Effective scale up of refractive error and primary eye care service within a District Health System: Results of the Seeing is Believing Program in the province of KwaZulu-Natal, South Africa Kovin S Naidoo 1, 2, 3, Kesi Naidoo 1,2, Yashika Maharaj 2, Prasidh Ramson,2, Diane Wallace,2,3 and Reshma Dabideen,2 1 International Centre for Eyecare Education, Durban, South Africa 2 African Vision Research Institute (AVRI), 3 University of KwaZulu-Natal

Giving Sight to Africa Standard Chartered Bank - Seeing is Believing KwaZulu-Natal DOH 1.28 Million USD July 2007 to June 2011

Giving Sight to Africa July 2007 to June 2011 Population: 10 Million 11 Health Districts

OBJECTIVES Development of guidelines for Eye care within District Health System Guiding principle: Sustainability through integration

Suburb 2 Municipality 1 Municipality 2 THE DISTRICT HEALTH SYSTEM Building blocks of the national health system – South Africa = 53 health districts Structure of the District health system Health District CHC Clinic Suburb 1 Clinic Suburb 3 Clinic Suburb 4 Clinic DH RH

HRD PEC ONOptom Professional Nurses National Guideline 4 day training TOT approach Nurse Educators Skills Audit In – service program CHALLENGE Training BECN Recruitment SLA -Project supported -DOH commitment to take over funding secured upfront Develop skills in line with scope of practiseUtilise existing cadres’

Referral protocol and policy Define service available at different levels CONSULTATION To ensure efficient utilisation of scarce human resources and effective management of patients Define referral criteria Define referral pathway Clinic CHC DH RH

Infrastructure Development Advocate for space Equipment donation process Define Physical space needed at institutions Define Equipment needs for cadres Provide equipment to cadres

Data Parallel Data Collection Process Direct reporting to project Worked well for optometrists - direct contact Poor reporting from PHC Resource intensive DHIS New indicators developed Improved reporting Sustainable

Training – overview

RESULTS

Primary Eye Care service

PHC – Reporting from clinics

PHC – Patients examined

Optometry Service

Optometrists 0nly 6 in the public sector at inception in July 2007 Supported recruitment through initial employment of optometrists Negotiated with institutions in advance to secure future employment Marketed opportunities to graduating classes 38 optometrists in the public sector at June 2011

Optometry – Reporting from clinics YEAR

Optometry – Patients examined

Optometry service percentage by level

Assistive Device’s dispensed

Overview by service level

% age of patients examined by level

Conclusion Working within the DHS provides the opportunity for developing sustainable service delivery systems that are able to address the needs of large populations This is most effectively achieved through institutionalisation of program components Sufficient time for Advocacy and program development consultation is essential to ensure success

THANK YOU Kesi Naidoo Sub Regional Manager: Southern Africa Brien Holden Vision Institute