PRIMARY LEVEL PRIMARY LEVEL EYECARE EYECARE SERVICESSERVICES

PALESA DUBE PALESA DUBE

Introduction:Introduction: Primary level Services Primary level Services Human resourceHuman resource EquipmentEquipment Screening programsScreening programs Community Community

Participation/Awareness(Health Participation/Awareness(Health Promotion)Promotion)

Monitoring of servicesMonitoring of services

VISION 2020VISION 2020

Vision 2020 will strive to make refractive Vision 2020 will strive to make refractive services and corrective spectacles services and corrective spectacles affordable and available to the majority affordable and available to the majority of the population through primary health of the population through primary health care facilities, vision screening in care facilities, vision screening in schools and low-cost production of schools and low-cost production of spectacles. Similar strategies will be spectacles. Similar strategies will be adopted to provide low vision services.adopted to provide low vision services.

VISION 2020VISION 2020VISION 2020VISION 2020

PHC vs PECPHC vs PEC

PPrimary health care in relaltion to rimary health care in relaltion to Primary eyecare Primary eyecare

11.. Better nutritionBetter nutrition--Prevents vitamin A Prevents vitamin A deficiencydeficiency

22. Water and sanitation programmes. Water and sanitation programmes--Relevant in trachoma controlRelevant in trachoma control

3. 3. Delivery of maternal and child health Delivery of maternal and child health carecare--Reduce retinopathy of prematurityReduce retinopathy of prematurity

4.4. Health education Health education--Prevention of eye Prevention of eye traumatrauma

IAPB DurbanIAPB Durban

Refractive services can be the entry Refractive services can be the entry point for developing health care and point for developing health care and for screening for other diseases, eg for screening for other diseases, eg glaucoma, diabetic retinopathy etc.glaucoma, diabetic retinopathy etc.

Integration is therefore criticalIntegration is therefore critical

IAPB MEETING IN IAPB MEETING IN DURBANDURBAN

IAPB MEETING IN IAPB MEETING IN DURBANDURBAN

Refractive Correction: Refractive Correction: PriorityPriority

-High Priority: < 6/18-High Priority: < 6/18 -Moderate Priority: <6/12-Moderate Priority: <6/12 -Low Priority: <6/9-Low Priority: <6/9 -Children: < 6/12-Children: < 6/12 -Adults: < 6/18-Adults: < 6/18 This should inform services at the This should inform services at the

primary eye care levelprimary eye care level

Priority GroupsPriority Groups

Children aged 11-15 with myopia and Children aged 11-15 with myopia and people over the age of 45 years who people over the age of 45 years who require spectacles for near visionrequire spectacles for near vision

Refractive error in Refractive error in Children Children

Visual acuity screening of children Visual acuity screening of children can be performed at community can be performed at community level by teachers, health care level by teachers, health care workers etc. workers etc.

STRATEGIESSTRATEGIES

Ophth., Opt., Managers

OphN., Oph.Tech, Dispensing

Opt.Com Worker, Teacher, PHCW

Vision 2020

Specialists

Mid Level

PersonnelComm.

Level

STRATEGIESSTRATEGIESSTRATEGIESSTRATEGIES

Primary EyecarePrimary Eyecare

Key components:Key components: PreventionPrevention AwarenessAwareness Community involvement etc.Community involvement etc.

The Importance of The Importance of Primary EyecarePrimary Eyecare

TrainingTraining SupervisionSupervision SupportSupport ReferralReferral

This extends from from the clinic This extends from from the clinic nurse at the district and community nurse at the district and community health centre to the eye nurse at the health centre to the eye nurse at the district hospital and the eye doctor at district hospital and the eye doctor at the regional hospital. the regional hospital.

Community LevelCommunity Level

Services provided:Services provided: Screening programs Screening programs Case FindersCase Finders Sifting out and correcting Sifting out and correcting

PresbyopesPresbyopes ReadersReaders for presbyopia for presbyopia Referring for ocular diseaseReferring for ocular disease

Primary Level ServicesPrimary Level ServicesPrimary Level ServicesPrimary Level Services

District Health SystemDistrict Health SystemWHO: Framework for DeliveryWHO: Framework for Delivery

CLINIC

CLINIC

CLINIC

DISTRICTHOSPITAL

DISTRICTHOSPITAL

REGIONAL

HOSPITAL

COMMUNITY HEALTH CENTRE

COMMUNITY HEALTH CENTRE

PROVINCIAL HOSPITAL

NON- SPECIALIST

HEALTH DISTRICT

3o LEVEL CARESPECIALISED SERVICES

SPECIALIST & SUPER-SPECIALIST CARE (40)

Fig 1.

REGIONAL

HOSPITAL

District Health SystemDistrict Health SystemWHO: Framework for WHO: Framework for

deliverydelivery

District Health SystemDistrict Health SystemWHO: Framework for WHO: Framework for

deliverydelivery

District HospitalDistrict Hospital

•Refer to district:Refer to district:

Ophthalmic Ophthalmic

nurse/OCO/Optometrist/Refractionistnurse/OCO/Optometrist/Refractionist

­ TreatmentTreatment of Ocular Disease of Ocular Disease

­ Refraction including Diagnoses of Refraction including Diagnoses of

astigmatismastigmatism

­ Basic Low VisionBasic Low Vision

Human Resources Human Resources RequiredRequired

Primary Health Care nursesPrimary Health Care nurses Community Health Care facilitatorsCommunity Health Care facilitators Community Health Care workersCommunity Health Care workers Teachers, Social workersTeachers, Social workers Community representatives and Community representatives and

structuresstructures

Skills neededSkills needed Recognition and primary care Recognition and primary care

management of the following:management of the following:-Eye injuries -Eye injuries -Refractive errors -Refractive errors -Eyelid swelling-Eyelid swelling-Red eye-Red eye-Cataract-Cataract-Educating patients about hypertensive -Educating patients about hypertensive

and diabetic retinopathy, trachoma etcand diabetic retinopathy, trachoma etc

Training needsTraining needs

Training NeedsTraining Needs

-Vision assessments-Vision assessments

-Vision screening/ School screening -Vision screening/ School screening techniquestechniques

-Presbyopic correction -Presbyopic correction

-Management of basic eye conditions -Management of basic eye conditions eg. conjunctivitiseg. conjunctivitis

ResponsibilitiesResponsibilities

Case HistoryCase History Visual AcuityVisual Acuity External exam with a penlightExternal exam with a penlight Installation of eyedrops and Installation of eyedrops and

ointments (Antiallergic and ointments (Antiallergic and antibiotic ointments and eyedrops)antibiotic ointments and eyedrops)

Awareness of cataract surgery, other Awareness of cataract surgery, other eye conditions etc.eye conditions etc.

Equipment requiredEquipment required

Screening Tools:Screening Tools:Distance VA chartsDistance VA chartsNear VA chartsNear VA charts+2.00 spectacles (Children sreening)+2.00 spectacles (Children sreening)OcludderOcludderPinholePinholePd rulerPd rulerTorchTorch

Provision of SpectaclesProvision of Spectacles

-Affordable and or subsidised-Affordable and or subsidised -Ready mades: -Ready mades: Presbyopic Presbyopic

correctioncorrection Inventory of spectacles for same Inventory of spectacles for same

day dispensingday dispensing

Provision of spectaclesProvision of spectaclesProvision of spectaclesProvision of spectacles

SCREENING SCREENING PROGRAMSPROGRAMS

School based School based screeningscreening

School based School based screeningscreening

Aim of school vision Aim of school vision testingtesting

Amblyopia Amblyopia Refractive errors Refractive errors To detect eye diseases in older To detect eye diseases in older

childrenchildren Limited by resources: human, Limited by resources: human,

infrastructure and financeinfrastructure and finance

Aim of school vision Aim of school vision testingtesting

Aim of school vision Aim of school vision testingtesting

Age of vision screeningAge of vision screening

Options:Options:Preschool agePreschool agePrimary school agePrimary school ageSecondary school ageSecondary school age

Age of vision screeningAge of vision screeningAge of vision screeningAge of vision screening

ChildrenChildrenCHILDRENCHILDRENCHILDRENCHILDREN

Adults over 45 yearsAdults over 45 yearsAdults over 45Adults over 45Adults over 45Adults over 45

Community ScreeningCommunity Screening

Primary health care centersPrimary health care centers Collaboration with community based Collaboration with community based

organisations organisations For children in the community the For children in the community the

same school screening techniques same school screening techniques should be followed.should be followed.

Community ScreeningCommunity ScreeningCommunity ScreeningCommunity Screening

COMMUNITY COMMUNITY PARTICIPATIONPARTICIPATION

Community ParticipationCommunity Participation

Providing affordable (even free) Providing affordable (even free) and accessible services does not and accessible services does not guarantee that they will be used.guarantee that they will be used.-Cultural and other beliefs -Cultural and other beliefs and/or fearsand/or fears-Sense of ownership is important -Sense of ownership is important in ensuring uptake of servicesin ensuring uptake of services

Community ParticipationCommunity Participation

Access to and uptake Access to and uptake ofof existing eye- existing eye-carecare servicesservices::

- Ensure there are no - Ensure there are no barriers or other barriers or other constraints to the use of services at constraints to the use of services at the eye unit itselfthe eye unit itself..

- DDevelop outreach servicesevelop outreach services that that operate effectively.operate effectively.

- Ensure adequateEnsure adequate number of staff number of staff working in primary eye care and in working in primary eye care and in outreach facilities. outreach facilities.

Community ParticipationCommunity Participation

Continuation:Continuation:- Ensure thatEnsure that community members community members

seek out eye-care services when seek out eye-care services when neededneeded..

- Ensure Ensure ththatat communi communities areties are actively involved in eye-screeningactively involved in eye-screening..

AWARENESSAWARENESS

Potential approaches to increase Potential approaches to increase awareness/health promotionawareness/health promotion

Basic eye health workers and general Basic eye health workers and general health staffhealth staff

CBR workersCBR workers Village health workersVillage health workers Survey/questionnaire/focus groupsSurvey/questionnaire/focus groups Mass mediaMass media Traditional healersTraditional healers School teachers and schoolchildrenSchool teachers and schoolchildren Community groups (women’s groups, Community groups (women’s groups,

religious groups)religious groups)

Monitoring of servicesMonitoring of services

-S-Schoolchool children identified with refractive children identified with refractive errors and provided with spectacleserrors and provided with spectacles..

-Number of adults given presbyopic -Number of adults given presbyopic correctionscorrections

-Number of referrals for refraction at the -Number of referrals for refraction at the secondary levelsecondary level

-Uptake of spectacles-Uptake of spectacles-Number of people referred for other eye -Number of people referred for other eye

conditionsconditions