Questions/Answers

There are about 253 million people live with vision impairment. Even more, 36 million are blind and 217 million have moderate to severe vision impairment. In the mean time, 90% of people with vision impairment live in developing countries. However if this situation keeps going without any action, the number of people with vision impairment could triple due to population growth. (WHO) Furthermore in South Sumatra, from 8.1 million populations, 1.7% and 0.4% of them suffer cataract and blindness. Subsequently, from 1.7% of inhabitants with cataract, 42.1 and 9% of them do not know their own condition and unable to pay for their treatment. By The high of vision impairment rate, shall be social problems needs to be solved in coordinately because Blindness and vision problems are physical limitations affecting psychological and socioeconomic conditions of the patients, families, and the neighborhoods. This effect then will diminish the society’s quality of life and its turn will impair the rapid of economic development in South Sumatra. Besides, it happens the increase of healthcare cost due to the implementation of high-technology, direct cash payment to the healthcare, also inflation, so that the government must find the appropriate solutions to solve this. In accordance with the issue above, 1. Ministry of Health has compiled the Strategic National for Overcoming the Vision Disorder and Blindness in 2005. This effort is in line with the commitment of 2020 global Vision: The Right to Sight, promoted by WHO, that expects every citizen has the right to obtain optimal vision in 2020. 2, The Local Government has developed structural system through Integrated eye care service program initiated by Eye Hospital that is based health service should be implemented in comprehensive and integrated. The most importantly, the service should be easily accessed to reach and affordable for poorest

20.3 % from total of inhabitants in South Sumatra at the age of 14-45, of them wear glasses. According to data collected from 1.6 million students, 87.5% are unable to buy glasses. If this condition keeps going, it will affect kids’ intelligence development.. South Sumatra owns region area of 87.017.41 km² by 17 city and regencies and total villages are 3232, then it causes backlog (cataract patient’s accumulation) at rural area, and furthermore the total poor people in South Sumatra per March 2017 about 13.19% of total inhabitant and about 67.58% of them live in rural areas. The overall objectives from this initiative is providing eye care services for poor people across South Sumatra's, such as free screening and cataract surgery, with the integrated services in eye healthcare and also. The main target of this initiative is who experience difficulties in accessing eye healthcare services. These groups are predominantly poor people, elderly people, productive age group and other vulnerable groups. This program is expecting to eliminate blindness, to improve the quality of life the cataract patients and to alleviate the household burden due to blindness, while at the same time trying to increase the welfare of patients and their family

This initiative relevant with one of the selected category, because priority from this initiative is aimed to reach and ensure poor people’s and most vulnerable rights in accessing eye health care and improve their lives quality. This initiative project is initiated by Eye Hospital of South Sumatra that is based on a dogma stating that health service should be implemented in comprehensive, integrated, equal, accessible and qualified way. Furthermore, to expand the outreach of poor people healthcare across South Sumatra's countryside, this initiative offers both extensive facilities and flexibility. An optimization mobility partnership was conducted to reduce the number of blindness in South Sumatra during 2012, Eye Hospital of South Sumatra Government as the leading sector for Blindness Prevention and Eradication established the Blindness Prevention and Eradication Committee which consist of institutions across sectors, such as South Sumatra Provincial Health Office, NGO;s and Indonesian Ophthalmologists Association

1. (Goal 3) 3. 8. Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all; Since cataract takes the largest proportion to the number of national blindness, then cataract surgery is the most possible prevention strategy to blindness caused by cataract. Thus, by this program (Integrated eye care services), cataract surgery can be intensively conducted across South Sumatra. Evenmore, the cost of the surgery will be free covered by Local Health Insurance, namely Jamsoskes Program. By using Jamsoskes, it will cover all treatments of all the poor people in South Sumatera. Thus, the poor people will get equality based health service especially eye treatment since almost all of their medical-indicated surgeries are covered by Jamsoskes program. 2. (Goal 5) 5.5. Ensure women’s full and effective participation and equal opportunities for leadership at all levels of decision-making in political, economic and public life; Human resources data shows that there are 168 employee, 54 Man and 116 woman. Meanwhile, the 12 ophthalmologists consist of 8 Woman. The equality aspect in this initiative is applied. Woman officers role as the main initiator in this initiative

The most critical problem is the decentralized and commercial facility of eye care service with high tariff such as for ophthalmologists examination and LASIK surgery. In addition, cataract surgery is not so affordable for poor people condition and most vulnerable cannot even afford it, they lack access towards advanced health service in secondary and tertiary health care, including eye health service and cataract surgery. In addition, the scarcity of ophthalmologists and eye health care facilities in district hospitals made the blindness rate even worse. The high rate of blindness caused by cataract also results social problems that need to prevent, because cataract will disturb the patients’ productivity and mobility. This disorder will also cause social-economical effect in citizens. This effect then will diminish the society’s quality of life and negatively affect the rate of economy development in South Sumatra. Therefore, to reduce the blindness and visual impairment rate in South Sumatra. the Governor has stipulated Integrated eye care services and Eye Camp (IE Care & EC) program through Eye Hospital of South Sumatra. This initiative provides community-based eye health care, including eye screening and cataract surgery for poor people, elderly and those who live in remote areas

South Sumatra owns region area of 87.017.41 kilometers square by 17 city/ regencies and total villages are 3.232. People had limited access to blindness prevention services. It was difficult to the elders, women with children; people live in remote areas, the poor people, and people with disabilities to perform eye care and cataract surgery because they need to travel to secondary and tertiary health facilities located in the city areas. Therefore, they could not afford to pay for transportation, accommodation. Moreover, they must take a work absence and lost daily income. It was a costly option to conduct an eye health care procedure for people in South Sumatra who live spread in 3.232 of villages. To perform that wide distribution of eye services, this initiative implemented by using one of the program from this initiative, namely Filtering Program/Eye Camp means the mass-roving eye healthcare held routinely every year throughout remote areas in South Sumatra. Eye camps are held evenly in South Sumatra in 2014 – 2015 occurs the decrease of surgery is about 33% to 1.260 patients in 2014 and 680 patients in 2015 (report data). It means the Eye Camp program is significantly reducing backlog (cataract patient’s accumulation)

Blindness has decreased productivity and life quality of the patients and their family, hence creating social and economic problems. To solve this problem, South Sumatra government through Eye Hospital introduced; 1. Integrated eye care services and Eye Camp (IE Care & EC), This initiative constitutes facilities for entire public in all social classes who wish to gain the integrated, comfortable and low-cost eye healthcare. The low-cost means, for LASIK surgery in this hospital is the cheapest throughout in Indonesia. Moreover, this program is free of charge for all the poor, elderly and those who living in remote areas in performing cataract screening and surgery 2. Jamsoskes Program, it will cover the treatments of all the underprivileged society. Thus, the poor people will get equality based health service especially eye treatment. 3. filtering program (Eye Camp/EC) which applied wheel system, that means to expand the outreach of public health across South Sumatra’s and to simplify health service access through performing surgery outside the building. The provision of EC is more practical, effective and efficient than build a surgery room in public health centers. and this program also routinely collaborates with NGO's and other private sector

The initial approach for blindness prevention in South Sumatra was started in 1995, which was established by several stakeholders, with stipulated The Hall of the Eye Care before the structural bureaucracy changed to be Eye Hospital of South Sumatra's. The main activities were providing public eye health care services for poor people, such as free screening and cataract surgery. However, this program had not been optimally conducted in lowering blindness prevalence in the region since it lacked full support from South Sumatra Provincial Government. An optimization strategy was conducted to reduce the number of blindness in South Sumatra started from 2012. South Sumatra Provincial Government has stipulated the Establishment of Committee of Blindness Disorder Prevention in South Sumatra in 2012 under the Decree of Governor Number 813/KPTS/DINKES/2012. In relation with the decree, South Sumatra Eye Hospital had stipulated as the referred hospital to blindness prevention in across South Sumatra

1. Human Resources : The main motor is all Eye Hospital employees, appropriate with organization structure and respective duties and functions, who synergize with functional groups like medical, nurse paramedic and non-paramedic also administration personnel, Then, a team that composed of representatives from the structure organization hospitals and other sector perform in-depth evaluations on the eye health issues to the patients and families. Improving the quality and quantity of human resources. It has been done by organizing capacity improvement, including doctors and nurses' training. The curriculum focused on finding cataracts cases and following up post-surgery treatment. Moreover, Eye hospital of South Sumatra has promoted empowerment by involving students and young generations in early detection of blindness. 2. The mobilization of financial resources. held by hospital budget, NGO, supported by local budget funds plus Corporate Social Responsibility fund from the companies to cover operational costs

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Opportunities for the replication of this initiative; IE Care & EC has received visits from several other regions in Indonesia such as Regency of East Oku, Nusa Tenggara Barat Province, City of Makassar, City of Medan, Kalimantan Province, City of Surabaya, etc. to conduct a comparative and cooperation study in Eye Hospital The outline of the opportunities to replicate this initiative are 1. The existance of will (desire and willingness) 2. It is easier to replicate when the services are one kind. 3. The synergy between, a. Potential (optimal human resources and other resources), ideas, technology and budget b. and authority (the role of stakeholders), the use of regulation and reward of policy formulation and taking initiatives replication appropriately to the existing conditions

This initiative is being developed and will be continued, certainty that this initiative will be sustained namely, Certainty in the field of public health; Blindness and visual Impairment problems are physical limitations affecting psychological and socioeconomic conditions of the patients, families, and the neighborhoods. Furthermore, blindness makes the patient has certain limitations to work, hence affecting their domestic condition. In addition cataract is the largest contributor to the problem of blindness community and is a degenerative process that is influenced by factors of age, therefore this case will continue to increase in line with the increasing number of elderly people, and the activities of this initiative is in line with Indonesian Government attention by Ministry of Health has compiled the Strategic National for Overcoming the Vision Disorder and Blindness in 2005. This effort is in line with the commitment of 2020 global Vision: The Right to Sight, promoted by WHO, that expects every citizen has the right to obtain optimal vision in 2020, this initiative will continue to be developed either by the improvement of facilities and infrastructure and the quality of human resources, to the institutional structure in Eye Hospital

When low cost projected started, the program has provided economic benefits, for example to perform Lasik Surgery approximately USD 480 to one eye, its the cheapest Lasik in Indonesia ; (1) Equal distribution of eye health care services in South Sumatra province. Qualitatively, the direct benefits perceived by the public are equality of eye health care services because they are accessible to all society. Furthermore, a family that is free from blindness is reducing family’s burden, increasing the productivity of patients and their family members, preventing poor people from becoming poorer, and increasing family’s income level. (2) Increasing and strengthening the synergy between government and other organizations: private companies, universities, Non-Governmental Organizations (NGOs), and other communities. Corporate Social Responsibility (CSR) is also utilized to support Integrated Eye Care Services & Eye Camp (IEC Services & EC) 1. Regulatory sustainable, In order the service provided to the maximum local governments expected to play a role through regulatory support and adequate the Establishment of Committee of Blindness Disorder Prevention in South Sumatra and the regulatory for local funding Hospital 2. Activities sustainable, The activity assurance with routine budget allocation, Integrated Eye Care Services & Eye Camp (IEC Services & EC) has started since 2012 in the line with the Governor service’s stipulation constitutes the sustainable services and budgeted activities annually for the service operational implementation

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In order to be more comprehending this initiative implementation, this initiative has a monitoring and internal evaluating to the achieved progress orderly, then this initiative gradually holds a monitoring review and evaluation for services unit performance, activity monitoring shall be done to identify the scheduled activity results, hospital management performs a monitoring, which functions as the controlling towards the conducted service activity’s implementation.Monitoring and evaluation activities become very significant for assuring the activity implementation, whether the scheduled activities has carried out as their tracks, what kind constraints are experienced, and etc., regarding the conducted monitoring and evaluation shall be focused to: 1. INPUT : the Budget has been compiled in the Budget Business Plan (RBA/Rencana Bisnis Anggaran), human resources and means & infrastructure 2. PROCESS :work plan,public service accuracy 3. OUTPUT : prime services, reachable to all public levels even most vulnerable

Below are IEC Services & IC outcome according to evaluation program : Significant improvement of cataract patients' health condition Cataract Surgical Rate (CSR) is a cataract surgery number per one million populations per annum. CSR is an indicator to measure the success rate of cataract blindness prevention program by IC. In 2015, the medical record data shows the patient visit’s increase for medical treatment at Eye Hospital by totally visit is 51.546 patients from the said amount is more less about 75 % of the poor people using the Jamsoskes program. Thus this initiative may fulfill the public requirement upon the eye health’s importance also the higher of inhabitant efforts to gain optimally life quality, includes having better vision, furthermore Based upon the medical record data indicates that patient visit from 2013 until 2015 averagely about 1.4 - 2% annually, for the latest 2 years are having visit increase about 2.3%. Regarding Eye Camps are held evenly in South Sumatera on 2014 – 2015 occurs the decrease of surgery realization is about 33 % namely 1260 patients in 2014 and 680 patients in 2015. It means the Eye Camp program is significantly reducing backlog (cataract patient’s accumulation) in South Sumatra

The key point of this initiative is a routine activity for all officers. The activity includes providing excellent service - in this case easy, affordable and even free, comprehensive and integrated eye treatment service- to society in all social classes. In order to support the fluency of implementation of service in this initiative program, there are several stages: 1. Performance Review, It is functioned as reporting unit from each activity. This unit will report the synergism, coordination, available monetary resource, condition and situation of the activity. 2. Planning, The following activities are conducted in order to compile the planning: 1) Technical meeting of management and planning division 2) Continuous planning compilation for Capacity Building 3) Expert meeting with certain topics 2. Organizing, The corresponding units share their roles to reach the stipulated goal 3. Implementing, 1) All units, by their own job desks, implement the initiative (inside the building) 2) Compiling budget allocation of filtering program / eye camp, stipulating target, and decreasing the number of backlog 4. Supervising, Conducting monitoring and evaluation program to supervise the service activity

In the beginning for making the low-rate and free of charge for poor people is the idea of South Sumatra Governor of which in accordance with the visions of South Sumatra Province’s Governor are namely, SOUTH SUMATERA IS MORE ADVANCE, AND INTERNATIONALLY COMPETITION”; As an effort to accelerate the reduction of blindness rate, this program involves several stakeholders. Each of them has different roles and responsibilities, as follows: (1). South Sumatra Provincial Government as initiator, policymaker, primary contact as well as the fund provider. The local government has responsibility to fulfill public rights, including equality of opportunity to access eye health care services. Hence, they require to allocate budget and prepare policies to implement this initiative. As an executor, the government should conduct advocacy, dissemination, coordination, synchronization of activities and foster partnerships with other stakeholders. (2). Indonesian Ophthalmologists Association as an active party in conducting advocacy, dissemination, health promotion and providing competent specialist doctors. (3). Public Health Centers as a unit that directly delivering the services to the public. They are carrying out pre-screening activities, facilitating the filtering process and undertaking examination of cataract post-surgery. (4). Family Welfare Development team as a structural unit in hospital that facilitates public health activities to educate people on how to prevent and cure blindness caused by cataract. They also perform pre-screening along with the public health center. (5). The corporations are actively involved in financing this WheRS program through their Corporate Social Responsibility budget as the contribution towards public health in the community

IE Care & EC brings lesson to society, specifically to poor and vulnerable people. From the activities' evaluation conducted in 2015-2016, the proportion who received cataract surgery about 95% of them are poorest. In addition, as a tropical country, Indonesian are more vulnerable to cataract disease. Unfortunately, the regular cataract surgery is expensive that make many people cannot afford to pay for medical treatments. Basic Health Research in 2013 found out that as many as 9% of cataract patients about 1240 patients in South Sumatra do not have money to perform cataract surgery. IE Care & WheRS has made the poor and vulnerable people, especially those who live in suburban to receive a cataract surgery free of charge. the common knowledge and goal will stimulate government by providing equitable eye health services to the whole society regardless their gender, social, and economic differences. In addition, the target has pushed down the treatment care borne by patients to the zero level treatment cost or free. Since everyone knows that the treatment if provided for free and without discrimination, no one is willing to bribe officials. It breaks the corruption chain that has been flourished in public service units