performed in mass at the eye
unit. Follow-up was done at primary level. Spectacles were provided
at an affordable price. This pilot study has successfully convinced
all sectors that this programme can now be fostered and extend
ed into other provincial areas. The national programme, has
eventually stepped into a new phase. to fight against cataract
in the whole Kingdom.
Recently, a large scale operation covering 50 provinces will be
implemented, it is a tribute to His Majesty the King on the occasion
of his 60th birthday this year. Preparation is now well underway.
However, to eye sectors, the overall plan is cataract service
development of long-term basis. The target
is given that 60,000 cataract could have been operated annually
by 1996. There is a long way ahead for the Thai Programme, however,
light is now seen infront to lead us to "Eye Health
For All'.
Thai J Ophthalmol 1987; 1(1):
1
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