1. Comprehensive school eye health programmes
Child Eye Health course: IAPB General Assembly
Clare Gilbert, ICEH, LSHTM

2. School eye health programme
School eye programmes often focus on refractive errors alone, are vertical, bypass the education and health system, and are not sustainable
They are rarely monitored or evaluated
? what difference are they making
? are they cost effective/a good use of resources?
Programmes need to be
comprehensive
integrated within school health programmes
monitored and evaluated
cost effective

3. Components of comprehensive school eye health programme
Identify children with significant refractive errors and supply spectacles
Education about eye conditions and eye health
Primary eye care for children
Eye care for teachers (e.g. presbyopia)
Health promoting school environment
Child-to-Child approach
Links to control programmes for local endemic diseases

4. Education about eye conditions and eye health
Engage with Ministries of Education and Health
What is taught depends on local epidemiology:
Keeping their eyes healthy (diet; avoid trauma)
Common conditions affecting their age group
Common conditions affecting younger age group
Common conditions affecting the elderly
Promote positive attitudes towards blindness and how to interact with someone who is blind

5. Eye health embedded in school curriculum

10. Education about eye conditions and eye health
Educational materials for children
Manuals for teachers

11. Primary eye care for children
identify and treat /refer simple eye complaints
identify children with locally endemic eye conditions (e.g. trachoma; vitamin A deficiency) and taking action necessary
identify and refer children with non-RE causes of visual impairment

12. Primary eye care for children
Developing curriculum for school nurses:
Task analysis – what they should be able to do after training
Drives content of training
knowledge
skills
attitudes
Drives what they will need to do the job
medication / supplies
visual acuity charts

13. Primary eye care for children
Focus on common eye problems affecting children
allergies
conjunctivitis (viral/bacterial)
styes/chalazions etc
foreign bodies and trauma
refractive errors
Rare but more serious problems
cataract

14. Primary eye care for children
Supplies of topical medication e.g. tetracycline eye ointment
Supplies of eye pads, eye shield etc
Know where the nearest eye unit is
Communication with parents
Record keeping

15. Eye care for teachers Spectacles for uncorrected presbyopia
Cup:disc ratio assessment for glaucoma
Counsel diabetics to have regular retinal examination

16. Health promoting school environment
Physical:
clean
water for face and hand washing
appropriate sanitation for boys and girls
water collection
kitchen gardens...how to grow (and cook) nutritious foods
Attitudinal
disability and inclusion

18. Child-to-Child: children as agents of change
Developed in 1978 by a paediatrician and health educator
Builds on natural care-giving and relationships of children
Entails a 6 step process
links learning, using fun activities with action at home and in the community.
participatory learning involving discussion, action and evaluation e.g. carrots in Mongolia
Programmes in many countries for nutrition; HIV etc but none for eyecare or ear care. Unpublished pilot studies in India and Nigeria
Peer education is inherently sustainable

19. Link to programmes for control of locally endemic conditions
Primary school
vitamin a deficiency
measles infection
All ages
MDA for trachoma

20. Integration Work with Ministries of health / education so that
eye health is part of broader school and child health
schools are safe and healthy places
children learn about eye health
school nurses can deliver primary eyecare
Should not be a stand alone, vertical program that only deals with refractive error