A dispersed population and widening wealth gap pose great difficulties in providing affordable and equitable eye health care for the citizens of Lao People’s Democratic Republic (PDR). The Fred Hollows Foundation has been working in Lao PDR since 2008 to eliminate avoidable blindness.
Lao PDR has a population of only 6.8 million. The small landlocked country faces significant health challenges through poverty, low public spending on health care and a largely rural population with poor access to medical services, many of which are rudimentary and inadequately served with trained eye care personnel.
In the past decade or so, Lao PDR has enjoyed strong economic growth and is now classified as a lower-middle- income country by the World Bank. However, the World Health Organization reports that inequality is increasing – more than a quarter of the population lives below the poverty line – as are disparities in access to food, health care and education. The mountainous landscape means many places are difficult to access; approximately one in five people live in areas with no paved roads.
The prevalence of blindness is estimated to be as high as 5% in some rural or remote areas of the country, where more than eight in ten people live. Women account for up to twice as many cases of blindness as men. Cataract is the most common cause, with approximately 10,000 people in need of a relatively straightforward cataract operation to restore their sight.
Thirty years ago, Lao PDR had just one ophthalmologist and three cataract surgeons, and all were based in the capital, Vientiane. Today, there are 20 ophthalmologists – about one per 340,000 people – though many services remain confined to Vientiane, and many of the country’s 17 provinces still have no ophthalmologist, and in some cases not even a basic eye doctor. Compare the situation with Australia where it’s estimated there is one ophthalmologist for every 30,000 people.
Since 2008, The Fred Hollows Foundation has been pursuing the goals of delivering eye care services in remote areas and educating the community about eye health and avoidable blindness, in partnership with the Ministry of Health and provincial health departments.
Working with our partners in 2015 we:
- Screened 26,507 people and conducted over 18,000 eye operations and treatments
- Supported 1,450 sight restoring cataract operations
- Distributed 1,964 pairs of glasses
- Trained four surgeons, 46 clinic support staff, 872 community health workers and 665 teachers
About the program
The Foundation has been working in four northern provinces – Oudomxay, Luang Namtha, Bokeo and Phongsaly. Since we began work in Lao PDR in 2008, we have carried out over 10,000 sight-saving operations and treatments, helped to train 15 ophthalmologists, 72 clinical staff, and provided important eye care equipment.
A key achievement of Phase 1 of our Sustainable Comprehensive Eye Care project has been the construction of a specialist eye unit at Oudomxay Provincial Hospital; it serves as a surgical centre but also a training base for regional eye health workers. Phase 2 of the project will see The Foundation’s work expand into a further six provinces.
The majority of people in remote and rural regions are unaware of eye care and eye disease and fearful of surgery. The Foundation considers that a strong focus on eye health education is an important part of our work. We are training village health volunteers to make their communities aware of eye disease and how to prevent and treat avoidable blindness.
A further barrier to eye health provision in rural areas is cost: most people cannot afford to pay for surgical treatment or the cost of transport to a health facility which could be several days’ walk from where they live. We are training clinical eye care personnel at the provincial, district and local clinic levels to deliver services in remote areas.
The Foundation’s priorities in Lao PDR include:
- Partnering with provincial governments to establish comprehensive eye care services, including screening, cataract surgeries and dispensing of spectacles
- Supporting the National Ophthalmology Centre to address staffing shortfalls in eye health, especially eye surgeons, eye health nurses and community health workers
- Strengthening our partnership with the Ministry of Education to pilot a School Eye Health Education Project
- Advocating to the Lao PDR government for increased investment in eye health and commitment to the National Prevention of Blindness action plan
The Foundation will continue to work in Lao PDR to reduce avoidable blindness through improving access to sustainable eye care services and raising the public and political profile of avoidable blindness issues.