The Promise of Toolkits
Rènée du Toit
The Promise of Toolkits
To solve technical problems while aiming for self-reliance
Despite potential, rigour and evidence base
“the usefulness of toolkits in the field has often not lived up to expectations”
WHR 2008. PHC: Now more than ever
Why??
• Under-estimates the complexity of the problems
• If accepted as an off the shelf solution: limits engagement with countries.
Engaging Science: Thoughts, deeds, analysis and action Wellcome Trust Report
PEC ToolkitCollection of materials: 1. Existing 2. Fill gaps3. New ideas
I cannot
see close
by
Did it happen
suddenly or
gradually over time
Refer
Referurgently
Reassure
Refer OR provide
presbyopic spectacles if available
LOSS OF VISION
My vision is blurry
Measure distance
vision
Measure distance
vision
Gradual loss
ReassureVision normal
Vision abnormal in one or both eyes
Vision abnormal
Measure near
visionVision normal
Vision normal
Vision abnormal in one or both eyes
Sudden loss in one or both eyes
WHO - algorithm
Toolkit1. Training course• Health promotion and
prevention • ‘Curative’ care• Health systems information2. Implementation tools
Referral
Tertiary
Secondary
Primary
Service delivery: Accessible care
Appropriate referral pathways exist
Well trained staff / equipped facilities Human resources:
competent referral decisions;
patient informationRetains competency
Finance: can people afford
it? universal access Leadership: implementation
Guidelines / algorithmsFeedback on referral
(continuing education, continuity of care)
HIS: # of people seen
# referred, # reported, # correctly referred; evaluation of referral pathways & services
Equipment and supplies:
sufficient at primary and referral level
Health systems
support for referral
pathways
Implementation toolsSelect training materials• Who?• Where?• What must they do?
Set up support required• Do they have what they
need?• How can we be sure of
the quality of care?• Can this be scaled up?• Is it sustainable?
• mobile phones: enter symptoms into a decision-tree based algorithm
• mobile broadband or SMS/MMS to connect to a remote doctor for a consultation
New ideas
http://clickmedix.com/
• first aid• recognise and refer / reassure (most common
eye conditions)
skills required by different groups
• integrate eye health into other messages• tailor these to the audience • be creative / imaginative in promoting
health promotion and prevention
• evidence based guidelines / expert group consensus on guidelines/algorithms
• health systems support for implementation
quality & sustainability
• guidelines / expert group consensus on guidelines/algorithms
• adapt & pilot & improveevidence based
The answer is…..
• We don’t have all the answers• The answer will not be simple• The answer is not only a hammer
"If the only tool you have is a hammer, you will see every problem
as a nail.” Maslow
Any suggestions?
• Content of toolkit – what will be useful to you?
• What can you contribute?• Any volunteers to piloting algorithms /
processes?