1. Childhood Blindness Mohammad Muhit PhD Child Sight Foundation &
University of South Asia

2. Country profile: Bangladesh
Area: 144,000 sqkm
Population: 140 million, 50m children
Health budget : 1.7% of total budget
Life expectancy 58.9
Per capita GDP: US$1,483
Population below poverty line: 35.6%
Literacy rate: M- 51.1%; F- 28.6%
Rural population: 53.6%
Human Development Index rank: 132
(out of 162 countries)

3. Causes of childhood blindness in Bangladesh
Childhood blindness due to Cataract

4. Childhood Blindness Profile
National Childhood Blindness Study by ICEH-
Prevalence of CHB: 0.7/1,000 children
40,000 blind children in Bangladesh
36% treatable    
32% preventable
Childhood cataract (31%)
Treatable cataract -12,000 blind children!
Innovative approach to case detection (KIM).
Potential of further development of services using ‘register for blind children’.

5. Situation in 2003 Paediatric Cataract Backlog!
12,000 children with bilateral cataract
50 million children in the country.
1 fully trained paediatric ophthalmologist.
Absolute lack of awareness about cataract in children – Public and Professionals.
Services for children’s eye care-limited, expensive, inaccessible.
No programme for childhood cataract.

6. Way Forward- Research – Causes, Barriers, SA.
Advocacy-Childhood Blindness Workshop 2003
Alliances- GO, NGO, policy makers, media..
Establish the Need
Provide a Framework for Action
Develop appropriate tools (KIM)
Mobilise resources

7. BCCC: Partnership in Practice
Sight Savers International
ORBIS International
International Centre for Eye Health
Child Sight Foundation
Uttaran
YPSA
CBR projects
Islamia Eye Hospital
BNSB Sirajgonj Eye Hospital
BNSB Khulna Eye Hospital
CEITC, Chittagong Eye Hospital
BJAKS Comilla Eye Hospital
MOH & MOSW, Govt. of Bangladesh

8. Goal & objectives of the campaign
The Goal is to contribute to the elimination of avoidable Child Blindness by the year 2020, as part of the V2020 programme.
Objectives are-
To eliminate 90% of the backlog of Childhood cataract in Bangladesh by the year 2008
To contribute to the development of long term systems that will ensure that future incidence of childhood cataract in Bangladesh is adequately dealt with
To support the development of long term systems to ensure that all irreversibly blind children receive the services to which they are entitled
To provide lessons that can be used to inform similar programmes elsewhere

9. Bangladesh Childhood Cataract Campaign
Identify 40,000 blind children
Treat 10,000 cataract blind children
20,000 cataract surgery in children
Raise awareness throughout the country
Develop paediatric ophthalmic centres
Develop and maintain a database of blind children in the country for future services
Document & disseminate programme learning.
In 4 years!
With £2 million programme budget.
Campaign was launched in 2004 World Sight Day

10. Focal areas of action FIND all blind children
EXAMINE at the sub-district/district
REFER for surgery to specialized units
OPERATE by trained surgeons
FOLLOWUP regularly and long term.
National register & database of blind children
Develop Systems for Long-term impact.

11. Training on ‘how to identify a blind child’ Health education
Community based eye care services for children
Awareness campaign
Training on ‘how to identify a blind child’
Health education
Empowering communities & key informants
Community Mobilizer for Child Sight
Working with key informants, volunteers and other organisations to develop linkages and to overcome barriers.
Blind Children
in their home
Assessment, counselling & referral by mobile team
Incurable
Treatable
Eye hospital
Schools
Rehabilitation

12. Harun-Ur-Rashid, with children Ahsanullah, Fazar Ali, Osman Gani, Khadija, and Yunus, who all can now see thanks to a simple operation.
Salma and Shetu after cataract surgery; with their mother
Photo courtesy: : Ian Rutherford, Daily Scotsman
Photo courtesy: : Pany Petro CSF

13. Achievements in the first year: 2005
2 Paed Ophth teams trained in India & Tanzania
5 Centres has been enhanced with equipments
Over 3,000 cataract surgery in nearly 1,500 cataract blind children
3 ‘case finding’ NGOs are working in 3 divisions
Database for blind children designed & tested
Working Group of BCCC partners formed & active
Standard data recording forms have been designed and trained for Child Cataract clinical data
Baseline data collected on KAP and SA
Key Performance Indicators for programme monitoring

14. Challenges and lesson in the first year
Broad based partnership is challenging
Case finding in remote areas
Training of Paed Ophth team- expensive, training centres, time
Procurement of IOL, glasses and LVA for children
Follow-up: long term and regular?
Multiple donors, hospitals, MOUs etc.
Programme monitoring system
Engaging media for awareness campaign
Competition between partners
Transparent and democratic decision making
BCCC partner hospitals- inclusive or exclusive?
Linkage with education and rehabilitation

15. Strategic Evaluation: BCCC 2010
Effectiveness: BCCC was effective, as the objectives and targets were met or almost met.
Blind children
Cataract blind children
Traced
Operated
Target
Identified N
% of those traced
BCCC
28,520
9,373
33%
Non-BCCC1
4,456
1,286
29%
Total:
40,000
32,976
(82%)
10,659
32%
10,000
7,674
(77%)

16. BCCC Efficiency: efficiency of the different types of case finding
financial efficiency i.e. the cost per blind child and cataract blind child found
whether the project was good value for money.
Next slide: Number of blind children and cataract blind children expected, and identified, by case finding partner.

17. Population allocated (millions)
 Case finding partner
Population allocated (millions)
Population estimates
Cases identified
Cases operated
Method
All ages
Child pop
Blind1
Cat blind (30%)
Blind found
% of est-imate
Cat blind
From CFP
Uptake (%)
Walk-in
CSF KI
38.2
15.7
10,960
3,288
10,492
96%
3,439
105%
2,361
69% 49
All CBR
CBR
26.7
11.0
7,670
2,301
1,438
19%
1,147
50%
1,083
94%
387
YPSA
H-t-H
17.7
7.3
5,087
1,526
4,992
98%
607
40%
587
97% 82
Uttaran
15.9
6.5
4,557
1,367
6,433
141%
1,517
111%
708
47%
RDSS
11.4
4.7
3,268
980
2,018
62%
1,046
107%
819
78%
108
VARD
9.1
3.7
2,612
783
2,287
88%
1,133
145%
530
Not clear
9.9
4.1
2,848
854
510
18%
147
17%
100%
233
1.5
0.61
426
128 15 4%
12% 32
Subtotal:
37,428
11,227
28,185
75%
9,051
81%
6,250
891
CSF MA
12.2
5.0
3,509
1,053
4,456
127%
332
32%
322
211
TOTAL
42.6
8.8
40,937
12,280
32,641
80%
9,383
76%
6,572
70%
1,102

18. Time efficiency Months Cataract blind found Cataract blind/month
Under BCCC:
CSF Dhaka 20
2,567
1281
CSF Barisal 24
827 35
Uttaran 42
1,517 36
YPSA Chittagong
560 16
YPSA Chittagong HTs 29 47 2
VARD Sylhet 26
1,133 44
RDSS
1,046 40

19. Acceptance of surgery among bilaterally cataract blind children
Uptake of cataract surgery among cataract blind children identified, by case finding partner
Case finding partner
Acceptance of surgery among bilaterally cataract blind children
CBR
94%
CSF
69%
RDSS
78%
Uttaran
47%
VARD
YPSA
97%

20. Cost efficiency in case finding
Case finding partner
Total reimbursed (BDT)
Blind children found
Reimbursed per blind child found
Cataract blind children found
Reimbursed per cataract blind child found
CSF
22,012,048
10,492
2,098
3,439
6,401
Uttaran
9,699,355
6,433
1,508
1,517
6,394
YPSA
4,992
607
VARD
6,549,507
2,287
2,864
1,133
5,781
RDSS
9,569,689
2,018
4,742
1,046
9,149
CBR partners
848,594
1,438
590
1,147
740
Others
115,724
860
135
494
234
Sub-total
59,528,517
28,520
2,087
9,383
6344

21. Reimbursement of clinical partners for managing cataract in children.
Surgeries
Total reimbursed
Reimbursed per surgery
(BDT)
BNSB Mymensing
499
4,652,548
9,320
BJAKS
1,605
14,669,112
9,140
BNSB Moulavibazar
722
5,631,687
7,800
BNSB Dinajpur
3173
19,150,605
6,040
BNSB Khulna
2202
12,554,893
5,700
BNSB Sirajgang
5994
33,805,763
5,640
CEITC
2000
9,077,197
4,540
Islamia Eye Hospital
8398
36,965,653
4,400
Others
218
360,355
1,650
Sub-total
24,811
136,867,813
5,520

22. Beyond BCCC Unique programme for Child Cataract
Replicable in other Asian, African and LA?
200,000 cataract blind children globally
Development of more training centres
Technical input & collaboration –ICEH
Standard data recording forms and software available – childhood blindness & childhood cataract
Sustainability- Technical, managerial, financial

23. Thank you!