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10 COMMUNITY EYE HE ALTH JOURNA L SOUTH ASI A | VOLUME 3 3 | NUMBER 110 | 2020
CASE STUDY: NEPAL
Rajendra
Gyawali
President: Better
Vision Foundation,
Kathmandu, Nepal.
Rabindra
Adhikary
Master of Optometry
Student: Tilganga
Institute of
Ophthalmology,
Kathmandu, Nepal.
Himal Kandel
Kornhauser
(postdoctoral)
Research Associate:
Save Sight Institute,
Sydney Medical
School, Sydney.
Allied eye health professionals in eye
care services in Nepal
eye care system is witnessing
including an increase in eye
hospitals and better cataract
surgical coverage.
Allied eye care professionals are engaged in the outreach eye camps in
remote communities in Nepal. NEPAL
I
care system has made remarkable
progress in reducing the magnitude
of blindness. Some of the achievements
include:
• A decline in the prevalence of
blindness from 0.84 per cent (1980) to
0.35 per cent (2019),
1
• Increased cataract surgical coverage
(for people with visual acuity less than 3/60) from
35 per cent (1980) to 85 per cent (2011),
2
and
• The elimination of trachoma as a public health
problem in 2019.
3
From just one eye hospital in 1980, Nepal today
has more than 40 secondary and tertiary hospitals,
ophthalmic departments and more than 100 district
and community eye care centres. The last three
development of the eye care workforce, making the
country self-reliant in most of the human resources for
its eye care services.
3
Allied eye health professionals
have played a major role in these achievements.
The WHO Global Action Plan 2014–19 recognises a
range of health care professionals as allied ophthalmic
personnel.
4
Ophthalmic assistants/technicians,
ophthalmic nurses, opticians, and ophthalmic
photographer/imagers are the major allied health
optometry technicians, orthoptists, vision therapists,
ocularists and dedicated ophthalmic administrators,
but in limited numbers.
Ophthalmic assistants
Ophthalmic assistants (OAs) form the backbone of the
rural eye care structure in Nepal, where the services of
to meet the need. Since 1981, over 1,000 OAs have
been trained to assist ophthalmologists in outpatient
departments, operating theatres and community
outreach camps.
3
and management of common eye conditions and
refractive errors. They also work as facility managers
in the district and community eye centres. These
are usually situated within the district headquarters,
especially in the remote, mountainous regions.
or community eye centres especially in remote,
mountainous regions.
Opticians
It is estimated that about 350 formally trained
opticians and an equal number of unregistered,
informally trained dispensers are providing spectacle
dispensing services in various outlets, mainly in urban
areas and southern plains of the country.
Ophthalmic nurses
An estimated 120 ophthalmic nurses currently serve
in eye hospitals and eye departments, assisting
ophthalmologists in operating theatres and pre- and
post-operative care. Ophthalmic nurse training is not
available in Nepal, and the hospitals recruit general
nurses, who gain in-service exposure to become
ophthalmic nurses.
Other allied eye care personnel
The ophthalmic photographers do not have a formal
training programme. Currently, about 15 OAs with an
exposure and experience in clinical photography are
present at major eye hospitals. Similarly, an estimated
REIYUKAI EYE HOSPITAL
BETTER VISION FOUNDATION NEPAL
Figure 2 An
ophthalmic
Assistant
performs
refraction in a
school student in
a community eye
centre.
COMMUNITY EYE HE ALTH JOURNA L SOUTH ASI A | VOLUME 3 3 | NUMBER 110 | 2020 11
20 orthoptists (ophthalmic assistants trained for a
availability of hospital management training in the
country, the number of eye hospitals run by trained
managers or administrators is gradually increasing.
supporting roles at hospitals and eye care centres
across the country. The training for these workers is
not standardised, and are based on the needs of the
eye hospitals.
Challenges
• Equitable distribution of the workforce is one of
the major challenges faced by the allied eye care
personnel. For example, the Karnali province, the
least developed regions in Nepal has 17 OAs (1
OA per 90,000 people) compared to 210 (1 OA per
30,000 people) in Bagmati pprovince. A similar
pattern is likely for opticians and other allied eye
care personnel.
• There are concerns about the retention of these
professionals. Of the 1,025 registered OAs, only 625
are estimated to be active in the eye care sector.
Factors such as poor job satisfaction, low salary
and other incentives, lack of career growth, and an
inappropriate match between the skills they have
and those that the job demands may be responsible
for demotivation and high attrition.
•
services has also led to fear about job security
among all levels of the ophthalmic workforce.
• Training programmes for several of these
personnel are not available in the country, and the
programmes (e.g., optician and orthoptists) that are
available are sporadic and lack standardisation.
Opportunities
Despite these challenges, several opportunities exist
to maximise the contribution of the allied ophthalmic
personnel to eye care in the rural areas of Nepal. The
National Ophthalmic Health Policy 2017 envisages
integration of primary eye care into the existing
primary health system, although this has not yet been
implemented. The changing trend in eye diseases
presents further opportunities for these personnel
in primary eye care. Whereas cataract and refractive
errors are major causes of vision impairment, the
rising burden of diabetic retinopathy, glaucoma and
other age-related eye diseases demands mobilisation
of allied health personnel in awareness creation,
early detection and primary prevention activities in an
integrated health system. It is also encouraging to note
that new training opportunities are being standardised
for opticians.
Conclusion
Allied ophthalmic personnel in Nepal have made
However, their reach to the rural areas beyond district
headquarters, is limited due to lack of integration into
the existing primary health care system. Government
job opportunities, standardised training, career
opportunities, and incentives can help address the
inequitable distribution and concentration of these
personnel in urban regions. Further investigation is
of these professionals, as well as the factors associated
with their recruitment and retention within the
References
1 Nepal Netra Jyoti
Sangh. Epidemiology
of blindness: RAAB
survey report. 2012
http://nnjs.org.np/
[accessed 20 January
2020]
2 International Agency
for the Prevention of
Blindness (IAPB).
Nepal eliminates
trachoma
https://
www.iapb.org/
news/nepal-
eliminates-
trachoma/
[accessed
22 January 2020]
3 Singh SK, Thakur S,
Anwar A. Nepal:
self-reliant in
ophthalmic human
resources. Community
eye health. 2018;
31(102): S9.
4 World Health
Organisation. Universal
eye health: A global
action plan 2014-2019.
2013
https://www.
who.int/blindness/
actionplan/en/
[accessed 18 January
2020]
RABINDRA ADHIKARY
Figure 3 Most
opticians in the
rural areas rely
upon manual
edger for
spectacle tting.
