Building a national eye-care service in post-conflict Timor-Leste

Abstract

ProblemViolent conflict left Timor-Leste with a dismantled health-care workforce and infrastructure after 2001. The absence of existing health and tertiary education sectors compounded the challenges of instituting a national eye-care system.ApproachFrom 2001, the East Timor Eye Program coordinated donations and initially provided eye care through visiting teams. From 2005, the programme reoriented to undertake concerted workforce and infrastructure development. In 2008 full-time surgical services started in a purpose-built facility in the capital city. In 2014 we developed a clinical training pipeline for local medical graduates to become ophthalmic surgeons, comprising a local postgraduate diploma, with donor funding supporting master’s degree studies abroad.Local settingIn the population of 1.26 million, an estimated 35 300 Timorese are blind and an additional 123 500 have moderate to severe visual impairment, overwhelmingly due to cataract and uncorrected refractive error.Relevant changesBy April 2018, six Timorese doctors had completed the domestic postgraduate diploma, three of whom had enrolled in master’s degree programmes. Currently, one consultant ophthalmologist, seven ophthalmic registrars, two optometrists, three refractionists and four nursing staff form a tertiary resident ophthalmic workforce, supported by an international advisor ophthalmologist and secondary eye-care workers. A recorded 12 282 ophthalmic operations and 117 590 consultations have been completed since 2001.Lessons learntInternational organizations played a pivotal role in supporting the Timorese eye health system, in an initially vulnerable setting. We highlight how transition to domestic funding can be achieved through the creation of a domestic training pipeline and integration with national institutions.

Advocacy for global surgery: a Pacific perspective

“…As Ophthalmology in the Pacific and PNG, and otorhinolaryngology in PNG, have formed their own associations, their contribution to addressing the burden of disease, training the workforce and advocacy for investment, need to be included and coordinated within the forthcoming NSOAPs. 17,39,[57][58][59][60]…”

“…Timor Leste still faces a considerable shortfall in its ability to deliver surgical and anaesthesia services to its population 16 . The development of a national eye‐care service also with the support of the Royal Australia and New Zealand College of Ophthalmologists, and 20 years of activity by the East Timor Eye Program has been highly successful 17 …”

“…16 The development of a national eye-care service also with the support of the Royal Australia and New Zealand College of Ophthalmologists, and 20 years of activity by the East Timor Eye Program has been highly successful. 17 Advocacy for universal access to safe, affordable and timely surgical care…”

Ophthalmic services during ongoing conflict: the eye health system in Yemen

“…Rao et al 51 demonstrated that high-quality and low-cost eye care can be delivered in rural areas without patients needing to travel great distances and with more than 50% of services free, while still maintaining self-sustainability by integrating into primary health services. Lessons can be learnt from efforts to rebuild national eye health services in other postconflict zones such as Timor-Leste 52. They show how a high-volume intermittent service delivery approach initially focused on local capacity-building rather than infrastructure provision can ensure that donated resources are optimised.…”

“…The key to long-term rebuilding is transition to local ownership (figure 3), not just with reducing the backlog of disease prevalence, but ensuring guidance into a fully functioning, self-sustaining service with local recruitment and training of eye health workers. Wing et al 52 described how they were initially able to mitigate the dearth of subspecialists by inviting visitors to donate their expertise, noting that in the long term this is unsustainable and emphasising the effectiveness of intensive training attachments abroad for local graduates.…”