PRIMARY LEVEL EYECARE SERVICES

1. PRIMARY LEVEL EYECARE SERVICES PALESA DUBE

2. Introduction: • Primary level Services • Human resource • Equipment • Screening programs • Community Participation/Awareness(Health Promotion) • Monitoring of services

3. VISION 2020 VISION 2020 • Vision 2020 will strive to make refractive services and corrective spectacles affordable and available to the majority of the population through primary health care facilities, vision screening in schools and low-cost production of spectacles. Similar strategies will be adopted to provide low vision services.

4. PHC vs PEC • Primary health care in relaltion to Primary eyecare 1.Better nutrition-Prevents vitamin A deficiency 2. Water and sanitation programmes-Relevant in trachoma control 3. Delivery of maternal and child health care-Reduce retinopathy of prematurity 4. Health education-Prevention of eye trauma

5. IAPB MEETING IN DURBAN IAPB Durban • Refractive services can be the entry point for developing health care and for screening for other diseases, eg glaucoma, diabetic retinopathy etc. • Integration is therefore critical

6. Refractive Correction: Priority • -High Priority: < 6/18 • -Moderate Priority: <6/12 • -Low Priority: <6/9 • -Children: < 6/12 • -Adults: < 6/18 • This should inform services at the primary eye care level

7. Priority Groups • Children aged 11-15 with myopia and people over the age of 45 years who require spectacles for near vision

8. Refractive error in Children • Visual acuity screening of children can be performed at community level by teachers, health care workers etc.

9. STRATEGIES STRATEGIES Vision 2020 Ophth., Opt., Managers Specialists OphN., Oph.Tech, Dispensing Opt. Mid Level Personnel Com Worker, Teacher, PHCW Comm. Level

10. Primary Eyecare Key components: • Prevention • Awareness • Community involvement etc.

11. The Importance of Primary Eyecare • Training • Supervision • Support • Referral This extends from from the clinic nurse at the district and community health centre to the eye nurse at the district hospital and the eye doctor at the regional hospital.

12. Primary Level Services Community Level Services provided: • Screening programs • Case Finders • Sifting out and correcting Presbyopes • Readers for presbyopia • Referring for ocular disease

13. District Health SystemWHO: Framework for delivery District Health SystemWHO: Framework for Delivery HEALTH DISTRICT SPECIALIST & SUPER-SPECIALIST CARE (40) 3o LEVEL CARE SPECIALISED SERVICES NON- SPECIALIST CLINIC COMMUNITY HEALTH CENTRE REGIONAL HOSPITAL DISTRICT HOSPITAL PROVINCIAL HOSPITAL CLINIC COMMUNITY HEALTH CENTRE DISTRICT HOSPITAL REGIONAL HOSPITAL CLINIC Fig 1.

14. District Hospital • Refer to district: Ophthalmic nurse/OCO/Optometrist/Refractionist • Treatment of Ocular Disease • Refraction including Diagnoses of astigmatism • Basic Low Vision

15. Human Resources Required • Primary Health Care nurses • Community Health Care facilitators • Community Health Care workers • Teachers, Social workers • Community representatives and structures

16. Skills needed • Recognition and primary care management of the following: -Eye injuries -Refractive errors -Eyelid swelling -Red eye -Cataract -Educating patients about hypertensive and diabetic retinopathy, trachoma etc

17. Training needs • Training Needs -Vision assessments -Vision screening/ School screening techniques -Presbyopic correction -Management of basic eye conditions eg. conjunctivitis

18. Responsibilities • Case History • Visual Acuity • External exam with a penlight • Installation of eyedrops and ointments (Antiallergic and antibiotic ointments and eyedrops) • Awareness of cataract surgery, other eye conditions etc.

19. Equipment required • Screening Tools: Distance VA charts Near VA charts +2.00 spectacles (Children sreening) Ocludder Pinhole Pd ruler Torch

20. Provision of spectacles Provision of Spectacles • -Affordable and or subsidised • -Ready mades: Presbyopic correction • Inventory of spectacles for same day dispensing

21. SCREENING PROGRAMS

22. School based screening

23. Aim of school vision testing Aim of school vision testing • Amblyopia • Refractive errors • To detect eye diseases in older children • Limited by resources: human, infrastructure and finance

24. Age of vision screening Age of vision screening • Options: • Preschool age • Primary school age • Secondary school age

25. CHILDREN Children

26. Adults over 45 Adults over 45 years

27. Community Screening Community Screening • Primary health care centers • Collaboration with community based organisations • For children in the community the same school screening techniques should be followed.

28. COMMUNITY PARTICIPATION

29. Community Participation Providing affordable (even free) and accessible services does not guarantee that they will be used.-Cultural and other beliefs and/or fears-Sense of ownership is important in ensuring uptake of services

30. Community Participation • Access to and uptake of existing eye-careservices: - Ensure there are no barriers or other constraints to the use of services at the eye unit itself. • Develop outreach services that operate effectively. • Ensure adequate number of staff working in primary eye care and in outreach facilities.

31. Community Participation • Continuation: • Ensure that community members seek out eye-care services when needed. • Ensure that communities are actively involved in eye-screening.

32. AWARENESS

33. Potential approaches to increase awareness/health promotion • Basic eye health workers and general health staff • CBR workers • Village health workers • Survey/questionnaire/focus groups • Mass media • Traditional healers • School teachers and schoolchildren • Community groups (women’s groups, religious groups)

34. Monitoring of services -Schoolchildren identified with refractive errors and provided with spectacles. -Number of adults given presbyopic corrections -Number of referrals for refraction at the secondary level -Uptake of spectacles -Number of people referred for other eye conditions