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Paul Courtwright - Outreach Models

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									   The role of outreach in refractive error
               service delivery




Kilimanjaro Centre for Community Ophthalmology
               Moshi, Tanzania
                   Outreach
• Surgical (cataract)
   – Settings that will soon have full-time surgical team

• Non-surgical
   – Settings that do not have comprehensive eye care
     services
   – Screening and/or transport of surgical cases to
     hospital


        Outreach generally does not include
                 school screening
                Rationale
• Patients do not know why they “don’t see
  well”
• Important to make services convenient (trust)
• Team approach strengthens relationships
  between different professions
• Potential for refractive services to support
  costs of conducting outreach
Refractive errors integrated
  into outreach activities

            • Planning sites/activities
            • Promotion
            • Service provision
            • Spectacles
            • Profits supporting
              outreach
            • Monitoring/research
   Planning sites & activities
• Planning based upon population needs
• Decide on range of services to be
  provided
• Avoid single-service trips
• Services provided must be consistent
  (promotion must match service delivery)
Promotion & health education

               • Mechanisms
                 – Radio
                 – Village leaders, religious
                   leaders, other
                   community leaders
                 – Health facility workers
               • Clarity of messages
                 – Elderly (presbyopia)
                 – Cost of service
    Service provision on outreach
• Clear outline of
  patient flow
• Separate “station” for
  refraction
• Display (with mirror)
• Ability to refer back
  to clinician
• Special tasks
  – Cataract post op
    follow up
  – Albino assessment
                       Spectacles
• Purchasing
  – Need for foreign
    exchange
  – Local purchases
• Range of “ready-made”
  – Evidence of “best sellers”
  – Set price
• Prescriptions
• Stock control
  – Excel systems
  – Include cases & glasses
    chain
• Recycled spectacles
Profits supporting outreach
               • Rationale clearly
                 understood
               • Requires local
                 accounting
                 system (receiving
                 funds, etc.)
               • Salaries covered
                 by government/
                 programme
       Monitoring/research
• Sustainability & service monitoring
• Operational research
 Refractive error service
delivery should be part of
         outreach


It must be planned for, integrated
  well, managed effectively, and
            monitored.

								
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