The Duke Elder lecture: the challenge of equitable eye care in Pakistan.
OBJECTIVE
Pakistan, like many other developing countries, is caught in the vicious cycle of poverty, illiteracy, violence, and disease. Right from its inception, it has been facing serious challenges of fast growing population, longevity, unemployment, wars, floods, double burden of diseases including blindness, as well as earthquakes, insurgencies, and political instability. Despite such challenges, the country has managed to reduce the burden of blindness from 1.78% in 1987-88 to 0.9% in 2003.This paper will highlight the methods used to achieve such a difficult goal.


METHODS
The country used the report of the World Health Organization (WHO) temporary consultant as the initial tool for advocacy to obtain political and professional commitment. Results from the first National Blindness Survey 1987-1990 were used as baseline for development of the programme. Under the Ministry of Health, national and provincial committees with respective coordinators were constituted. To ensure access and equity, the national programme was developed on the basis of district comprehensive eye care services. The concept was carefully tested in a laboratory and then piloted in a real district before it was rolled over to the country. Strong national institutes for human resource development, research and development, and service delivery were established. A strong network of high-quality national institutes was set up and run by powerful national non-governmental organizations. The second National Blindness Survey evaluated the achievements of the programme in 2001-2003.


CONCLUSIONS
National prevalence of blindness was reduced by 100% by improving the uptake of services at the district level, especially by females.
CHEF International, Khyber Pakhtunkhwa, Pakistan. profmdkhan@gmail.com
M D
MD
Khan
D001766:Blindness / Q000517:prevention & control*; D003153:Community Health Services / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D009313:National Health Programs / Q000458:organization & administration*; D009885:Ophthalmology / Q000458:organization & administration*; D010154:Pakistan
Invest Ophthalmol Vis Sci. 2006 Nov;47(11):4749-55
17065483
Br J Ophthalmol. 2007 Oct;91(10):1269-73
17556430
Br J Ophthalmol. 2007 Aug;91(8):1005-10
17229806
J Pak Med Assoc. 2005 Feb;55(2):77-8
15813635
J Pak Med Assoc. 1992 Aug;42(8):196-8
1433800
Br J Ophthalmol. 2007 Apr;91(4):420-6
17151060