Presenter Gail M Ormsby – CBM Australia; Centre for Eye Research Australia Noela Prasad – Centre for Eye Research Australia Manfred Mörchen – Takeo Eye Hospital, Cambodia Te Serey Bonn – Takeo Eye Hospital Ngeth Sarun – Takeo Eye Hospital Evangeline Dunton– Takeo Eye Hospital Myrna Porto – Takeo Eye Hospital Natalie Maggay– CBM Viet Nam Nguyen Hong Nga – CBM Viet Nam Nguyen Ngoc Anh – CBM Viet Nam Jill Keeffe – Centre for Eye Research Australia Symposium – The World Report on Disability: Implications for Asia and the Pacific University of Sydney, 5-6 December, 2011 Establishing an evidence-base for disability inclusion in eye health programmes

Cambodia and Vietnam “Disability” inclusive approach to community eye health Our experience – Gender – Education – Disability As related to eye health knowledge, attitude and practice How this informed project implementation

Context: Disability Inclusion AusAID strategy for disability inclusion - Development for All: Towards a disability inclusive Australian aid program , – all AusAID funded activities will need to show consideration of disability mainstreaming, – so disability inclusion training and guidelines were included under AusAID Avoidable Blindness Initiative. Field research included Rapid Assessment of Avoidable Blindness (RAAB) and surveys of Knowledge, Attitude and Practice (KAP) to – Provide baseline data on blindness and vision impairment – Provide a picture of the community’s perception of eye health so that the project responds to needs of the community being served.

Baseline information Results of RAAB survey Prevalence of vision impairment in people over 50 years of age Cambodia (conducted in 2007) Vietnam (conducted in 2010) RegionPrevalence of blindness <3/60 Prevalence of severe visual impairment <6/60 – 3/60 Prevalence of moderate visual impairment <6 / 18 – 6/60 Cambodia 2.8 %17.61 % Viet Nam 3.1 % Son La %1.3 %7.1 % Thanh Hoa %3.48 %12.24 %

Baseline information Areas of focus for KAP survey Knowledge and attitude of the community regarding their eye health. Current practices and attitudes regarding uptake of eye care services. Perception and practices on the inclusion of women, children and persons with disability in community eye care programmes.

Survey Locations Thanh Hoa and Nghe An Provinces Bati Takeo Kiri Vong

600 people surveyed from across 3 districts 200 people per district 30 randomly selected villages from across districts 10 villages per district 20 people surveyed from each village –6 or 7 people from each age group surveyed from each village (At least 1 or 2 people with a disability) Random walk to find people –Random lank mark chosen, called in at consecutive houses until number of participants reached –If people with disability not in this sample, convenient sampling used where village leader was asked where person with disability lives (was not found necessary) 4 cities & districts in each province selected according to the following criteria: 2 districts that will be sites of project implementation, 1 urban area where available eye services are linked to the project, 1 district adjacent to site of project implementation. Quota: people from each district 75% of the total number of respondents in a province from each project district (94 people per district), 15% from urban areas (37 people from each area), 10% from adjacent sites (25 per site). Ensure at least 1 or 2 people with a disability are included at each site. Sampling Cambodia Vietnam

Results Potential service users surveyed 1130 people over 25 years of age 599 from one province in Cambodia 531 from two adjacent provinces in Vietnam MenWomen Cambodia Vietnam

Education Cambodia

Disability TypeCambodiaVietnamTotal Seeing Hearing Walking Understanding Other TOTAL Vision disability reported in 18% (Cambodia) & 33% (Vietnam) 39% (443/1130) of the surveyed population reported SOME disability.

Multiple disability CambodiaVietnam Total MalesFemalesMalesFemales Single disability Two ‘disabilities’ Three or more ‘disabilities’ % (18/149) in Cambodia, and 13% (39/294) in Vietnam reported having more than one ‘disability’.

Knowledge: heard about eye conditions

Knowledge: know treatment for cataracts

Attitude Can a child with Vision Impairment or Seeing Difficulty attend school?

Practice: getting eyes examined

Conclusions Self-reported ‘Disability’ is common among the sampled population. Inclusive planning can be achieved even without positive discrimination towards persons with disability. – through integration into existing eye programmes – at minimal additional cost Some people with disability report accessing access eye care services if available. But people with disability have less access to eye health information. Evaluation at end of the project period will assess outcomes of a disability inclusive approach to community eye heath programme.