The Promise of Toolkits Rènée du Toit

The Promise of Toolkits To solve technical problems while aiming for self-reliance Despite potential, rigour and evidence base “the usefulness of toolkits in the field has often not lived up to expectations” WHR PHC: Now more than ever

Why?? Under-estimates the complexity of the problems If accepted as an off the shelf solution: limits engagement with countries. Engaging Science: Thoughts, deeds, analysis and action Wellcome Trust Report

PEC Toolkit Collection of materials: 1.Existing 2.Fill gaps 3.New ideas

I cannot see close by Did it happen suddenly or gradually over time Refer urgently Refer urgently Reassure Refer OR provide presbyopic spectacles if available LOSS OF VISION My vision is blurry Measure distance vision Gradual loss Reassure Vision normal Vision abnormal in one or both eyes Vision abnormal Measure near vision Vision normal Vision abnormal in one or both eyes Sudden loss in one or both eyes Sudden loss in one or both eyes WHO - algorithm

Toolkit 1.Training course Health promotion and prevention ‘Curative’ care Health systems information 2. Implementation tools

Referral Tertiary Secondary Primary

Service delivery: Accessible care Appropriate referral pathways exist Well trained staff / equipped facilities Service delivery: Accessible care Appropriate referral pathways exist Well trained staff / equipped facilities Human resources: competent referral decisions; patient information Retains competency Finance: can people afford it? universal access Leadership: implementation Guidelines / algorithms Feedback on referral (continuing education, continuity of care) Leadership: implementation Guidelines / algorithms Feedback on referral (continuing education, continuity of care) HIS: # of people seen # referred, # reported, # correctly referred; evaluation of referral pathways & services HIS: # of people seen # referred, # reported, # correctly referred; evaluation of referral pathways & services Equipment and supplies: sufficient at primary and referral level Health systems support for referral pathways

Implementation tools Select training materials Who? Where? What must they do? Set up support required Do they have what they need? How can we be sure of the quality of care? Can this be scaled up? Is it sustainable?

mobile phones: enter symptoms into a decision- tree based algorithm mobile broadband or SMS/MMS to connect to a remote doctor for a consultation New ideas

first aid recognise and refer / reassure (most common eye conditions) skills required by different groups integrate eye health into other messages tailor these to the audience be creative / imaginative in promoting health promotion and prevention evidence based guidelines / expert group consensus on guidelines/algorithms health systems support for implementation quality & sustainability guidelines / expert group consensus on guidelines/algorithms adapt & pilot & improve evidence based

The answer is….. We don’t have all the answers The answer will not be simple The answer is not only a hammer

"If the only tool you have is a hammer, you will see every problem as a nail.” Maslow

Any suggestions? Content of toolkit – what will be useful to you? What can you contribute? Any volunteers to piloting algorithms / processes?