Increasing access to Diabetic Retinopathy Services in Rural Myanmar WDF18-1634

Objectives

To pilot integration of a primary health care level eye care model within the WHO-PEN model in four townships in Myanmar.

Approach

The proposed project will engage the MOHS in demonstrating a replicable model for integrating DR screening, referral and treatment services into Myanmar’s existing public health system. It will link an existing Secondary Eye Center (SEC) based in Sintgine, which provides services at the district level with tertiary facilities to build capacity for more localized DR management, including laser treatment and administration of Avastin as appropriate.

The project will establish a network of trained Health Assistants (HAs) who will conduct screening and rudimentary grading at Rural Health Centres (RHCs) using portable fundus cameras on a rotational basis among four townships to provide monthly screening in each location during established NCD PEN clinic days. At the community level, the project will work with Basic Health Staff (BHS), using the WHO PEN package, already endorsed by the government of Myanmar and rolled out in some areas. BHSs will provide counselling to diabetic patients on diabetes management, including the importance of annual DR screening.

Furthermore, at the community level the project will engage with existing, government-recognized VHWs, who will raise awareness about the prevention and management of diabetes within their own villages. These VHWs will work closely with BHS and encourage patients at risk of diabetes to seek care, while also following up with current diabetic patients. Existing religious and community organizations will also be engaged in awareness-raising activities. At the national level, the project will develop a National Guideline for DR management to ensure that quality secondary and tertiary services are provided consistently and equitably across Myanmar

Expected results

• 380 HCPs (360 BHSs and 20 HAs) and 280 VHWs trained, representing 24 primary level clinics; one secondary level hospital and 4 township hospitals strengthened.
• 10,000 patients screened for DR, 5,000 patients referred for further assessments, and 1,250 patients treated.
• Estimated 35,000 diabetes patients provided with improved care