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 WellcomeTrust Report
PEC Toolkit Collection of materials: • Existing • Fill gaps • New ideas
Reassure WHO - algorithm LOSS OF VISION Vision normal I cannot see close by Measure near vision Measure distance vision Vision normal Refer OR provide presbyopic spectacles if available Vision abnormal in one or both eyes Refer urgently Vision abnormal Sudden loss in one or both eyes Did it happen suddenly or gradually over time Refer Vision abnormal in one or both eyes My vision is blurry Gradual loss Measure distance vision Reassure Vision normal
Toolkit • Training course • Health promotion and prevention • ‘Curative’ care • Health systems information 2. Implementation tools
Service delivery: • Accessible care • Appropriate referral pathways exist • Well trained staff / equipped facilities • Equipment and supplies: sufficient at primary and referral level • Human resources: competent referral decisions; patient informationRetains competency Health systems support for referral pathways • HIS: # of people seen • # referred, # reported, # correctly referred; evaluation of referral pathways & services • Finance: can people afford it? universal access • Leadership: implementation Guidelines / algorithms • Feedback on referral (continuing education, continuity of care)
Implementation tools Select 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?
New ideas • mobile phones: enter symptoms into a decision-tree based algorithm • mobile broadband or SMS/MMS to connect to a remote doctorfor a consultation http://clickmedix.com/
skills required by different groups • first aid • recognise and refer / reassure (most common eye conditions) • health promotion and prevention • integrate eye health into other messages • tailor these to the audience • be creative / imaginative in promoting • quality & sustainability • evidence based guidelines / expert group consensus on guidelines/algorithms • health systems support for implementation • evidence based • guidelines / expert group consensus on guidelines/algorithms • adapt & pilot & improve
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?