Sailesh Kumar Mishra
The COVID-19 pandemic has created unprecedented disruption for the global health and development community. Eye Care Service providers of Nepal are also facing a difficult time in this situation. All the eye hospitals are struggling to balance financial challengesdue to steep decline in patients’ footfalls which has lead in reducing the cash flows.
The short-term implications of this global and national challenge are evident everywhere, but the long-term consequences of the pandemic for eye care service providers are still difficult to imagine.
Right now, eye care service providers are only providing emergency services and there will be an overwhelming challenge in resuming normal eye care services after the lock down is lifted. Eye hospitals are more focused on developing a system and processes which will make sure their patients are safe, they themselves are safe, and obviously their staff are safe too. It seems that it is not possible to reach the same levels of services that existed prior to the pandemic in the immediate future due to norms of physical distancing and norms like thermal screening, clinical screening, examination of patients wearing PPE, decontamination norms and reorganizing the space. Eye Hospitals just cannot examine the same number of patients due to capacity reduction. In this situation, eye hospitals must evaluate the needs of their patients, build patient trust through safety protocols, awareness and make them accessible through shift schedules and change in the system to reduce patient care cycle time and making the demand uniform.
Right now, most of the government funding is going toward fighting the coronavirus. The new policy and program of Government has not addressed any relief package for eye health sector. As a result, budget for eye care has been reduced and many eye care centres and eye hospitals will have difficulty in covering the operating cost. If there will not be a support from local government, we can see some eye care centres closed and stress on the sustainability status of eye hospitals. There has also been seen a kind of stress and anxiety among the staffs as they have a fear for infection during emergency services, fear for salary cuts, fear of financial crunch, fear of layoffs.
Hence staff retention and engagement is another challenge eye care service providers are going to face in future as we all know that human resources in eye care are most critical and valuable asset for eye hospitals and it takes longer time to develop a motivated and trained staff who are aligned to the goal and culture of the organization. Keeping them motivated and paying the salary will also be a major challenge. Hence mutual consultation between staffs and management on regular basis is necessary to find the best solutions.
There will be limited fundraising from External Development Partners supporting eye care program of Nepal as rich countries will go into recession due to huge economic losses. Development assistance for health will be cut due to COVID-19. Eye Care organizations have to raise the fund locally.
COVID-19 could also act as a catalyst for positive change as well and can be an opportunity to design social marketing strategy to attract more Nepali patients in the primary eye care centers and eye hospitals. There is also a unique opportunity to start the online appointment system.
The COVID-19 pandemic will transform the global health community’s and Nepal's acceptance of use of digital health technologies. Eye care service providers of Nepal still do not use telemedicine and virtual consultations. Now they have already started to explore the possibilities to provide the services to the patients through telemedicine to reduce exposure to COVID-19 and connect the primary care centres to base hospital. In the future they must discover innovative means to provide the services though virtual consultations. In future, technology will play a big role: telemedicine, telehealth, tele optometry. People will be more open to accepting technology simply because it gives the scale, reach, and impact without losing quality of service.
There will also be increase in cost of procedures for eye care service delivery which will add additional burden on operating cost of the eye hospitals. Hence many eye hospitals will reinvent the ways they are delivering services. They will be more focused on cost reduction, professional management, new learning, bringing innovation around efficiency and embrace technology. Eye care service providers will be focusing on online classes, webinars/ online courses, wet Labs & dry Labs and mentoring through Cybersight.
All the stakeholders and Government of Nepal will understand the importance of integration i.e integrating primary eye care into the government health care system. Future investment should be done to strengthen and upgrade the services of primary eye care center and shifting the care to lower units so that patients can get the maximum services at their doorstep.
The increase in hand-washing and better hygiene will have an overall positive impact on general health as well in Nepal. It could also limit the spread of eye infections — like trachoma —which spreads through contact with discharge from the eyes or nose of an infected person.
Canceling scheduled outreach camps and lot of challenges for conducting these outreach program in future will lead to additional backlog of avoidable blindness in remote areas. In future door to door screening in the community around primary eye care centres along with eye care and corona awareness will be a safe and effective option to deliver the services in the community. Also, school screening can be done with new norms.
After the lock down more people may be working from home in areas where those facilities are available. They are spending more time watchingscreens whether it’s online learning or classes. The staring at screens constantly, combined with reduced time outdoors, can cause eye fatigue, dryness, and accelerate the rate of short-sightedness, or myopia. This will add an additional challenge in future.
Although there are lot of challenges, we should always attempt to address the service delivery initiatives going forward in future because COVID-19 pandemic by itself is not going to change the incidence or prevalence of various eye diseases.
Let us work together to preserve, enrich, and enlighten the legacy of eye care service delivery of Nepal which is considered as a model program in south east Asia delivering quality, affordable and sustainable eye care services through public-private partnership and in terms of reducing the prevalence of blindness and eliminating trachoma from Nepal.
-(Mishra is an Executive Director of Nepal Netra Jyoti Sangh)
