British Colombia Centre for Epidemiologic and International Ophthalmology.
The AI Noor-Magrabi Foundation is a charitable non-governmental organization dedicated to combating the needless blindness and supporting eye care services provided to deprived communities in Africa, particularly in Egypt and Sub Sahara.
The AI Noor-Magrabi Foundation is locally and regionally, affiliated to Magrabi Eye Medical Group and internationally, to the WHO and the International Agency for Prevention of Blindness (IAPB). The mission of the foundation is to provide leadership and demonstrate evidence-based approaches for alleviating the burden of blindness and visual disability.
The main targeted groups for the AI Noor work are health policy decision-makers in the national and international bodies interested in eye health, eye-care service providers, low vision persons and communities in rural and slum areas in Egypt. AI Noor-Magrabi Foundation as being dedicated to the activities of prevention of blindness and empowering community eye care in Egypt, and has set up its strategy focusing mainly on the main preventable and curable blinding diseases within the most at risk groups.
The main objectives for the AI Noor-Magrabi Foundation are to:
Build a detailed and updated situation analysis for eye care in Egypt through conducting action research and epidemiological studies.
Upgrade the quality of eye care services through capacity building and training offered to the main eye care providers.
Provide eye care services that have good quality, large volume and are self sustainable through the Charitable Hospital based in Cairo and through a program for outreach in different locations in Egypt.
Initiate an integral approach with action plans for care & rehabilitation of low vision and visually disabled persons.
Empower community awareness and behaviors related to the eye care through conducting awareness campaigns and health education.
Advocate for the prevention of blindness and for strategy and action plans among policy makers as well as community members.
The Model for Integral and self-Sustainable Eye Care:
As per the WHO global estimates, there are nearly 314 million persons suffer from visual impairment. Regionally, in the Eastern Mediterranean region, there are 36.3 million visually impaired persons. However, 75 % of this visual impairment could be treated, cured or prevented by highly cost-effective means.
Certain sources for data have been utilized to build up figures for eye care in Egypt. These sources are: National Census for Population (last done in 1996 and updated in 2004), Surveys for Eye Care in governorates of Menofiya 1999, Menia 2002, Fayoum 2004, Extrapolation for clinically-based data and the Ministry of Health records.
Based on those sources, Egypt has a total population of 75,000,000 million with rural communities of 56%. Life expectancy is 67 years. The overall prevalence of blindness is 1,1 % (Considering presenting vision in best eye < 3/60). Cataract accounts for 57.0 % of all causes for blindness followed by Corneal Opacity (13.0 %). The annual GDP loss from blindness & low vision is estimated to be over $170 million while the health expenditure within National Budget is limited to nearly 6%.
Total number of eye doctors is nearly 3000 doctors with only 40 % (1200) are doing Cataract surgery with Intra Ocular lens(IOL). Total surgery done /year for the year 2004 were estimated at 100,000 surgeries. Cataract Surgical Rate (CSR) for the year 2004 is estimated at 1400. As per the WHO estimations, the CSR for Egypt should range from 2000 to 3000. Consequently, a backlog for cataract surgery is significantly growing. Volume of surgery needed is estimated to be over 450,000 surgery (for blinding cataract) while the backlog for all cataracts would be over 1.5 million surgeries.
Main gaps in the current eye care in Egypt are created by the mal distribution of eye services between big cities and rural areas, the limited volume of service provided and the lack of integral system for rehabilitation and low vision care. The main barriers against the uptake of eye care services are the inaccessibility, in affordability and the low quality.
In view of these circumstances, Al Noor Foundation felt the need for setting up models for service delivery that would be capable of overcoming those barriers and providing service in large volume, high quality and meantime be self sustainable and subsequently established its project A Model for Integral and self-Sustainable Eye Care, which aims to establish an operational model for integral eye care delivered with good quality, high volume, self-sustainability and accessibility to all community members particularly groups deprived from service.
The objectives of the project are:
Provide eye care services with good quality in a sustainable way that include medical, refractive, surgical and rehabilitation services to communities in rural and slum areas in Egypt.
Build capacity of eye care providers including doctors, surgeons, nurses, technicians, opticians, managers and health visitors.
Advocate for eye health to be prioritized on the national agenda for health and lobby to mobilizing resources towards elimination of avoidable blindness on national level.
The project’s main idea is addressing the barriers that deprive poor and low income persons from getting good eye care services:
The mobile outreach team and satellite clinics with full equipment are a good mean to reach community members who could not be reached (out of reach) due to barriers of accessibility, affordability and acceptance. Medical and refractive services are provided at the spot while persons in need for surgical and rehabilitation services are referred to the base hospital in Cairo according to a certain arrangement and as per a definite schedule. One of the main barriers is the cost of services. With the project’s idea of having multi-tire levels for the cost (category A-full price, category B -subsidized price and category C – free) based on a process of social counseling, the category will be defined within the person’s capacity. Meantime with providing service for high volume, the revenues created from categories A & B could cover costs needed for the whole categories and allow for providing services for category C totally free. Having low vision and rehabilitation services available at the same facility within the base hospital helps providing better service for low vision and blind personsand low vision children to enhancetheir skills for reading and writing that allow them for inclusion in the mainstream education. Blind persons are able through training to obtain computer skills on their own with no more need for someone to help in reading or writing.
The Al Noor Magrabi Foundation’s proposal for eye care services would have a significant impact on improving the eye health throughout Egypt. There are currently hundreds of thousands of people throughout Egypt that need eye care, but several factors, such as accessibility and affordability, prevent life-changing health care from reaching the population. The AI Noor Magrabi Foundation’s proposal is a model that will provide eye health care in a comprehensive and sustainable way, which will work to truly reach the greater population in need. It contains innovative ideas that not only would work to expand services but work in new capacities: innovation must be fostered to achieve real effective change in any field.
The project has been able to overcome the barriers of accessibility, affordability and acceptance by means of its well planned components;
A mobile team for outreach caravans
Two satellite clinics in two slum areas
A charity base hospital
Low vision care unit
Wet lab and resource center
The mobile team addresses communities in rural areas in preplanned visits to conduct free outreach caravans for eye care. At the camp site, medical and refractive services in addition to health education are delivered. Persons in need for further investigations and / or surgical interventions as well as rehabilitation services are referred to the base hospital (located in Cairo) in accordance to definite scheme and schedule. The two satellite clinics are located in densely populated areas in the suburb of Cairo city (Misr Elkadema area and Elsaf area) where medical and refractive services are provided with referring persons in need for surgical or rehabilitation services to the base hospital. The unit for low vision provides low vision care to eligible children and adults while the rehabilitation unit provides services for the blind adults. Training for surgeons and other staff is provided through the wet lab and operating rooms as well as the facilities of the resource center. Services at the base hospital are categorized in terms of cost into three different categories: (category A with full price, category B 60 % subsidized and category C. free). A team of social counselors help the beneficiaries in deciding the convenient category. Revenues created from categories A & B are used to partially support category B and fully support category C.
The full system allows for providing eye care in an integral context with self sustainable way.
The project objective is strongly well defined. It has a strong program concept / logical framework. In addition to the utilization of medical technologies, it also fostering behavioral changes /KAP to the beneficiaries. The funding resources are clearly defined, including proportional contribution from the beneficiaries. The AGFUND targeted beneficiaries which cover women and children from rural slump areas are clearly reported. Similar program approaches, using the same external funding supports are also implemented in Arab and some middle-east countries. The implementation of this program approaches in other developing countries require strong financial support from external resources.
The Al Noor Foundation provides a wide range of comprehensive quality eye care in the integral and sustainable way that include medical, surgical and rehabilitation
services to the most disadvantaged segment of the population in addition to capacity building of eye care provider in the country. Moreover, this project advocate far activities and strategies supportive for prevention and elimination of eye impairment.