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Kovin S Naidoo 1, 2, 3 , Kesi Naidoo 1,2 , Yashika Maharaj 2 , Prasidh Ramson ,2 , Diane Wallace ,2,3 and Reshma Dab

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.

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Kovin S Naidoo 1, 2, 3 , Kesi Naidoo 1,2 , Yashika Maharaj 2 , Prasidh Ramson ,2 , Diane Wallace ,2,3 and Reshma Dab

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  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,2,3and ReshmaDabideen,2 1International Centre for Eyecare Education, Durban, South Africa 2African Vision Research Institute (AVRI), 3University of KwaZulu-Natal

  2. Giving Sight to Africa • Standard Chartered Bank - Seeing is Believing • KwaZulu-Natal DOH • 1.28 Million USD • July 2007 to June 2011

  3. Giving Sight to Africa July 2007 to June 2011 Population: 10 Million 11 Health Districts

  4. OBJECTIVES • Development of guidelines for Eye care within District Health System • Guiding principle: Sustainability through integration

  5. Building blocks of the national health system – South Africa = 53 health districts Structure of the District health system THE DISTRICT HEALTH SYSTEM Suburb 1 Clinic Municipality 1 Health District Clinic CHC Suburb 2 Clinic DH Clinic CHC RH Suburb 3 Clinic Municipality 2 Clinic DH CHC Suburb 4 Clinic Clinic

  6. HRD Utilise existing cadres’ Develop skills in line with scope of practise PEC ON Optom Professional Nurses National Guideline 4 day training TOT approach Nurse Educators Skills Audit In – service program CHALLENGE Training BECN • Recruitment • SLA • Project supported • DOH commitment to take over funding secured upfront

  7. Referral protocol and policy To ensure efficient utilisation of scarce human resources and effective management of patients Define service available at different levels CONSULTATION Clinic CHC Define referral criteria DH Define referral pathway RH

  8. Infrastructure Development Define Physical space needed at institutions Advocate for space Equipment donation process Define Equipment needs for cadres Provide equipment to cadres

  9. 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

  10. Training – overview

  11. RESULTS

  12. Primary Eye Care service

  13. PHC – Reporting from clinics

  14. PHC – Patients examined

  15. Optometry Service

  16. 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

  17. Optometry – Reporting from clinics YEAR

  18. Optometry – Patients examined

  19. Optometry service percentage by level

  20. Assistive Device’s dispensed

  21. Overview by service level

  22. % age of patients examined by level

  23. 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

  24. THANK YOU Kesi Naidoo Sub Regional Manager: Southern Africa Brien Holden Vision Institute kesi@brienholdenvision.org.za

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