Applying principles of health system strengthening to eye care

Blanchet, Karl; Patel, Daksha

doi:10.4103/0301-4738.100553

Cited by 19 publications

(19 citation statements)

References 21 publications

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“…Four papers described the importance of health systems strengthening with regards to eye health [55-57,72,73]. Table 1 shows that most of the 173 papers included in this review, 43 of which are reviews, contain information from sub-Saharan Africa (76) or from low- and middle-income countries (47).…”

Section: Resultsmentioning

confidence: 99%

“…For example it is recommended that health personnel should identify ways to collaborate with peers, advocate for change and engage with the health system [56,57]. There is however insufficient evidence about how health care providers, as active agents of change within a complex health system, can influence health systems.…”

Section: Discussionmentioning

confidence: 99%

“…Many countries have thus adopted policies using priority health interventions as an entry point to strengthen health systems (health systems strengthening: HSS), based on a primary health care approach [52-54]. The importance of a health systems strengthening approach has been recognized in the eye health literature [55-57]. …”

Section: Introductionmentioning

confidence: 99%

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Evidence for integrating eye health into primary health care in Africa: a health systems strengthening approach

Toit¹,

Faal²,

Etya’ale

et al. 2013

BMC Health Serv Res

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BackgroundThe impact of unmet eye care needs in sub-Saharan Africa is compounded by barriers to accessing eye care, limited engagement with communities, a shortage of appropriately skilled health personnel, and inadequate support from health systems. The renewed focus on primary health care has led to support for greater integration of eye health into national health systems. The aim of this paper is to demonstrate available evidence of integration of eye health into primary health care in sub-Saharan Africa from a health systems strengthening perspective.MethodsA scoping review method was used to gather and assess information from published literature, reviews, WHO policy documents and examples of eye and health care interventions in sub-Saharan Africa. Findings were compiled using a health systems strengthening framework.ResultsLimited information is available about eye health from a health systems strengthening approach. Particular components of the health systems framework lacking evidence are service delivery, equipment and supplies, financing, leadership and governance. There is some information to support interventions to strengthen human resources at all levels, partnerships and community participation; but little evidence showing their successful application to improve quality of care and access to comprehensive eye health services at the primary health level, and referral to other levels for specialist eye care.ConclusionEvidence of integration of eye health into primary health care is currently weak, particularly when applying a health systems framework. A realignment of eye health in the primary health care agenda will require context specific planning and a holistic approach, with careful attention to each of the health system components and to the public health system as a whole. Documentation and evaluation of existing projects are required, as are pilot projects of systematic approaches to interventions and application of best practices. Multi-national research may provide guidance about how to scale up eye health interventions that are integrated into primary health systems.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Evidence for integrating eye health into primary health care in Africa: a health systems strengthening approach

Toit¹,

Faal²,

Etya’ale

et al. 2013

BMC Health Serv Res

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“…To achieve better population eye heath, Vision 2020 and the Global Action Plan promote the integration of eye care services into the general health system [ 3 , 4 , 37 ]. Health services would ideally be available as close as possible to where people live and be affordable [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

“Planning eye health services in Varamin district, Iran: a cross-sectional study”

Katibeh

Blanchet

Akbarian

et al. 2015

BMC Health Serv Res

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BackgroundA recent survey of avoidable blindness in Varamin District, Iran, identified moderately high levels of visual impairment (10%) and blindness (1.5%) in people >50 years. This study aimed to define current provision, identify gaps and suggest practical solutions for improving eye health services in this area.MethodsThe World Health Organization (WHO) framework for analyzing health systems has several key components: service delivery, health workforce, information system, medical products and technologies, financing, and governance. We used this structure to investigate the strengths and weaknesses of the eye health system in Varamin. All public and private eye care facilities and a random selection of primary health care (PHC) units were assessed using semi-structured researcher-administered questionnaires.ResultsVaramin has 16 ophthalmic clinics, including two secondary hospitals that provide cataract surgery. There were ten ophthalmologists (1:68,000 population), two ophthalmic nurses and five optometrists working in Varamin district. There were no eye care social or community workers, ophthalmic counsellors, low vision rehabilitation staff. Although the Vision 2020 target for ophthalmologists has been met, numbers of other eye care staff were insufficient. The majority of patients travel to Tehran for surgery. The recent survey identified cataract as the leading cause of blindness, despite the availability of surgical services in the district and high health insurance coverage. Poor awareness is a major barrier. No units had a written blindness prevention plan, formal referral pathways or sufficient eye health promotion activities. Only one of the PHC units referred people with diabetes for retinal examination. There is partial integration between eye care services and the general health system particularly for prevention of childhood blindness: chemo-prophylaxis for ophthalmia neonatorum, school vision tests, measles immunization and Vitamin A supplementation.ConclusionsThis analysis demonstrated the need for better integration between eye care services and the general health system, local planning for prevention of blindness, an information system, a better staff mix and health education to increase community awareness and service uptake. There is the capacity to deliver far more surgery locally. All aspects of a health system need to be developed to deliver comprehensive and efficient eye care.

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“…The comprehensive holistic Eye Health Strategic Planning and Evaluation Framework and the Checklist , which provides seven domains, 50 components, and 253 indicators, has been developed as a practical visual tool to address the gaps identified in the Universal Eye Health Action Plan (2014‐2019) and VISION 2020 strategists advocating that eye health‐care services be integrated into the health system . The Framework and the Checklist address the specific objectives of the Action Plan 2014‐2019: the need for improved integrated programs within the health system, which involves multi‐sectors and aids the development of a monitoring process by providing a spectrum of components associated with the eye health programs cycle, embracing the principles of universal coverage, equity, human rights, evidence‐based practice, a life cycle approach and empowerment of people with vision impairment.…”

Section: Discussionmentioning

confidence: 99%

Formative research for the development of an Eye Health Strategic Planning and Evaluation Framework and a Checklist: A health systems approach

Ormsby

2019

Health Planning & Management

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Summary This formative research process aimed to develop an Eye Health Strategic Planning and Evaluation Framework and indicator Checklist. The research process utilized a multi‐phased multiple methods approach including literature review, initial expert review (n = 27), findings from a Cambodian Avoidable Blindness Initiative demonstration project (2009‐2012), observation and analysis of four rural sites of the Indian LV Prasad Eye Institute Pyramid Model (n = 21), and finally, a critique by Cambodian government eye health professionals/staff (n = 15), health center staff and community representatives (n = 77) and patients (n = 62). Results from three Cambodian population‐based surveys (KAP n = 599, patient follow‐up n = 354, and RAAB 4650) also informed the development of the Framework and the Checklist. The Framework domains include: situation analysis, determinants of accessibility, service delivery systems, operation systems, networks and linkages, outcomes, and impact. Domains were subdivided into 59 components. The Checklist consists of 253 indicator items. The Eye Health Strategic Planning and Evaluation Framework and the Checklist can assist policy makers, program planners, and evaluators to develop a comprehensive whole of systems approach to eye health care to improve coverage and utilization of services.

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Applying principles of health system strengthening to eye care

Cited by 19 publications

References 21 publications

Evidence for integrating eye health into primary health care in Africa: a health systems strengthening approach

Evidence for integrating eye health into primary health care in Africa: a health systems strengthening approach

“Planning eye health services in Varamin district, Iran: a cross-sectional study”

Formative research for the development of an Eye Health Strategic Planning and Evaluation Framework and a Checklist: A health systems approach

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