Chan Ngin was a commanding officer who led 200 brave soldiers fighting for freedom against the Pol Pot regime. In June 1982, he led a daring mission to suppress the remaining Khmer Rouge troops in a camp nearby. But little did he know that mission would end his military career. Ngin stepped on a land mine which saw his legs amputated above the knees at the Battambang provincial hospital. He then moved to his hometown in Kampong Chhnang province for retirement.
And years later, Ngin was again confronted by a different enemy which he was not trained for. He had cataract, an eye condition in which the lens becomes progressively opaque, resulting in blurred vision. Ngin was losing his sight, and it posed serious implications for his mental health. His eyesight was later restored at a mobile eye camp organised by the National Programme for Eye Health supported by The Fred Hollows Foundation. With his sight restored, Ngin regained his confidence and brave spirit.
Ngin had successful eye surgery. When asked who he was looking forward to seeing the most, Ngin quickly replied, “There is one person I want to see – my wife.” It is a beautiful story, isn’t it?
But Ngin’s case is not an isolated incident. A recent study found that 57,500 Cambodians become blind every year, up from 28,800 cases in 2000. And cataract has been identified as the main cause of avoidable blindness in Cambodia.
The 2019 Report of Cambodia’s National Rapid Assessment on Avoidable Blindness found that 92.2 per cent of all causes of blindness are avoidable, 80.9 per cent are treatable, and 5.9 per cent are preventable with primary eye care. Nine out of 10 people who are blind or vision impaired don’t need to be.
These have threatened the effort of the Cambodian government to reduce poverty and achieve the Sustainable Development Goals by 2030.
A report of the International Agency for the Prevention of Blindness indicates that 90 per cent of those suffering from vision loss live in low and middle-income countries. And women are 12 per cent more likely to have vision loss compared to men. This same report also notes that free high quality cataract surgery has contributed to a 46 per cent increase in household income, and an 88 per cent increase in household expenditure per capita. These reassert that in low and middle-income countries, good eye health can lead to better opportunities in terms of livelihood and income.
Key achievements to date
The implementation of the National Strategic Plan for Blindness Prevention and Control 2008-2015, and its subsequent 2016-2020 iteration, has laid the foundation for the eye healthcare services that Cambodians enjoy today.
The annual cataract operations have increased from 16,667 in 2009 to 41,864 in 2019, resulting in an increase in the country’s cataract surgical rate – from 1,182 per million population in 2009 to 2,791 per million population in 2019. This means more Cambodians with cataract are getting sight-saving treatments.
The Kingdom has successfully eliminated trachoma in 2015, and this was officially announced by the World Health Organisation (WHO) in 2017.
The health decentralisation policy reform has further strengthened the governance and institutional arrangement of health sector in Cambodia. The recent plan to transfer 20,000 medical personnel and allocate $166 million to each capital and provincial health unit will address the unequal distribution of health workers in urban and rural areas. And it will bring quality health services closer to the community members in rural Cambodia.
The Kingdom has also demonstrated a strong commitment to strengthen equitable and affordable healthcare services. The adoption of Health Equity Funds and the National Social Security Funds have enabled the most at-risk community members to access eye healthcare services across the country.
The implementation of a standardised and integrated Health Information Management System has made evidence-based decision making possible and easier in Cambodia.
The University of Health Sciences has established ophthalmic nurse and ophthalmology residency training programmes and provided scholarships to a new generation of dedicated health workers. And the Ministry of Education is planning to design and include eye health into the school curriculum to strengthen awareness among teachers, students and their parents.
Challenges along the road
The growing aging population and longer life expectancy means a stronger investment in the eye health sector is needed more than ever. Modern equipment and facilities are needed throughout the country and will require more financial resource from the government and development partners.
The shift towards unhealthy lifestyle habits among Cambodians increases the likelihood of diabetic retinopathy – an eye disease that can cause blindness. WHO has estimated that Cambodians with diabetes could reach 317,000 by 2030, which means that more people will experience vision impairment or loss.
Like other countries in the region, the Kingdom is struggling to ensure that the trained health personnel are willing to work and stay in rural countryside.
There is a hope in sight. Cambodia is about to launch the National Strategic Plan for Blindness Prevention and Control 2021-2030 which aims to strengthen the eye health sector for the next 10 years.
Good eye health is essential for poverty reduction and gender equity. And Cambodia is committed to end avoidable blindness by 2030.
Tokyo Bak is Cambodia Country Manager of The Fred Hollows Foundation, an international eye health organisation working to end avoidable blindness in more than 25 countries.