Introduction: Primary level Services Human resource Equipment Screening programs Community Participation/Awareness(Health Promotion) Monitoring of services
VISION 2020 VISION 2020 VISION 2020 Vision 2020 will strive to make refractive services and corrective spectacles affordable and available to the majority of the population through primary health care facilities, vision screening in schools and low-cost production of spectacles. Similar strategies will be adopted to provide low vision services.
PHC vs PEC Primary health care in relaltion to Primary eyecare1. Better nutrition-Prevents vitamin A deficiency2. Water and sanitation programmes-Relevant in trachoma control3. Delivery of maternal and child health care- Reduce retinopathy of prematurity4. Health education-Prevention of eye trauma
IAPB MEETING IN DURBAN IAPB DurbanIAPB MEETING IN DURBAN Refractive services can be the entry point for developing health care and for screening for other diseases, eg glaucoma, diabetic retinopathy etc. Integration is therefore critical
Refractive Correction: Priority -High Priority: < 6/18 -Moderate Priority: <6/12 -Low Priority: <6/9 -Children: < 6/12 -Adults: < 6/18 This should inform services at the primary eye care level
Priority Groups Children aged 11-15 with myopia and people over the age of 45 years who require spectacles for near vision
Refractive error in Children Visual acuity screening of children can be performed at community level by teachers, health care workers etc.
STRATEGIESSTRATEGIESSTRATEGIESVision 2020 Ophth., Opt.,Specialists Managers OphN., Oph.Tech,Mid Level Dispensing Opt.Personnel Com W orker, Comm. Teacher, PHCW Level
Primary EyecareKey components: Prevention Awareness Community involvement etc.
The Importance of Primary Eyecare Training Supervision Support Referral This extends from from the clinic nurse at the district and community health centre to the eye nurse at the district hospital and the eye doctor at the regional hospital.
Primary Level Services Community Level Primary Level ServicesServices provided: Screening programs Case Finders Sifting out and correcting Presbyopes Readers for presbyopia Referring for ocular disease
District Health System District Health System District Health System WHO: Framework for delivery WHO: Framework for Delivery WHO: Framework for delivery HEALTH DISTRICT SPECIALIST & SUPER- SPECIALIST CARE (40) 3o LEVEL CARE NON-CLINIC SPECIALISED SERVICES SPECIALIST COMMUNIT Y HEALTH DISTRICT REGIONA CENTRE HOSPITA L L HOSPITA PROVINCIACLINIC L L HOSPITAL COMMUNIT Y HEALTH DISTRICT REGIONA CENTRE HOSPITA L L HOSPITACLINIC L Fig
District Hospital•Refer to district: Ophthalmic nurse/OCO/Optometrist/Refractionist Treatment of Ocular Disease Refraction including Diagnoses of astigmatism Basic Low Vision
Human Resources Required Primary Health Care nurses Community Health Care facilitators Community Health Care workers Teachers, Social workers Community representatives and structures
Skills needed Recognition and primary care management of the following:-Eye injuries-Refractive errors-Eyelid swelling-Red eye-Cataract-Educating patients about hypertensive and diabetic retinopathy, trachoma etc
Training needs Training Needs-Vision assessments-Vision screening/ School screening techniques-Presbyopic correction-Management of basic eye conditions eg. conjunctivitis
Responsibilities Case History Visual Acuity External exam with a penlight Installation of eyedrops and ointments (Antiallergic and antibiotic ointments and eyedrops) Awareness of cataract surgery, other eye conditions etc.
Equipment required Screening Tools:Distance VA chartsNear VA charts+2.00 spectacles (Children sreening)OcludderPinholePd rulerTorch
Provision of spectacles Provision of Spectacles spectacles -Affordable and or subsidised -Ready mades: Presbyopic correction Inventory of spectacles for same day dispensing
School based screeningSchool based screening
Aim of school vision testing Aim of school vision testing Aim of school vision testing Amblyopia Refractive errors To detect eye diseases in older children Limited by resources: human, infrastructure and finance
Age of vision screening Age of vision screening Age of vision screening Options: Preschool age Primary school age Secondary school age
Adults over 45 45 Adults over years Adults over 45
Community Screening Community Screening Community Screening Primary health care centers Collaboration with community based organisations For children in the community the same school screening techniques should be followed.
Community ParticipationProviding affordable (even free) and accessible services does not guarantee that they will be used. -Cultural and other beliefs and/or fears -Sense of ownership is important in ensuring uptake of services
Community Participation Access to and uptake of existing eye-care services:- Ensure there are no barriers or other constraints to the use of services at the eye unit itself.- Develop outreach services that operate effectively.- Ensure adequate number of staff working in primary eye care and in outreach facilities.
Community Participation Continuation:- Ensure that community members seek out eye- care services when needed.- Ensure that communities are actively involved in eye-screening.
Potential approaches to increase awareness/health promotion Basic eye health workers and general health staff CBR workers Village health workers Survey/questionnaire/focus groups Mass media Traditional healers School teachers and schoolchildren Community groups (women’s groups, religious groups)
Monitoring of services-School children identified with refractive errors and provided with spectacles.-Number of adults given presbyopic corrections-Number of referrals for refraction at the secondary level-Uptake of spectacles-Number of people referred for other eye conditions