Established in 1966 by a group of medical professionals and teachers, the International Assistance Mission (IAM) works exclusively in Afghanistan. IAM has maintained continuous operation in the country longer than any other non-governmental organization. Initially, IAM began its activities with eye care and literacy programs, and it has since expanded its scope over the last several decades to encompass a broad array of projects that help Afghans increase capacity in the areas of health services, education, and economic development.
Committed to helping Afghans develop the capability to direct the development of their country over the long term, IAM implements sustainable programs designed to continue delivering positive impacts even after IAM workers withdraw from direct management. IAM’s paid staff of more than 500 Afghans works together with 50 foreign professional volunteers, all of whom have learned the local language and customs of the region where they are posted. Together they create innovative solutions to complex challenges facing Afghanistan and provide the resources and training to enable Afghans outside of IAM to carry out these initiatives. Moreover, each project is strategically planned to best serve the needs and enhance the capacity of a particular target population, either those Afghans in positions of leadership or the residents of underserved rural and urban communities.
IAM maintains active projects in seven provinces, through which it facilitates such diverse services as ophthalmic and mental health care training, micro-hydroelectric plant installations, community-based rehabilitation for those with disabilities, and English language instruction. Since its inception nearly half a century ago, IAM has assisted over 5 million Afghans, especially through its foundational eye care program, through which all of its other projects have grown.
IAM’s Program for Sustainable Eye Care in Afghanistan
Following the commencement of IAM’s work, the Afghanistan government appealed for the organization to concentrate its efforts on eye care, and IAM responded with the formation of the National Organization for Ophthalmic Rehabilitation Eye Care Program (NOOR). Since NOOR began in 1966, it has remained a central component of IAM’s work, accounting for 34% of its total program expenses in 2014. NOOR aims to provide Afghans with local access to inexpensive, quality eye care, and the program currently offers or supports the majority of ophthalmologic services offered in Afghanistan. To minimize reliance on international donors and strengthen self-sufficiency, NOOR charges service fees whenever possible, but never refuses to treat patients who lack the means to pay. In 2014, NOOR conducted eye examinations for 182,000 patients and offered support for the examinations of an additional 152,000 individuals.
In partnership with Afghanistan’s Ministry of Public Health, NOOR has helped train Afghan ophthalmologic professionals, as well as facilitated the operation of eye care centers across Afghanistan. In addition to managing the NOOR Eye Care Training Center in the Darulaman district of Kabul, NOOR runs referral hospitals in Mazar-e-Sharif (Mazar Ophthalmic Center) and Kandahar (Kandahar NOOR Eye Hospital). NOOR also founded the Central Polyclinic in Kabul and the Herat Ophthalmic Center, both of which the Ministry of Public Health now administers, with continued logistical assistance and financial supervision from NOOR.
NOOR Eye Care Training Center
IAM’s primary facility for instructing ophthalmic care professionals, the NOOR Eye Care Training Centre (NETC) also serves as a key referral hospital and as the base for NOOR’s eye care outreach projects in communities that are underserved. Since NETC’s relocation in 2012 to new premises constructed specifically to accommodate its functions, the center has been able to broaden its training and treatment services, including the launch of the Pediatric Department in 2014. During that year, NETC also conducted 35,784 eye examinations and distributed 4,675 pairs of eyeglasses. Furthermore, both public and private eye care providers in Afghanistan continue to refer patients with conditions requiring surgery to NETC, where the staff performed 2,881 operations between 2013 and 2014.
As part of NOOR’s mission to establish sustainable ophthalmic care provided for Afghans by Afghans, NETC delivers eye care training programs for local professionals at all levels, ranging from ophthalmologists to community health workers. NETC’s four-year Ophthalmological Residency Program, for example, offers doctors the opportunity to earn a certificate in ophthalmology by passing a government-sanctioned exam administered by NOOR.
Training Ophthalmic Technicians from Rural Communities
IAM and NOOR place particular importance on increasing eye care capabilities in those regions of Afghanistan that are most in need. Through the Ophthalmic Technician Training Program (OTTP), NOOR recruits residents from remote rural areas in need in Afghanistan and prepares them to deliver mid-level eye care. After completing a two-year training curriculum, ophthalmic technicians return to their home communities and provide a range of services, including the diagnosis of common eye diseases, refraction tests, distribution of eyeglasses, and referrals for the treatment of complex conditions.
From 1996 through 2014, OTTP had trained 71 students, accounting for all of the ophthalmic technicians in Afghanistan. NOOR continues to seek new recruits for the program, as OTTP plays a key role in a nationwide initiative to enhance eye care and combat preventable blindness.
Bringing Eye Care Services to Populations in Need
In order to further augment the provision of eye care services to marginalized populations and those in rural areas, IAM and NOOR initiated the Provincial Ophthalmic Care (POC) outreach program in 1998. POC’s mobile day clinics serve communities in need in Kabul and Parwan provinces on a weekly basis. Led by ophthalmic technicians, day clinic teams provide basic eye examinations and treatment, as well as referrals to NETC for those with conditions that necessitate surgery. POC has also run an eye camp in the Lal-wa-Sarjangal District of Ghor province where, in 2014, staff performed 92 surgeries and 1,370 eye exams.
Another component of POC is a satellite surgical clinic in the Dashte Barchi district of Kabul city. The clinic seeks to improve access to eye health services for local residents in need, many of whom would otherwise go without care because they feel unsafe leaving the confines of their neighborhood. Members of the Hazara minority ethnic group also receive examination and treatment at the clinic, traveling two to three days to reach the facility.