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

Abstract

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.

A situational analysis of eye care services in Swaziland

“…This section relates to existing strategic policy frameworks that are in line with legislative plans, accountability as stated by the national health strategic plan and system designs. 8 Swaziland’s National Health Policy of 2006 is the cornerstone of health care delivery, and enshrines the rights of its citizens to equal access to affordable health services. 7 However, the policy ignores issues pertaining to preventative services, and does not have national priority goals and targets.…”

“…Proper health services are those that do not discriminate but promote equity in accessing quality effective services, even in a less resourced facility, as well as those concerned with promotive and preventative programs. 8 The Director of Health services noted that the current service provision to meet its citizen’s needs is inadequate, being additionally compromised by the mal-distribution of resources, including the absence of primary and secondary eye care facilities. Hence, the lack of resources also makes it difficult for the tertiary health centers to function effectively, with ophthalmic services only being provided at this level.…”

“…This section relates to having adequate, efficient, effective and competent staff who are provided with all necessary resources to achieve the best outcomes. 8 The document review revealed that Swaziland’s health system has a chronic shortage of skilled human resources, which impacted on the country’s capacity to effectively implement primary health and specialist care. 12 Few of the eye health professionals practicing in Swaziland are of Swazi origin, with foreign eye professional being employed by the church missions and working in the public sector.…”

“…An ideal health financing system is the one that has adequate funds to deliver equitable access and utilization of services without any payment burden on patients. 8 However, Swaziland’s health budget is insufficient to cater to all its citizens’ health care needs. 16,21 This situation is compounded by the HIV/AIDS epidemic, with Swaziland having one of the highest incidences in the world, which consumes a considerable portion of the health budget.…”

“…In an effort to assist countries in developing health policies or guidelines, the WHO introduced the following six framework components to analyse health systems: leadership and governance, health workforce, health services, health financing systems, medical supplies and technologies, and health information. 8 As a strategy towards developing a child eye health access framework in Swaziland, this paper presents a situational analysis of these six components in an eye health care service context.…”