Hospital-Based Community Eye Health Model

Our model takes an inclusive, integrated approach to eye health care.

PLANNING
Choosing a Location

In each country that we work in, we analyze available statistics for avoidable blindness to determine where the prevalence of blindness is the highest. Once we determine these target areas, we look for a nearby local hospital to partner with. Next, we divide the target area into clusters by ensuring that any village can be reached from the most centrally located village in the cluster within two hours. Each cluster has a population of 5,000 to 25,000 people.

Ensuring Quality

When we enter a partnership with a local hospital, our first step is to conduct a quality audit of the facility and its services. This allows us to assess what training and improvements are required to ensure the delivery of quality care. The second step is to identify the gaps preventing quality service provision. This could include structural facility upgrades, lack of necessary equipment, lack of training, etc. The third step is to develop an action plan with our staff, members of the hospital staff, and relevant local stakeholders such as district health officials to determine how to address these gaps.
Determining Project Costs

It is during this quality audit stage that we can determine the estimated costs for the project. To do this, we divide costs into two categories. The first category is capital costs. Capital costs are one-time costs, such as facility upgrades or equipment procurement. The second category is recurring costs, such as staff salaries and consumable products like eyeglasses or medication.

IMPLEMENTATION
Recruitment

In our programs in South Asia, we provide eye health training for community health workers (CHWs) who are already employed by the local health system to educate their communities on things like nutrition, pre and ante natal care, and immunizations. In our programs in Africa, we train community health volunteers who are retained by the government for the purpose of running health education campaigns. For each cluster, we recruit two community health workers/volunteers who live in the area and are part of that community. These CHWs have a minimum qualification of secondary school and are preferably female. Other staff include a project coordinator and a data entry operator.

Training

The community health workers/volunteers and other staff undergo a training program spread over 10 to 20 days. Training is conducted by trained staff from the hospital, and is based on a curriculum developed by Operation Eyesight. An ophthalmologist and optometrist provide training on topics including the anatomy of eye, measuring visual assessment, and the identification of cataract and other eye diseases. Local staff provide guidance on administering door-to-door surveys, formulating action plans and promoting health education and gender equity.
Door-to-Door Surveys

Teams comprising of two trained community health workers/volunteers conduct door-to-door surveys in their respective clusters using a standard format. The survey lasts two to five months, depending on the population of the area. The survey focuses on identifying people who are blind or visually impaired; assessing people’s current knowledge, attitude and practice when it comes to eye health (KAP survey); and assessing the immunisation and antenatal/ postnatal care status of the population. Validation of the survey is done on a periodic basis by qualified ophthalmic personnel. Next, each CHW uses the results of the door-to-door surveys to develop an annual action plan tailored to meet the specific needs of the community.

Screenings

An ophthalmologist from the hospital conducts an exclusive screening program in the villages within the project area to screen and examine patients requiring medical and surgical intervention. Incurably blind patients who are medically unfit for transportation or operation are examined and certified, including those who are bedridden and unable to attend the screening program.
Delivering Eye Care

Following the screenings, the CHWs refer all patients requiring follow-up care to outreach camps, a nearby vision centre, or the closest base hospital for treatment/surgery, depending on what is available and the level of intervention required. This establishes a linkage and referral system between the community and primary and secondary level eye health care services. CHWs/CHVs and ophthalmic staff ensure that all those who require further diagnosis and care present themselves at the proper facility for surgery or other medical treatment. The staff in the field ensure 100 per cent follow-up. Surgery is done free of cost for patients who cannot afford to pay.

Health Education Events

CHWs conduct intense health education awareness events specially focusing on those with identified vision problems who have not undergone treatment or are reluctant to undergo treatment. Patients who have received treatment are asked to counsel patients who do not want to undergo surgeries because of various barriers such as fear or familial pressure. Public group meetings with youth and elected representatives are conducted with the objectives of creating awareness, encouraging patients to pursue treatment and ensuring commitment to the sustainability of the project.
MAINTENANCE
Monitoring and Evaluation

Continuous monitoring of all activities is done by the project coordinator daily, and by the hospital management on a weekly basis. The results of door-to-door surveys and community action plans serve as the basis for regular monitoring by hospital management.

Ensuring Sustainability

The community health workers or volunteers and the primary eye care/vision centre staff ensure the ongoing delivery of quality eye care beyond the project’s duration. Community-based action groups, such as village vision committees, women’s groups and youth groups, are trained and encouraged to work with community health workers to increase community participation. All recurring expenses related to surgical consumables, spectacles, etc. are absorbed by the hospitals as part of their regular annual plans and budgets.
Working with Local Governments

To ensure the success and sustainability of our programs, we consult local ministries and relevant community groups at every stage. Although the exact process varies from country to country, we meet with local stakeholders before the project begins to explain who we are and how our model works, and then we discuss how we can tailor our model to best meet the local needs. Throughout the project, local governments and ministries are kept abreast of all progress. They are involved in sustainability planning to ensure provision of the required support to hospitals after the projects have ended.

SHARING OUTCOMES
Declaring Results

The ultimate goal of a hospital-based community eye health program is to declare a village avoidable blindness free, which is when everyone, regardless of gender, age, religion or ability to pay, is treated for curable eye conditions and is able to see a minimum distance of six metres with their better eye. We have a tested methodology to declaring communities as ‘avoidable blindness-free.’ This means that all backlogged cases have been cleared, a post-project door to door survey has been conducted, and local government authorities have provided certification to those who cannot be treated due to medical or other extenuating circumstances. The declaration of a village as avoidable blindness free is often marked by a public celebration typically attended by district authorities, elected representatives and other agencies operating in the area.