Transcript Slide 1
Effective scale up of refractive error and primary eye care service within a District Health System: Results of the Seeing is Believing Program in the province of KwaZulu-Natal, South Africa Kovin S Naidoo1, 2, 3, Kesi Naidoo1,2, Yashika Maharaj2, Prasidh Ramson,2, Diane Wallace,2,3 and Reshma Dabideen,2 1International Centre for Eyecare Education, Durban, South Africa 2African Vision Research Institute (AVRI), 3University of KwaZulu-Natal Giving Sight to Africa • Standard Chartered Bank - Seeing is Believing • KwaZulu-Natal DOH • 1.28 Million USD • July 2007 to June 2011 Giving Sight to Africa July 2007 to June 2011 Population: 10 Million 11 Health Districts OBJECTIVES • Development of guidelines for Eye care within District Health System • Guiding principle: Sustainability through integration THE DISTRICT HEALTH SYSTEM • Building blocks of the national health system – South Africa = 53 health districts • Structure of the District health system Clinic Suburb 1 Municipality 1 Health District Clinic CHC Clinic DH Suburb 2 CHC RH Clinic Clinic Suburb 3 Municipality 2 Clinic DH CHC Clinic Suburb 4 Clinic HRD Utilise existing cadres’ Develop skills in line with scope of practise PEC ON Optom Professional Nurses Skills Audit Recruitment In – service program SLA National Guideline 4 day training TOT approach Nurse Educators CHALLENGE Training BECN -Project supported -DOH commitment to take over funding secured upfront Referral protocol and policy To ensure efficient utilisation of scarce human resources and effective management of patients Clinic Define service available at different levels Define referral pathway CONSULTATION Define referral criteria CHC DH RH Infrastructure Development Define Physical space needed at institutions Advocate for space Define Equipment needs for cadres Provide equipment to cadres Equipment donation process Data Parallel Data Collection Process Direct reporting to project Worked well for optometrists - direct contact Poor reporting from PHC Resource intensive DHIS New indicators developed Improved reporting Sustainable Training – overview Cadre Trained Primary Health Care Nurses Primary Health Care Nurses Part 1 Part 2 Key Competencies Developed Duration of Training Measurement of Visual acuity Identification of basic eye pathological conditions 5 days Ophthalmoscopy Identification of basic posterior segment diseases 5 days Basic Refraction Diagnosis & Management of Ocular Disease Low Vision Assessments (Advanced Training offered to a percentage of those that completed Part 1) Ophthalmic Nurses Optometrists Treatment of Binocular Vision Anomalies Posterior Segment Pathology 5 days 5 days 2 days Numbers Trained Level Cadre 07/08 08/09 09/10 Total Trained PHC Primary Health Care 92 540 292 924 75 75 42 42 Nurses - Part 1 Primary Health Care Nurses - Part 2 CHC; District; Ophthalmic Nurses Regional and Tertiary Optometrists 38 Total Trained 38 1004 RESULTS Primary Eye Care service PHC – Reporting from clinics YEAR Number of PHC Percentage of Clinics reports reporting received Percentage of patients treated by PHC nurse 2007 22 67 58 2008 107 39 59 2009 643 50 66 2010 702 76 80 2011 731 53 84 PHC – Patients examined PHC 120000 99422 100000 84346 80000 71153 63291 60000 PHC 51820 40000 20373 20000 8736 4417 0 Jul - Dec 07 Jan - Jun 08 Jul - Dec 08 Jan - Jun 09 Jul - Dec 09 Jan - Jun 10 Jul - Dec 10 Jan - Jun 11 Optometry Service Optometrists • 0nly 6 in the public sector at inception in July 2007 • Supported recruitment through initial employment of optometrists • Negotiated with institutions in advance to secure future employment • Marketed opportunities to graduating classes • 38 optometrists in the public sector at June 2011 Optometry – Reporting from clinics Year Number of Clinics reporting Percentage of reports received Average number of patients per report 2007 50 82 37 2008 61 130 23 2009 84 276 18 2010 116 293 14 2011 124 274 13 YEAR Optometry – Patients examined 40000 35520 35000 30000 27158 26547 25000 23648 23351 22556 District Regional 20000 18466 Tertiary 15973 15774 15000 14828 11854 10359 10000 9821 8914 8241 6527 5000 4393 2806 1715 5961 7011 6001 4617 2143 1689 0 Jul - Dec 07 6570 Jan - Jun 08 667 Jul - Dec 08 1616 Jan - Jun 09 1681 Jul - Dec 09 2051 Jan - Jun 10 1727 Jul - Dec 10 2333 Jan - Jun 11 Total Optometry service percentage by level 80% 70% 68% 68% 67% 66% 63% 60% 60% 55% 50% 49% District 40% 39% Regional Tertiary 30% 20% 31% 19% 31% 28% 26% 26% 7% 6% 6% Jan - Jun 09 Jul - Dec 09 Jan - Jun 10 27% 21% 16% 10% 6% 8% 9% Jul - Dec 10 Jan - Jun 11 0% Jul - Dec 07 Jan - Jun 08 Jul - Dec 08 Assistive Device’s dispensed 9000 8000 7916 7813 7579 7000 6148 6000 6196 5288 5000 4622 4439 4000 3000 2000 1000 0 Jul to Dec 2007 Jan to Jun 2008 Jul to Dec 2008 Jan to Jun 2009 Jul to Dec 2009 Jan to Jun 2010 Jul to Dec 2010 Jan to Jun 2011 Overview by service level % age of patients examined by level 70% 65% 60% 57% 56% 50% 54% 49% 48% 44% 40% 40% 40% PHC 39% District 34% 31% 31% 30% 30% Tertiary 28% 25% 20% 17% 17% 10% 11% 11% 6% 8% 8% 8% 3% 0% Jul - Dec 07 Jan - Jun 08 Regional Jul - Dec 08 5% 4% Jul - Dec 09 Jan - Jun 10 9% 5% 8% 5% Jul - Dec 10 Jan - Jun 11 1% Jan - Jun 09 Conclusion Working within the DHS provides the opportunity for developing sustainable service delivery systems that are able to address the needs of large populations This is most effectively achieved through institutionalisation of program components Sufficient time for Advocacy and program development consultation is essential to ensure success THANK YOU Kesi Naidoo Sub Regional Manager: Southern Africa Brien Holden Vision Institute [email protected]