Blindness and visual impairment result in dependence and reduce the productivity of both the patient and the caregiver. In the Philippines, 75% of blindness and visual impairment result from three preventable or treatable conditions: cataract (62%); refractive error (10%); and childhood blindness (3%). If priority is given to these three diseases, then in 2020, it is calculated that the number of blind people will be significantly reduced by 62% from 790,000 to only 300,000 people.
But eye care is expensive--a cataract operation in Tarlac Province for instance would cost between PhP30,000 to PhP90,000. In 2010, eye care services available in Tarlac were primarily in private health facilities and clinics.
To address the problem, the provincial government came up with its Linaw Tingin or Clear Vision program which makes eye care affordable to the marginalized and the poor. Since its inception, Linaw Tingin has conducted 26,563 eye consultations and 3,624 cataract surgeries. The Philippine Health Insurance Corporation (PHIC) reimbursed 94% of the surgeries, making it possible for the Tarlac Provincial Hospital (TPH) Eye Center to remain financially sustainable in the long term. About 39% of the beneficiaries who are able to avail of PHIC services for their operation come from the poor. For patients who do not have health insurance but need surgery, the program coordinates with the Provincial Government of Tarlac to conduct cataract missions.
Capacity development was integral to the program. In 2013, the program developed the competencies of Primary Eye Care Trainers so that they, in turn, could effectively train community health workers on blindness prevention and eye health promotion. To date, there are at least 720 eye care workers in the province.
Linaw Tingin also addressed the lack of ophthalmologists and optometrists in government hospitals. Before the program started, there were only 12 ophthalmologists and 30 optometrists in the private hospitals in Tarlac, as compared to only one ophthalmologist and no available optometrist in the government hospital. With the establishment of the Tarlac Eye Center and launching of the Linaw Tingin Program, the number of ophthalmologists and optometrists increased. There are now 12 ophthalmologists and 7 optometrists serving in government-run hospitals.
Ophthalmologists from the private hospitals were tapped to provide quality services, and were encouraged by the assurance that they are paid 100% of their professional fees through the PHIC. The nine ophthalmologists willing to be consultants at TPH Eye Center signed Deeds of Undertaking in 2011, and as of 2013 there are 11 private ophthalmologists attending to patients at TPHEC. The same process was carried out in the engagement of optometrists to refract patients at the TPH Eye Center. Optometrists in the Philippines are confined to private practice with no public health component. At TPH Eye Center they refract patients and provide low cost spectacles of good quality. There are 6 optometrists who have also signed Deeds of Undertaking with TPHEC.
As a result, the number of patients that are able to access quality but affordable eye care services have increased by 400% in just two-and-a-half years, from only 2,582 in July 2011 to 13,810 patients by the end of December 2013.
The Tarlac Provincial Health Referral System serves as an avenue to promote advocacy for eye care among the marginalized and the poor—by imparting the knowledge that blindness can be avoided and that the poor can seek professional eye care at a lower cost. An indigent patient is also assured that he will be attended to immediately, will be informed of the right diagnosis and be given referrals for proper medical service and follow-on care. School children are provided with proper eye care and examinations through the involvement of the Department of Education.
Barangay Health Workers (BHWs) serve as the vision screeners, identifying patients with visual impairment and ocular disorders needing specialized care. Currently, there are 600 BHWs and 70 rural health physicians and nurses trained as Primary Eye Care Workers and Mid-level Eye Care Workers, respectively enabling proper referral and quality eye care delivery.
Private sector supporters of the program include the SUKOB Foundation, which provides equipment, personnel and some supplies during cataract missions, the UERM Department of Ophthalmology, which provides volunteers to do surgeries, and the Fred Hollows Foundation. Public-Private Partnerships enabled the program to attract more ophthalmologists to practice in the government hospitals. The Eye Center is now one of the few provincial community eye care programs in the country that demonstrate a sustainable and replicable model.