China has nearly a quarter of the world population and economic, social and political changes have made a major impact on health and health care. The disease burden in China has shifted from communicable to non-communicable diseases and injuries. According to the World Health Organisation (WHO) Chinas complex health financing system and long-standing underinvestment in public health services results in huge inequalities between eastern and western china, rich and poor and urban and rural population. Non-communicable diseases and injuries account for over 80 % of deaths in China. In 2012 the International Diabetes Federation (IDF) estimated 92.3 million people in China to be living with diabetes and the diabetes prevalence among the adult population is thus 9.42 %. It is estimated that half of the affected people is undiagnosed and over 1 million deaths in China is attributable to diabetes. In Liaoning province there are numerous large hospitals in big cities that provide advance prevention and treatment services for diabetes and diabetic eye disease patients. However, it is weak in the health service institution and health clinics in rural areas.To set up a low-cost, high-quality, duplicable and sustainable screening pattern for diabetic eye diseases based on county-level hospitals.
With support from the Ministry of Health of P.R. China, Liaoning province will construct a network to improve the prevention eye diseases at basic levels. Shenyang He Eye Hospital (SHEH) will set up a screening pattern for diabetic eye diseases in co-operation from country-level hospitals. To achieve the project objective the project will screen and refer people living with diabetes with eye diseases through a tele-ophthalmic system and raise awareness for diabetes related eye diseases among the general population.To ensure screening and referral mechanisms the project will provide fundus cameras to each of the co-operative hospitals and provide two week training for a minimum of 3 ophthalmologists at the hospitals provided with a fundus camera. The cameras are to be used to provide free photographs in rural areas. An experienced reader should interpret and identify diabetic retinopathy (DR) or suspected DR in the photos. Complicated cases will be offered consult and treatment on-line through the tele-ophtalmic system by forwarding the patient record to experts in SHEH. Additionally a two day training seminar on diabetes and ophthalmology will be provided to train 100 grassroot doctors from community health centers and rural areas. After training, the doctors are expected to obtain knowledge of diabetes and eye diseases, as well as carrying out eye screening activities for local people on regular basis to identify people living with diabetes to be able to refer the patients to screening activities at country level. The referral channels of the project will be built on existing health care networks in the country.To raise awareness for DR among the general population the project will educate relevant personnel to do public education for local residents during the screening sessions. People living with diabetes will be educated about prevention, life behavior/diet control, self-monitoring, drug therapy etc. People not living with diabetes will be educated to increase the awareness on diabetes and to advocate a healthy life-style. Large scale public education activities will also be organized by SHEH twice each year with 1,000 people expected to attend the activities each time.
· 20 county hospitals equipped· 79 county hospital doctors trained· 2,756 grassroot doctors trained· 153,896 people screened for DM & DR· 236,614 people reached through screening camps