Community Ophthalmology Lecture Series Lecture Ⅲ

Monitoring and assessment of activities of outreach eye camps Dr.Saman Wimalasundera MBBS, DO, PhD Senior lecturer in Community Medicine & Community Ophthalmologist Department of Community Medicine, Faculty of Medicine, University of Ruhuna, PO Box 70, Galle, Sri Lanka

Eye camp concept is a highly desirable and accepted strategy in providing eye health services to the populations in remote and underserved areas of developing countries. Eye camps are generally of two types. 1.Comprehensive eye care camps 2.Mass cataract camps

In mass cataract camps the prime emphasis is on cataract surgery. No other services are routinely provided.

Comprehensive eye care camps are concerned with primary eye care approach providing several types of services for many ocular or systemic conditions that lead to visual disability or blindness if left untreated.

Example:- Identifying corneal disease, cataracts, refractive errors, glaucoma, squints, Eye infections, allergies, trauma and other common eye conditions.

Most eye camps are organized by non governmental organizations. They have a major role in organization and conducting eye camps. Technical inputs are provided by the institutional ophthalmic team where the eye surgeon is the team leader.

The camp organizers should be highly motivated, devoted and committed to the cause and the community participation is a very important factor in making an eye camp a success.

Corrective measures for those identified conditions are usually undertaken either at the camp or after referral to the base or main center.

Manpower and Duties In addition to routine eye care workers (Eye surgeon, Ophthalmic nurses and refractionists) several other health personnel are required in such programs including ophthalmic assistants, public health workers and nurses.

Distribution of work during an eye camp has to be very clearly defined before the commencement. Work should be assigned to different personnel on their qualification and experience.

Work Screening for visual defects using Snellens chart and examination for obvious anomalies IOP checking using Shiotz tonometer Refraction Personnel Trained Ophthalmic - Nurse / Medical officer Trained Ophthalmic - Nurse / Assistant Refractionist / Trained - Ophthalmic assistant

Work Drug distribution Diagnosing, treating and referral Health education Logistics Personnel Trained Ophthalmic assistant Ophthalmologist Nurse /FHW / Ophthalmic assistant Camp organizers

For the improvement of camp services, Monitoring of activities, finding the constraints and evaluating the effectiveness are major important feedback mechanisms. Recommended follow up activities should also be carefully monitored for the fulfillment of the concept of eye camps.

Monitoring and evaluation provide a feedback on camp activities as well as information on the impact of the services provided. Some indicators are needed for this assessment.

Indicators should be based on 1.Measuring the progress 2.Finding whether the set targets are achieved

Different performance of eye camps are the easiest measures to use as the indicators. It must be comprehensive and cover all aspects of eye camp services. In using performance indicators a minimum manpower requirement should be finalized.

The team should consist at least one ophthalmologist, one optometrist and two ophthalmic assistants/nurses. Performance unit for each activity are expected to increase with the increase of manpower.

1.Patient examination A) 20 patient examinations and treatment (Vision checking, anterior segment examination Funduscopy) B) 5 refractions (Dry / cycloplegic) 1 Unit Indicators suggested Performance in units

C) 20 IOP checking D) 10 cataract referrals for surgery E) 30 referrals to base for follow up / investigation 1 Unit

2.Intervention at the camp / base A) 5 removal of superficial foreign bodies B) 5 any other minor procedure C) 1 cataract extraction at the camp D) 2 cataract extraction at the base E) 10 investigations and follow up at the base 1 Unit

3.Screening procedures only A) 50 school children B) 50 community members 1 Unit

4.Health education A) 25 people given education (lecture/leaflet/posters) B) 1 film show / video presentation 1 Unit

5.Rehabilitation A) Rehabilitation of 1 blind patient1 Unit

Progress of a camp can be assessed using those set indicators and their performance units. Total number of units for each camp can be compared with another same type of a camp for each activity or for overall activities.It may be compared with a gold standard or set goals for a single camp too.

This procedure would provide an opportunity for the organizers and the authorities to assess their own performances, which could be compared with other similar activities of the country. This ensures whether the planned procedures are on track and indicate the deviations allowing the adoption of corrective measures.

Eye camps are an essential component in prevention of blindness activities in the countries where community ophthalmology is not an established discipline.

In such situations if a national program is planed for the prevention of blindness, these indicators could be used targeting certain number of unit values for different activities or overall unit value for total events at different levels for peripheral mobile units and central mobile units separately to achieve in a given time period.

An example for performing evaluation of eye camp activities Five eye camps were conducted in different parts of a country for a period of six months.

Eye campNo. attended Camp 1 Camp 2 Camp 3 Camp 4 Camp Total766 Findings of eye camps conducted for past six months

Analysis of camp activities and earned unit values

ActivityCampTota l num ber %Total units earn ed C-1C-2C-3C-4C-5 Medical treatment at the camp Achieved unit values Refraction at the camp Achieved unit values

ActivityCampTota l num ber %Total units earn ed C-1C-2C-3C-4C-5 NAD Referred for surgery Achieved unit value Referred for further examination Achieved unit value

ActivityCampTotal numb er %Total units earn ed C-1C-2C-3C-4C-5 IOP Checking Achieved unit value Total number Total units achieved

This table provides the information about the activities done at the camp sites and the number of units earned through the performance indicators.

Analysis of activities at the base and earned unit values

EventCampTotal num ber %Tota l unit C-1C-2C-3C-4C-5 Cataract surgeries performed Unit value n= Followed up at the clinic Unit value n= Total number Total units achieved

This table shows the amount of work performed at the base in relation to individual camp. Units achieved at the base are added to the camp site units in finding the total unit achievement.

Total unit value achieved for past six months by performing eye camps and subsequent follow up and rehabilitative procedure equals to unit value of units. Average single camp value was 24.4 units. The total value or individual unit values could be used in comparison or assessment of camp activities. It may be useful in self-assessment too.