1. Kilimanjaro Centre for Community Ophthalmology (KCCO)
Tumaini University/KCMC
PO Box 2254
Moshi, Tanzania

2. Kilimanjaro Centre for Community Ophthalmology (KCCO)
…dedicated to the elimination of avoidable blindness through the integration of programmes, training, and practical research focusing on the delivery of sustainable and replicable community ophthalmology services

3. Community Ophthalmology
Manpower
Infrastructure
Community Ophthalmology
Patients

4. Karibuni Macho
Creating capacity for high-volume cataract surgery while improving financial & organizational sustainability
Computerized record & management information system
Accounting system
Financial planning for sustainability
Training to build human resource management capacity
Capacity building for nurses

5. Kilimanjaro Region, Tanzania
Indicator
2001
2004
# cataracts
( # total surgeries)
(1,420)
1,968
(2,934)
Regional CSR
402
1124
Cataracts/staff surgeon
188
492
Collaboration between partners
Non-existent; duplication & lack of trust
MoH, KCMC Hospital, CBR, Lions working together
Outreach to community
Campaign mode
Integrated; reaching all communities

6. Childhood Cataract
Training of district health staff in promotion and recognition of children with congenital or developmental cataract
Promotion throughout northern Tanzania to improve early recognition and referral
Free surgery and free spectacles post operation (subsidized transport, if necessary)
Integration within regional Vision 2020 plans
Also: assessment for development of regional low vision programme

7. Congenital/developmental cataract surgeries at KCMC
Girls
Boys
Boys
Girls
2004 (Oct)
= 121
2001 (n=60)
2003 (n=99)

8. Kilimanjaro Regional Vision 2020 Programme
Overall strategy for addressing cataract (also trichiasis & childhood cataract) needs in the region
Creation of a partnership to implement regional programme (MoH, CBR, KCMC, Lions, others)
KCCO coordinates activities
District health authorities decide on places for direct referral sites (DRS)
DRS are held on a regular basis to ensure trust in the service
Every village linked to a DRS
(Arumeru district of Arusha region added June 04)

9. Critical components Partnership Sustainability High quality of service
All partners with the same target/goal and complementary strategies
Engages religious centres, schools and village leaders in programme
Sustainability
Moving from externally supported activities to locally supported (Lions Clubs, local businesses, others)
Using community optometry to help support programme
High quality of service
Examiner has enough skills to provide final diagnosis (avoid bringing patients unnecessarily)

10. Critical components Reliability/trust Meeting needs of patient
Builds trust among community members by returning to same site
Never cancel date
Always provide a full range of services (eye medicines, spectacles, etc.)
Patients brought back for surgery that day, surgery the following, taken back the following day
Counseling of patients and family members done in the field (increasing utilisation among women).
Meeting needs of patient
No specific visual cut off for deciding on surgery
Village helps decide patients “too poor to pay”

11. Kilimanjaro Region
Population 1.4 million
DRS

12. Cataract surgery at KCMC by 6 months
Start of Kilimanjaro Regional Vision 2020 plan

13. Kilimanjaro Region (1.4 million) CSR by district for 2004 1,008 884
1,426
1,263
1,115
1,168
CSR = 1,165
Hospital

14. Male:Female CSR by district for 2004
1.28:1
1.19:1
Kilimanjaro Region
(1.4 million)
Male:Female CSR by district for 2004
1.10:1
1.59:1
0.90:1
Male:Female ratio = 1.12:1
0.91:1
Hospital

15. Tanzania
                                                                                                                    
Regions without ophthalmologist or cataract surgeon

16. Tanzania
                                                                                                                     15
Ophthalmologist 6
Cataract surgeon
in training

17. Cataract Surgical Rate (2002)
143
Tanzania
257
428
                                                                                                                    
317
736
340
198 37
240
234
201
216
Cataract Surgical Rate (2002)
Tanzania = 323
724
700 88
421
180
182 34
1st priority
227
118
2nd priority

18. Community Ophthalmology
Manpower
Infrastructure
Community Ophthalmology
“Bridging strategy”