1. Program Management Primary Eye Care Boateng Wiafe, MD, Regional Director for Africa Course 8, 9GA IAPB Hyderabad, 17 Sept, 2012

2. introduction Despite considerable investment in eye care by many organizations and governments, results in many countries have been disappointing

3. Program Management - PEC 1. Introduction 2. How do we manage? 3. Managing HR 4. Managing Infrastructure and Equipment 5. Managing Change 6. Advocacy 7. Monitoring and Evaluation 8. Conclusion

4. introduction There are a number of success stories that we can learn some lessons from. Good management is key to successful and sustainable primary eye care programmes

5. Planning 1. Problem Identification 2. Problem analysis 3. Strategy development 4. Action plan formulation 5. Implementation of the plans

6. Example The following slides show the summary of a series of situational analyses conducted in many different places

7. Human Resource(a) Staff of Eye Unit belong to wider hospital setup and are treated as such. Not responsible to unit head. Supervision difficult Staff can be deployed anyhow, even though they are trained in a specialised area. No direct reward for more responsibilities so they become demotivated. No establishment exists in the government structure for some members of the team – Cataract surgeons, Refractionists, opticians etc

8. Human Resource (b) Staff replacement due to retirement, transfers etc become difficult. Supervision and Discipline of staff is very difficult. Difficult to attract staff to places where they are needed because of the inflexibility of the system in place. Lack of career structure leads to a lot of staff changing to different areas.

9. Infrastructure, Equipment Historically supported by NGOs Location of Eye Clinics, Departments and Units. Considered not as part of the system. Try to look for the eye clinics in Government Setups Equipment and instruments are not planned as part of the general procurement so whatever is found is donated. No spare parts nor maintenance programme in place so when they break down and you will find many types of these furniture in many institutions.

10. Consummables, Drugs and Eyeglasses These are not part of the essential lists for the government medical stores and so in all government setups these are always in short supply Where they are found the drugs or supplies are inappropriate. Secondary level facility not functioning well due to above challenges

11. Challenges in management No integration with Existing reporting systems (HMIS) do not capture all the data from eye units so affects planning Supervisory Visits Planning Planning cycles – Vision 2020 plans out of tune with National Health Planning

12. How do we manage these ? Primary eye care is an integral part of Primary Health Care and should be managed as such. District Health is PHC Joint planning sessions are very important here. At the district level this is exactly what happens. Reports are shared with other departments as well We put systems in place to ensure that they compliment each other. Joint Monitoring

13. Managing Human Resources Human Resources are the most important asset in any eye programme, especially in the developing world The situational and the Gap Analysis will give us some valuable information. These are 3 essential aspects of HRM HRD/ Continuous Professional Development Teambuilding Motivation

14. HRD It is important to make sure that the training is task oriented. Entire Teams are trained Ensure there are opportunities for CPD

15. DELEGATE Task shifting and Task sharing are happening in so many other disciplines Many of us are scared to delegate for fear of failure Once you have trained the staff well you can safely delegate.

16. Motivation Remember that Motivation does not equal financial incentives. Following are some suggested forms of motivation: Recognition of their contribution Conducive working environment (Infrastructure and equipment) Opportunities for career advancement

17. Managing Infrastructure and Equipment These account for up to 70% of the budgets in eye care services and so they should be carefully managed Appropriate Technology does not mean cheap, low quality equipment Maintenance culture should be cultivated An up to date inventory should be in place

18. Managing Change This is what we have always done

19. Improving Quality of Care Improving the quality of Care is a change process and many of us are afraid to change Once the quality of care (Clinical and Non Clinical) improves, the uptake of services increases

20. Advocacy should be ongoing Advocacy is considered to be the lifeline of any sustainable eye care program, therefore advocacy should be A planned activity at all levels All key staff should be trained in advocacy skills

21. Financial Management It is important to consider all activities in the Primary Eye Care program along business lines. Activities undertaken should be cost effective It is important to know and apply the principles of resource mobilization and cost recovery

22. Monitoring and Evaluation This is a very important aspect of Management we always overlook. At the district level, we have always seen joint monitoring to be the best approach

23. In Conclusion In order to build sustainable primary eye care models we would recommend the following:

24. How do we build sustainable models? By developing a plan owned by the program By recognizing and understanding the importance of resource mobilization and financial management By maintaining and continually improving standards By investing in the best staff or developing them By monitoring and evaluating consistently By putting the patient first and treating them with respect at all times (Quality of Care)

25. Thank you