YEREVAN—The Armenian EyeCare Project announced Monday that it will embark on Phase 2 of its initiative, “Bringing Sight to Armenian Eyes.” The aim of the campaign is to bring accessible, quality eye care to the people of Armenia. At the request of the Armenian Minister of Health, Derenik Dumanyan, the EyeCare Project will take the lead, in partnership with the Armenian Health Ministry and the Malayan Eye Hospital, to build five Regional Eye Clinics throughout Armenia.
EyeCare Project’s Vision for Armenia
The Armenian Eye Care Project’s vision for Armenia is a country where no individual is without access to quality eye care; where Armenian ophthalmologists are trained to diagnose and treat eye disease at the highest level following United States standards and practices; and preventable causes of blindness are eliminated through an emphasis on prevention and early intervention. As a United States nonprofit corporation, established in 1992, the Project has made major advancements in the delivery of eye care for Armenia’s three million residents during the past 22 years, an achievement for which we can be proud.
Yet, the accessibility and affordability of eye care in Armenia continues to be extremely limited and disproportionately affects the poor and those living in remote regions. Only four towns outside of the capital city of Yerevan provide basic eye care and most surgery is available only in the capital. Further, a lack of equipment and professionally trained ophthalmologists and ancillary eye care professionals in the regions severely restricts access to eye care throughout Armenia. Of the 332 ophthalmologists in Armenia, just one-third or 110 practice outside of Yerevan and only a handful are trained to perform eye surgeries.
AECP Mobile Eye Hospital
Since 2003, the Armenian EyeCare Project’s Mobile Eye Hospital has been traveling throughout Armenia to provide basic eye care and cataract and other surgeries to those deemed poor by the state — five full rotations in ten years — visiting each marz five times. However, the AECP is not permitted to provide surgery for those who fall outside government guidelines for no cost treatment— yet many of these individuals are still objectively poor. This leaves a large number of people with no access to cataract or other surgeries.
The EyeCare Project has provided eye care for hundreds of thousands on the MEH over the past 11 years at no cost including comprehensive high quality eye examinations, basic eye care and eyeglasses for all Armenians and surgery for the poorest Armenians. However, this type of limited care has serious restrictions. Because the MEH visits the outlying cities and villages only once every two years there is no treatment for emergencies and eye trauma. Additionally, eye disorders and diseases that require frequent care and observation can worsen between visits making them more difficult to treat, such as with glaucoma and macular degeneration. In the case of children there is only a small window of time to treat eye disease or their sight can become permanently damaged. And, those who are not “poor” receive no surgical care. Even though residents are not designated as poor by government standards, most of those living in the regions do not have the money to pay for surgery and advanced care in Yerevan. They are often unable to travel the distance because of cost or other reasons and go without care, leaving many visually disabled.
Cataracts are the leading cause of blindness in Armenia and throughout the world. However, access to cataract surgery outside of Yerevan is very limited. In the United States, people accept cataract surgery as a part of aging and it is a very common procedure. Sadly, in Armenia, many have learned to accept blindness as a part of growing older because they have no access to cataract surgery. The AECP Regional Eye Clinics will address these problems and more, changing lives and providing all Armenians with access to surgical care and working toward eliminating preventable blindness.
Because of the limitations of the current eye care delivery system described above, Derenik Dumanyan, the Armenian Minister of Health, and his team asked the EyeCare Project to revitalize the region’s ophthalmological system throughout the marzes — there was a strong regional ophthalmological system in Armenia under the Soviet system, which collapsed along with the dissolution of the Soviet Union in 1991.
Effective Blend of Public-Private Partnerships
Five Regional Eye Clinics will be developed, implemented and managed by an effective blend of public-private and U.S.-Armenia partnerships as a specific strategy to leverage and maximize scarce human and financial resources. These partners have been selected for already existing relationships along with a proven track record for sustainability; a demonstrated convergence of common interests and guiding principles; and an existing and long-term record of joint accomplishments among the partners.
The three partners, representing three sectors — government, private enterprise and nonprofit — will each be responsible for the success of the Regional Eye Clinics and will contribute different elements and expertise. The partners include the Armenian EyeCare Project (AECP), the Ministry of Health of Armenia (MOH), the Malayan Ophthalmologic Center (MOC), Eighth Clinic Hospital and Children’s Hospital — the main private eye hospitals and clinics in Armenia. The AECP will be the lead partner and provide the equipment for each clinic as well as develop, implement, manage, monitor and evaluate the Regional Eye Clinics; the MOH will identify and provide the space for the eye clinics, which will be located in state hospitals; and the HOSPITALS will recruit and place ophthalmologists.
In addition to working closely with its Armenian partners and forging relationships that will utilize the strengths of each, the Project intends to formalize a virtual medical education and training program with top medical research institutions in the United States.
The AECP Regional Eye Clinics — the first one scheduled for opening this year in Ijevan in Tavush, will be built over a period of five years, each costing nearly $1 million. In addition to Tavush, the clinics will be located in Gyumri in Shirak, Vanadzor in Lori, Kapan in Syunik, and Yeghegnadzor in Vayots Dzor. The locations, selected by the Armenian Health Ministry, were based on several factors: the number of people who will be served in the geographic area; the absence of an eye clinic or a clinic of very poor quality; and the ability of the area to recruit and retain well-qualified ophthalmologists and ancillary personnel trained in eye care. This will enable rural Armenians to have access to quality eye care and surgery within a reasonable distance. They will no longer have to travel to Yerevan for most eye care or for cataract surgery — or have to wait for two years for the Mobile Eye Hospital to visit their town.
Regional Eye Clinic Strategy
The Regional Eye Clinic system will enable the EyeCare Project to accomplish its overarching goal — to provide access to quality eye care for all Armenians and to eliminate preventable blindness — set forth in 2002, when launching Phase 1. The Initiative, implemented over the past 12 years, has provided substantial and long-term benefits for the Armenian people — restoring the sight of thousands through cataract and other surgeries and preventing blindness in children and adults through countrywide eye examinations, treatment and eyeglasses at no cost.
The public health underpinnings and the framework of “Bringing Sight to Armenian Eyes” Phase 1, which has changed the landscape of eye care in Armenia, will serve as the foundation for Phase 2, the Regional Eye Clinics, through its integrated, comprehensive program. As we develop, implement and manage the Regional Eye Clinics throughout the marzes in Armenia we will employ our comprehensive, integrated five-point program, which includes (1) medical education and training; (2) direct patient care; (3) public education; (4) research; and (5) capacity building.
The EyeCare Project’s extensive experience delivering eye care on the Mobile Eye Hospital throughout the country for the past 12 years will provide an invaluable foundation in developing the Regional Eye Clinic system. The project has also developed strong relationships with local physicians, schools, community groups including senior centers and orphanages and government officials who will be assets and assure the success of the Regional Eye Clinics. The AECP’s role will include the design and development of five eye clinics; provision of equipment — state hospitals will provide space; training of ophthalmologists and ancillary staff; outreach and public education; and the management, monitoring and evaluation of the countrywide clinics for a specified period of time.
The Regional Eye Clinics will provide access to all levels of quality eye care in the regions of Armenia, providing eye surgeries and laser treatments to all income groups. Gradually, these clinics will replace the tours of the MEH. When the MEH is no longer needed it will be permanently located in an outlying area and serve as a stationary eye clinic.
The Regional Eye Clinics, which will operate as nonprofit health centers, have been structured by the AECP to be self-sustaining — so that Armenia will develop the capacity to provide eyecare for her people independent of outside assistance. All participating parties, including the Ministry of Health, private hospitals and the EyeCare Project, estimate that this can be accomplished within five years.
The sustainability program includes the following principles: (1) the socially vulnerable or “poor” — Paros-state ordered — will always be treated at no cost and the Regional Eye Clinics will be reimbursed by the state; (2) patients who are not “poor” will be charged a small fee according to their ability to pay; and (3) fees received for services will be reinvested into the eye clinics for purchase of equipment, payment to physicians, medications, disposable supplies, eyeglasses, etc. To ensure sustainability and to increase the demand for eye care services, the AECP will implement an aggressive outreach and public information campaign to increase the utilization of eye care services.
Eye care, with an emphasis on cataract surgery and refraction, is one of the few health care services that can become financially self-sustaining from patient fees while maintaining an orientation to serving the vulnerable, according to the International Council of Ophthalmology. Unlike the delivery of other health care services, where treatment varies from patient to patient, the costs for cataract surgery and refraction are the same for each patient and can be made affordable to the poor.
Based upon an analysis of a number of eye care programs in developing countries, the International Council of Ophthalmology found that income and expense follows the 80/20 Rule. Approximately 80 percent of blindness is due to cataract; 80 percent of program costs are for cataract surgery; and 80 percent of revenue comes from cataract surgery. As in other poor countries, patient fees from cataract surgery and refraction can be expected to subsidize services for those who are too poor to pay for services as well as support other eye care services that are not self-sustaining from patient fees alone.
Capital Fund Development Campaign
This month, the Armenian EyeCare Project will embark upon its largest capital fund development campaign, ever. Over the next year the Project will reach out to its friends and donors and Armenian Family Foundations to raise $5 Million to fund the five Regional Eye Clinics. Naming opportunities are available for major donors and all donors will be listed on a donor wall in each Regional Eye Clinic.
For more information about the Armenian EyeCare Project, contact the California office at 949-933-4069, or visit the AECP website at www.eyecareproject.com. To make a donation, call the AECP or mail a check to P.O. Box 5630, Newport Beach, California 92662.