BLINDNESS IN

INDONESIA

Farida Sirlan

Definition
WHO: < 3/60 - 3 m finger
counting
6/60 - 6 m finger
counting

Blind prevalence
0
( /0)
1996
Visual impairment
Severe visual imp.
Blind
1.50

1.80
1.10

Blind Prevalence (%) Based on Age

Group, Gender and Education
Variable
Total

Prevalence (%)
1.5

Age Group
0-4

0.5

5-9

0.2

10-14

0.1

15-19

0.4

20-24

0.6

25-29

0.4

30-34

0.8

Continue

Variable

Prevalence (%)

40-44

0.9

45-49

1.6

50-54

2.3

55-59

3.9

60-64

6.5

65-69

7.7

70-74

11.5

75

18.4

Gender
Male

1.3

Female

1.7

Continue

Variable
Education

Prevalence
(%)

Illiterate

2.9

Elementary school -

1.2

Elementary school

1.5

Junior High school

0.8

High school

0.4

Academic +

0.3

Blind Prevalence (%) Due to

Area and Province
Variable
Area
Rural
Urban
Province
West Sumatera
South Sumatera
West Java

Prevalence (%)
1.1
1.7
0.7
1.8
1.1
Continue

Variable
Central Java
East Java
West Nusa Tenggara
North Sulawesi
South Sulawesi

Prevalence
(%)
1.5
1.2
1.2
2.1
2.7

Blind Prevalence
(%) Due to the
Cause
Cause
Lens
Glaucoma
Refractive
Retinal
Corneal
Others

%
0.78
0.20
0.14
0.13
0.10
0.15

Distribution (%)
Cause of Blindness
Cause
Lens
Glaucoma
Refractive
Retinal
Corneal
Others

%
52.0
13.4
9.5
6.4
6.4
10.2

Trend of Blindness 1982-1996

Cause of blind 1982
Infection
Malnutrition

Cause of blind 1996

Degeneration
Retinopathy

Why Blindness ?

Lack of knowledge of the blind people

Lack of health priority and political will
Lack of awareness of the professional
Geographically difficult

Magnitude of Blind

1.5 million backlog of cataract blind

210.000 new cataract blind per year
420.000 people blind of glaucoma
300.000 people blind of refractive errors
275.000 people blind of retinopathy
210.000 people blind of corneal diseases
0.3%ofchildern.. Children blind

Government Policy
for Blindness
Blindness problem is under 2 DG MOH
Prevention of Blindness Committee,
report directly to Minister of Health
Inter Ministry Collaboration
MOU with NGOs
Program priority
Vision 2020, the right to sight

Program Priority
due to Blind
Cataract blind
Refractive
errors
Glaucoma
Retinopathy

Why priority?
Cataract blind
Avoidable
Refractive errors
Glaucoma
Unavoidable
Retinopathy

Cataract Blind Program

in Indonesia
Central level
Provincial level
District level
Community level

CENTRAL LEVEL
Ministry of Health: priority , political will
Ministry of Internal Affairs: depend on
approach
Ministry of Social welfare: depend on
approach
NGOs: depend on regional country
director/regional consultant / adviser

INDONESIA
Prevention of Blind Committee

National

Forum of cat.blind eradication

Province

Forum of cat.blind prevention

District

Team of cat.blind screening

Sub district

PROVINCIAL
LEVEL
Teaching hospital / University
Provincial Health Office
Residency training program
Community Eye Care Institution/BKMM
Professional Association
NGOs role

West Java Forum

Eye Camps
Affordable cat surgery
hospital based surgery
$ 20
Cross subsidy

DISTRICT LEVEL
District Health Office
District Hospital
equipment
subsidy
outreach service
eye camp

Ophthalmologist
awareness
skill
facility

Cataract Blind
-

52% causes of blindness

Starting at productive age
Avoidable blind by surgery
Cataract surgery is not
equitable, available,
accessible and affordable yet

Cataract Blind
Magnitude
0,78% population or 1,5 million cat.backlog
1 population
or 210.000 new cases
Cataract Surgical Rate
=
350/million/year
Target of cat.ops
= 210.000/year
Coverage
up to 2000 = 60.000/year

Barriers
Lack of
Hospital is

- knowledge
- awareness
not available
not familiar
not accessible

PROBLEM SOLUTION

1)
2)
3)
4)

Advocacy
Promotion
Training
Screening

5) Surgery:
- Cross subsidy
- Hospital base
- Eye camps
6) Patient satisfaction
7) Monitoring/evaluation

ADVOCACY
Ministry of Health increase
priority as training center
Province/local gov. forum as
referral hospital
District level forum district
as program coordinator
Sub district level key person,
GP, nurses, health cadres
as technical assistance

PROMOTION

Leaflet
Booklet
Books
Manual

UKMPK
PKKP
UKS

TRAINING
GP
Nurses
Cadres
Funded by : MOH and CBM
GP
MOH
CBM

Nurses

Cadres

SCREENING
Eye camps team
Health Centers
Head of Sub district
Cadres

Cross Subsidy 2001

Subsidi dampak BBM/PDPSE
JPSBK
Government

Non Government

Local Govern. Dharmais

MOH MOA

CBM

Dharmais CBM

Rotary
Rotary

Lions
Lions

TRAINING CENTER
CENTER
TRAINING

Eye care management

camps
counseling

Eye care team

Microsurgery course
High volume, high quality surgery

Cost of Blind
Before
Surgery

After
Surgery

Cost of
Surgery

Lost of
productivity

$ 20
consumable

Need
guidance

$ 20 others

ADL
$

$ 40

Cicendo Eye Hospital

Cataract Surgery Cost

$ 100 350
$ 20
cross subsidy (paid)
$ 40

Blind due to refractive errors

9.5% of blindness
Main cause is amblyopia and high
myopia / degenerative myopia
Screening at school age group
Providing affordable glasses
Training for teachers and paramedical
Primary eye care program

Blind due to Glaucoma

13.4% of blindness
In Indonesia mostly open angle glaucoma
Usually come in acute attack stage
Need early detection and screening at the
people over 40
Need promotion and training for primary
eye care program,GP from health centers

Blind due to Retinopathy

Mostly due to Diabetes Mellitus

Usually come at DR ll lll stage
Lack of awareness of the patients
Need promotion and early detection
Need training for GP from health centers
Not all hospital provide retinal services
and treatment

Children
Blindness
0.3% blind from children age group
The most important cause is amblyopia,
cataract congenital and retinoblastoma
Do not have yet the standard procedure
to treat children blindness
Still at low priority of blindness
Should develop pediatric ophthalmology

Xerophthalmia
1994 HKI present award for Soeharto
1997 monetary crisis
Malnutrition and xerophthalmia

Vision 2020, the right to sight

Reduce blind to 0.5% year 2020
cataract blind :
0.25% from 0.78%
other cause of blind: 0.25% from 0.72%
cataract surgical rate and coverage of cataract
surgery should increase 3 times as well as effort to
reduce the other blindness

THANK
YOU