Some estimates suggest that the prevalence of diabetes in Fiji may be as high as 16%. Since access to diabetes care and management of complications in particular is not widely available, this means that around 80,000 people may be at risk of diabetes related complications such as diabetic retinopathy.Diabetes related eye diseases like diabetic retinopathy are a significant cause of blindness and vision impairment in Fiji. The Fijian government recognises this, and in 2004 the Ministry of Health adopted a National Eye Health Plan, which aims at eliminating blindness by improving eye care services, training health personnel and strengthening infrastructure and policies.The project is aligned with the National Eye Health Plan and the Ministry of Health is supporting the Pacific Eye Institute in its endeavours to improve access to eye care services especially among the poor and those living in rural areas.The aim of the project is to improve access, quality and reach of eye care services in Fiji.
The project is implemented by the Pacific Eye Institute (PEI) with the support of the Ministry of Health. Other partners include the Fred Hollows Foundation New Zealand and the Fiji National Diabetes Foundation.The project will establish a new, permanent diabetes eye clinic at the Colonial War Memorial Hospital in the capital Suva. The clinic will be properly equipped and 22 members of the health personnel will be trained in screening and management of diabetes eye diseases as well as patient education.In addition, an already existing diabetes eye clinic in Lautoka will be upgraded with proper equipment.To fill the gaps in the existing services, referral, recording and recall systems will be developed. Activities include recording of patient information, establishment of referral pathways and annual recall for eye screening of diabetes patients.In order to further improve the delivery of diabetes eye care, standard guidelines and care protocols on diabetes eye care will be developed and implemented in the clinics.When these guidelines and systems are in place and the two diabetes eye clinics are up and running, screening of patients will be initiated at the clinics as well as via mobile outreach services. The central and eastern part of the country will be covered by outreach activities conducted by the Colonial War Memorial Hospital whereas the clinic in Lautoka will serve the western part.At least 120 outreach screening visits to primarily rural areas will be carried out. Mobile units will be equipped to provide care in the field. At least X annual visits will be made by mobile unit to each sub-divisional hospital targeted from Suva. The outreach visits will be conducted on a monthly basis and will thereby make diabetes eye disease related services available to people who could not otherwise access these services. The people reached through these visits will be screened for eye diseases and offered treatment for their disease. All patients reached either at the clinics or through the outreach visits will receive the services free of charge. It is expected that 12,875 people will be screened at the clinics and another 11,625 will be screened during the outreach visits.Independent of the project, from 2010 onwards, PEI will run 6-month postgraduate certificate courses in diabetes eye disease diagnosis and management for Fiji HCP thereby further strengthening and maintaining HR capacity in this area.Advocacy and awareness raising campaigns targeting media, general public, health leaders, GPs and politicians on diabetes and diabetes eye care will be carried during the project period.
• 1 new eye clinic has been established at the Colonial War Memorial Hospital in Suva (Central Division) and 9 outreach centres have been established.• 1 existing eye clinic has been upgraded (Lautoka, Western Division)• 9 doctors and 19 nurses have been trained in diabetes eye detection and management, aggregated 28 health care professionals• Referral system established• Standardised guidelines (Diabetes Retinal Screening Grading and Management Guidelines for Use in Pacific Island Nations 2009) have been developed and put into use in Suva. The guidelines form the basis of the six-month Postgraduate Certificate in Diabetes Eye Care training programme at the Pacific Eye Institute (qualification awarded by the Fiji School of Medicine).• 418 outreach visits have been conducted.• 27,190 people have been screened at the established clinics and outreach clinics. 10,875 people have been detected with DR of whom 2,260 received laser treatments.