Eye Care Situation Analysis of Nepal

Overview

The Ministry of Health and Population has published a report titled “Eye Care Situation Analysis of Nepal.” The reports provides a comprehensive situational analysis of the health system framework for eye care.

Summary

The Eye Care Situation Analysis Tool (ECSAT) is one of four tools in the Eye Care in Health Systems: Guide for Action that WHO launched in May 2022 to assist countries in planning eye health services. ECSAT is a standardized tool designed to support countries in planning, monitoring trends, and evaluating progress towards implementing Integrated People-Centered Eye Care (IPEC). It was recently updated, comprising 31 components, and assesses the systems approach for eye care across six health system building blocks: leadership and governance, service delivery- access, service delivery- quality, human resources and infrastructure, financing, and information systems. Each of the 31 ECSAT components includes a questionnaire, a maturity scoring system, and a set of possible actions. The maturity scoring system helps identify components of eye care that may be prioritized in the planning process.

As a member country, Nepal is taking the lead in implementing ECSAT under the guidance of the Ministry of Health and Population. It is the first country to implement ECSAT at the national level and is actively providing constructive input in software development as well. The objective of ECSAT is to undertake a comprehensive situational analysis of the health system framework for eye care.

A cross-sectional survey was designed to implement an ECSAT survey under the leadership of the Ministry of Health and Population. The Steering Committee on Eye Health and the core technical team, endorsed by MOHP, along with the national coordinator, guided the process. The ECSAT technical working group, consisting of members from MOHP, WHO, WHO CC Tilganga Institute of Ophthalmology, and Nepal Netra Jyoti Sangh (endorsed by the steering committee), played a pivotal role in guiding the ECSAT process. Data and information were collected from various stakeholders and sourced from accessible outlets, and interviews were conducted, as necessary. Key informant interviews and desk reviews were carried out based on whether the required information could be obtained from accessible sources or if interviews were deemed necessary. Certain questions necessitated related documentation to validate responses. A series of virtual and physical meetings were held at the federal level to assess the eye care status in Nepal.

The collected information was entered into the software, and the technical working group, along with the consultant, determined the maturity level and actions for each indicator. A data validation workshop may be the most effective way to achieve this. The draft report underwent discussions and consensus within the TWG and was presented to the High-Level Steering Committee before finalization. The findings of the ECSAT assessment tool serve as a crucial document, providing a basis for evidence-based interventions at both policy and programmatic levels. These interventions aim to make eye health care services more affordable, accessible, and equitable within the federal system of Nepal.

Key reflections

• Leadership and governance: Strong leadership is evident, though political commitment could be stronger. Integration across health policies and programs is largely successful, with room for improvement. The report acknowledges strong leadership in the eye care program but suggests there’s room for improvement in political commitment and integration across different health initiatives. While access to services is generally good, it disproportionately affects disadvantaged communities. There’s also a concern that the quality of care is perceived as low due to a lack of well-established interventions.
• Eye care service delivery – access: Limited access to eye care disproportionately affects disadvantaged communities. This focuses on the disparity in access between different populations.
• Eye care service delivery – quality: The community lacks access to well-researched and effective eye care interventions. This has led to a perception of low quality and limited effectiveness.
• Eye care workforce and infrastructure: The team is adequately staffed, with some flexibility to accommodate occasional shortfalls or surges in workload. The necessary infrastructure and equipment are largely available to ensure effective service provision. Spectacles need to be recognised as medical devices. The eye care team is adequately staffed and equipped to handle current needs. However, financial barriers remain a major challenge, especially for low-income patients and those requiring ongoing treatment. The current health insurance plans don’t fully cover eye care costs, including the cost of spectacles, highlighting the need for a more comprehensive financing strategy to improve accessibility and affordability of essential eye care resources.
• Eye care financing: Eye care costs create a financial burden for many. While some health insurance plans cover vision care, these plans often don’t fully address the needs of low-income patients or those requiring ongoing treatment. This highlights the need for a more comprehensive approach to integrating eye care financing into the broader healthcare system.
• Eye care information: A critical need exists for improved data collection on eye care. Limited reporting from the national HIS hinders our ability to assess service utilization, outcomes, and quality. There’s a critical need for better data collection within the eye care program. The current limitations in reporting hinder the ability to assess service usage, treatment outcomes, and overall program effectiveness.

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