Human Resources in eye care

Rengaraj Kumar
Fellow in Eye Hospital Management
Aravind Eye Care System

The major goal of VISION 2020: The Right to Sight is to make high quality eye care services available, accessible and affordable to all, through a sustainable delivery system. One of the key pre-requisites is the development of adequate, appropriate human resources. An analysis of current practices reveals problems related to number, quality of training, distribution and utilisation of various categories of eye care personnel.



The infrastructure pyramid given above is based on recommendaed structure by WHO. To have such a structure by the year 2020, for this we require
  • Dedicated eye operation theatre and eye wards located at service centers for each 5,00,000 1,00,000 population. This will ensure reach in approach universally. Service centers may, preferably, be located in towns with population above 50,000 so that long term sustainability could be ensured.
  • Strengthening of medical schools will be necessary to enhance their capacity to provide services as well as training. Provision of lasers, fluorescin angiography, and low vision centers should be made.
  • Provision of operating microscope, slit lamps, direct ophthalmoscopes, indirect ophthalmoscopes and gonioscopes should be made at District level hospitals
Targets
Target 2000 2010 2020
Ophthalmologist per population:
Sub-Saharan Africa 1 : 5,00,000 1 : 4,00,000 1 : 2,50,000
Asia 1 : 2,00,000 1 : 1,00,000 1 : 50,000



Target 2000 2010 2020
OMAs or eye nurses per population:
Sub-Saharan Africa 1 : 4,00,000 1 : 2,00,000 1 : 1,00,000
Asia 1 : 2,00,000 1 : 1,00,000 1 : 50,000


Fundamentally, most eye care delivery services in developing countries lack appropriate human resource planning and, therefore, implementation of services is seriously affected.

Human resources are required for primary, secondary and tertiary levels of eye care, to provide the medical/technical, management/administrative and community eye health services. This is best carried out by an eye care team.

With this in mind we have given below the various eye care model at different level.

Tertiary Care:

1. Kilimanjaro Centre for Community Ophthalmology, Tanzania
The Kilimanjaro Centre for Community Ophthalmology (KCCO) at Tumaini University/KCMC in Moshi, Tanzania was established in October 2001
Their statistics for the year 2004 is given below

OP 26000
IP 3000
Doctors 19
Paramedical Staff 12
Administrative Staff 4


19 Doctors include 6 medical officer, 7 doctors who completed their Post graduation and 6 doctors doing their Post graduation.

Specialties include
Retina
Glaucoma
Orbit and oculoplasty
UVEA
Neuro ophthalmology
Low vision

2. Aravind Eye Hospital, Madurai

Aravind Eye Hospital, Madurai has grown to accommodate 280 paying patients and 1100 (500+600(camp Hospital)) free patients. It has full-fledged super-specialty clinics including, Retina and Vitreous, Cornea, Glaucoma, IOL, Pediatric Ophthalmology, Neuro-ophthalmology, Uvea and Orbit and Oculoplasty, manned by highly-qualified specialists. Aravind Eye Hospital, Madurai, is the headquarters for the Madurai Eye Bank Association, which receives eyeball donations from various institutions in India and from the USA.

Manpower
Senior members : 18
Medical officer : 24
Fellows : 34
Residents : 50
Research : 17
Ward : 31
Theatre : 103
Outpatient : 166
Refraction : 60
Radiography : 1
Eye bank : 3
Lab : 12
Reception : 42
Social worker : 46
Housekeeping : 39
Sanitary worker : 52


3.Vivekananda Mission Asram Netra Niramay Niketan, Chaitanyapur, West Bengal, India
Vivekananda Mission Asram Netra Niramay Niketan hospital located in Chaitanyapur is a 100 bedded hospital providing eye care services

OP 91283
IP 8621


Manpower

Full time Part time
Ophthalmologist (Total) 8 1
Specify,Ophthmologist
With Retina 		2 -
Refractionist 6 -
Nurses (OP, OT & Ward ) 28 -
Administrative Staff 13 -
Camp Organizar 3 -
Counsellor 1 -
Others 43 -
Trainees 32 -
Total 136 1


Secondary Hospital

Aravind Eye Hospital, Theni
Established in August 1985, Aravind-Theni is the first satellite of the Aravind Eye Hospitals. Situated 80 km west of Madurai, it serves an area within a 50 km radius, covering a population of 1 million. It has facilities to accommodate 130 free and 20 paying patients. The hospital is outfitted with the latest equipment, including phaco and YAG lasers for cataract and minor eye surgeries. The hospital provides preventive, rehabilitative and promotive services through comprehensive eye care services through a unique project launched with support from Sight Savers

Aravind-Theni also contributes to the development of eye care delivery by providing a role model for the delivery of rural hospital services

Manpower
Medical Officer 1
Residents 8
Ward 6
Theatre 9
Outpatient 9
Refraction 9
Lab 1
Reception 4
Counselor 4
Housekeeping 2
Sanitary worker 4


Vision centre

Role of vision centres is to provide comprehensive primary eye care, referral services and also create adequate awareness creation in the community.

Horizontal model of training for primary eye care


Aravind Vision Centre

Next Step: Tele-ophthalmology
Why
  • Need to reach rural areas
  • Not enough doctors
  • Save patients travel and time
  • Train doctors well
Goals:
  • Link all Aravind Hospitals and also rural eye care centers
  • Develop affordable, easily adaptable Tele-Ophthalmology software (EyesTalk)
  • Promote use of this technology among partner hospitals
Patient per day : 10 to 15 patient per day

Staff pattern:

1 paramedical staff basically trained as a refractionist who performs refraction, takes care of medication, slit lamp, counsel the patient about the importance of the problem. The same person may be additionally trained to grind glass.

1 non clinical staff he takes care of patient flow, does computer operation, maintain statistics, and prescribe glass and maintaining information.

1 community worker he trains volunteers who does field work. He is involved in networking with leaders and schools. He is engaged in surveillance and does enumeration. The volunteers are trained to do preliminary vision check. He also coordinates with other vision centre