This comprehensive eye care programme fits in with the recently launched WHO Vision 2020 global initiative to eliminate avoidable blindness by 2020.  Vision 2020 is a world-wide effort involving governments, UN agencies, eye care organisations, health professionals and individuals working together in a focussed and co-ordinated way to combat blindness, with the common goal of eliminating preventable and treatable blindness by 2020.

Blindness and low vision are major causes of morbidity and have a profound effect on the quality of life for many people, along with a reduction in the economic well-being of individuals and their families. Cataract blindness develops at an earlier age in developing countries, often striking people in their early 40s when they need to be at their most economically active to support their families. Blindness is also a significant economic burden on the limited funds of national governments in developing countries, in terms of lost productivity and the costs of rehabilitation and education.  The major cause of blindness globally is cataract blindness, with an estimated 16 million cataract blind world-wide.  In Pakistan, it is estimated that 1.4 million people are cataract blind.

The World Bank has developed a single measure of health status known as Disability Adjusted Life Years (DALYs).  It is a combined indicator of the time lived with a disability and time lost due to premature mortality, and is both a qualitative and quantitative measure.  When this measure is considered with the availability and cost of interventions, it leads to an assessment of their comparative cost-effectiveness, i.e. cost per DALY saved.

World Bank research looked at more than 50 specific health interventions and this showed cataract surgery to be one of the most cost-effective of  all public health interventions (in the region of $15-$30 per DALY saved).  Its cost effectiveness derives from characteristics such as the speed of operation, the potential for high volume cataract surgery and the high success rate.

The population of the programme area is 4.8 million, and the prevalence (existing cases) of blindness is 1% in NWFP and estimated at 1.8% in FATA, which gives an estimated 70,000 blind people in the programme area.  Of these, 47,000 (70%) are estimated to be cataract blind.  However, 9,500 new cases of cataract blindness are estimated to be occurring each year (the new incidence of cataract blindness is taken to be c.20% of cataract prevalence rate).

The NWFP/FATA area is one of the poorest and least developed areas in Pakistan.  When the original proposal was submitted there were only 5 ophthalmologists in the programme area, and 5 of the 10 Districts had no eye care services at all, whilst the other 5 had insufficient infrastructure and personnel to fully function.   This programme’s strategies relate closely to the responsibilities Vision 2020 is advocating, which include creating the infrastructure to manage the problem, training eye care personnel and increasing awareness of blindness as a major health issue.

This programme aims to work within the government structure to provide accessible and affordable primary and secondary eye care services to the population of 3 Districts of North West Frontier Province (NWFP) and the adjacent 7 Federally Administered Tribal Agencies (FATA).

It aims to:
Reduce the level of preventable and curable blindness in 3 Districts of NWFP and the 7 FATA through strengthening government eye care services there.

Establish a sustainable model of delivering eye care services at a District level of the government health structure for replication throughout Pakistan.