Considerations in integrating optometry into regional VISION 2020 by fL3DlI


									Considerations in integrating
  optometry into regional
   VISION 2020 plans
       Meeting needs of the
• 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
      Meeting needs of the
• 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
• 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
 Refractive needs of children
    should be addressed
• 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
• 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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