Considerations in integrating optometry into regional VISION 2020 plans Meeting needs of the population • Magnitude of the needs not well-understood; however, presbyopia is universal. • Other refractive errors (myopia, hyperopia) not as common in Africa as in Asia, Europe. • Convenience and affordability important to rural Africans (part of comprehensive approach) Meeting needs of the population…..therefore: • A population based approach is necessary (few rural people needing optometric services will come to the “big city”) • A comprehensive approach is necessary (a “one-stop shop”) • Nevertheless, we must recognize that we cannot reach everyone who needs the service (75% a reasonable target?) Integrating refractive services into regional VISION 2020 plans • Part of cost recovery & sustainability programme of DRS programme • Paying salary of community optometrist based upon sales would be in conflict with salary structure for other eye care staff and cause conflict • How do we manage in areas where there are no optometrists? Paying for refractive services • Capacity and willingness to pay are important considerations in pricing • People want spectacles of good quality and appear to be willing to pay for them • Offering spectacles free-of-charge undermines willingness to pay and discourages sustainability of programme • How do we deal with short-term “want to do good but clueless as to the issues” visitors? Obtaining spectacles • Sourcing ready-made spectacles • How do we deal with donated spectacles? • How do we manage patients who require specially made spectacles? Management and accounting • Need for setting up an account in the hospital for eye care related activities • Funds generated from spectacles, cataract surgeries, eye drops are mixed together but need to be accounted separately. • Allocating funds for purchase of spectacles and cases • Building skills in management and accounting important Refractive needs of children should be addressed separately • Screening of secondary schoolchildren should be viewed as a separate activity and done at a school • Children love an eye examination but few actually need it (glasses as a status symbol?) • Low vision needs difficult to assess in the field Potential research questions • Who actually pays for the spectacles? (person needing them, family members?) • Is there any gender disparity in purchase of spectacles (among those who need them)? • How do presbyopic spectacles change quality of life and visual function of the elderly? What are the most important tasks?
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