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Service Delivery Models: District Health System

Service Delivery Models: District Health System. Kovin Naidoo. VISION 2020. VISION 2020.

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Service Delivery Models: District Health System

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  1. Service Delivery Models: District Health System Kovin Naidoo

  2. 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.

  3. Key Problems and Needs Models of Delivery Systems • Lack of Data for planning • Poor Practitioner to Patient Ratio • Poor distribution of personnel • Poorly Trained Personnel • Availability of Equipment • Availability of Spectacles • Funding

  4. KEY CONSIDERATION • Government key role player • Independent NGO programs individually successful but limited impact • Resistance from NPB Coordinators to programs that attempt to function outside the National Health System

  5. IAPB DURBAN IAPB Durban • For sustainability, refractive services should be part of the national NPBL activities. • Refractive services can be the entry point for developing health care and for screening for other diseases, eg glaucoma, diabetic retinopathy etc. • Fully trained optometrists/ECW to provide other services in the integrated eye care team.

  6. Need trained and equipped personnel to implement refractive services at the community, mid level and specialist level of health care

  7. Refractive exams Integration of Personnel • Children Exams should be carried out only by eyecare personnel(ECP) with the appropriate skills in objective and subjective refraction, ocular motility, basic eye examination, ability to detect potenially blinding diseases and communication skills.

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

  9. COMMUNITY LEVEL Community Level • First port of call • Screening programs • Case Finders • Sifting out the Presbyopes • Referring for ocular disease

  10. MIDLEVEL Mid Level • Spherical • Astigmatic

  11. SPECIALIST LEVEL Specialist Level • Complex refractions • Cycloplegic refractions

  12. STRATEGIES STRATEGIES Infrastructure Centre of Excellence 50 million CEC Training Centre 5 million TC Service Centre 500,000 SC Vision Centre 50,000 VC

  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. Clinics • Nurse • Comm. Health Worker • Primary eye care • Screening: Refractive & Non Refractive • Readers

  15. Community Health Center • Ophthalmic Nurse, OCO, Optometry Technician • Mx of Ocular Disease • Refraction Refraction • Optometrist (Visiting)

  16. District Hospital Optometrist/OCO/ Ophthalmic Nurse/Optometrist • Mx of Ocular Disease • Refraction including Basic Low Vision

  17. Regional Hospital(3o Level) Optometrist • Complex Refraction • Advanced Low Vision • Co-Management

  18. Provincial Hospital(40) • Refraction for Co-Management • Ophthalmologist Optometrist

  19. Training to Support DHS • Dedicated Personnel for Refraction

  20. Level 5 POST GRAD. Masters/OD M/O.D. Level 4 Ocular Disease, Binocular Vision, Pediatrics, Low Vision and Contact Lenses OPTOM. TECH OPTOMETRIST Opt. Tech. Level 3 Other Clinical techniques and Advanced Visual Science CHW Level 2 Optometric Asst./Tech Refraction and dispensing Course CECW Level 1 CHW/CECW Basic Eyecare Course Maths, Physics, Community Studies, Biology etc Optical Shop Assistants Anatomy, Physiology, Refractive Techniques Dispensing Course

  21. Establishing Numbers • Integrated health care team • Should be based on districts rather than population numbers • Number mask the reality

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