Health system dynamics analysis of eyecare services in Trinidad and Tobago and progress towards Vision 2020 Goals

Abstract

Avoidable blindness is an important global public health concern. This study aimed to assess Trinidad and Tobago's progress towards achieving the Pan American Health Organization, 'Strategic Framework for Vision 2020: The Right to Sight-Caribbean Region,' indicators through comprehensive review of the eyecare system, in order to facilitate health system priority setting. We administered structured surveys to six stakeholder groups, including eyecare providers, patients and older adult participants in the National Eye Survey of Trinidad and Tobago. We reviewed reports, registers and policy documents, and used a health system dynamics framework to synthesize data. In 2014, the population of 1.3 million were served by a pluralistic eyecare system, which had achieved 14 out of 27 Strategic Framework indicators. The Government provided free primary, secondary and emergency eyecare services, through 108 health centres and 5 hospitals (0.26 ophthalmologists and 1.32 ophthalmologists-in-training per 50 000 population). Private sector optometrists (4.37 per 50 000 population), and ophthalmologists (0.93 per 50 000 population) provided 80% of all eyecare. Only 19.3% of the adult population had private health insurance, revealing significant out-of-pocket expenditure. We identified potential weaknesses in the eyecare system where investment might reduce avoidable blindness. These included a need for more ophthalmic equipment and maintenance in the public sector, national screening programmes for diabetic retinopathy, retinopathy of prematurity and neonatal eye defects, and pathways to ensure timely and equitable access to subspecialized surgery. Eyecare for older adults was responsible for an estimated 9.5% (US$22.6 million) of annual health expenditure. This study used the health system dynamics framework and new data to identify priorities for eyecare system strengthening. We recommend this approach for exploring potential health system barriers to addressing avoidable blindness, and other important public health problems.

A retrospective study of causes of visual impairment and use of low vision devices in the low vision clinic in Trinidad and Tobago

“…A recent study reported poor infrastructure for glaucoma diagnosis and management in public hospitals in Trinidad and Tobago. 5 Glaucoma features prominently as the major cause of visual impairment worldwide. 2 , 18 , 20 However, a study reported a reduction in glaucoma blindness in high income countries which is attributed to improved diagnosis and management of the condition.…”

“…While congenital conditions feature as the major cause of visual impairment worldwide, 13 the high prevalence of congenital disorders could also be due to the lack of provision of neonatal eye examination to detect conditions such as congenital cataract and glaucoma in Trinidad and Tobago. 5 …”

“…4 Trinidad and Tobago spends 5.5% of its GDP in health, however, the healthcare provision faces serious challenges. 5 , 6 …”

The association between health literacy and self-medication behaviors among women referred to comprehensive health care centers in Sirjan, Iran, in 2017

“…Since low health literacy level is one of the major challenges for health policy-making and healthy lifestyle and behaviors, efforts to gain these skills are recommended along with public health promotion programs. Moreover, improving health literacy is part of the Healthy People 2020 program (43). Furthermore, in the strategic document of the health system policies of the Islamic Republic of Iran, the promotion of health information, accountability, structured ability, and participation of the individual, family and society in provision, preservation, and promotion of health are of the priorities of the health system, using the capacity of cultural, educational, and media entities, and organizations under the supervision of the Ministry of Health, Treatment, and Medical Education (29).…”

<p>A Review of Advancements and Evidence Gaps in Diabetic Retinopathy Screening Models</p>

“…106,107 A study in Trinidad and Tobago revealed that private sector ophthalmologists performed 80% of all eye care, but only 19.3% of the adult population had private healthcare insurance, leading to significant out-of-pocket expenditure. 108 Studies have investigated the impact of DR costs (real and perceived), as well as the impact of incentivizing DR screening, and identified significant predictors of decreased adherence, including when participants believed their medical insurance did not sufficiently cover the costs of diabetic eye exams, had poorly controlled blood glucose, or had only recently been diagnosed with diabetes. 109 In a UK study, methods for encouraging patient engagement with DR screening were studied and it was revealed that financial incentives attracted fewer patients to screening than standard invites.…”