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we want to continue to bring you through SiteNews resources related to various issues of managing eye care. These include addressing issues of quality, planning, sustainability, and evaluation. We have been covering the priority diseases under Vision 2020 in the past year. This year we hope to take it to a newer level of detail be looking at their management from a different angle.
The theme for this issue is "Paediatric Eye Care Service Delivery".
We look forward to your continuous patronage of our website as well as recommendation of materials that we can add to this storehouse of management resources in eye care.
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Regards,
Vision 2020 e-resource team
The Issue Features...
Paediatric Eye Care Service Delivery
Vol. 2 No. 4 April 2005
•   Understand the problem
•   Solution
•   Resources
•   Barriers
•   Strategies
Coming your way in a next year

Cataract, Diabetic Retinopathy, and Refractive Errors whatever the eye problem when we think of approaching it has to be in a holistic manner. This is where management comes in. In eye care, for most of the diseases the treatment is identified and it is possible to provide. Yet we know for a fact that people in the community are still not availing of it. Good management will result in successful diseases management. Hence we concisely present all the managerial issues in this regard and also the available resources which will provide more understanding the model.

As a first approach, we feature the management issues and solutions related to Paediatric Eye Care Service Delivery. This includes the following areas covered to approach the problem in a holistic way.


Understand the problem
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It is important to have a true understanding of the actual depth of the problem. This means one should know:

  • Magnitude incidence and prevalence of the disease
  • Social and economic magnitude of the disease and the lives of the people
  • Clinical aspects, in terms of what causes the disease, what are the various ways to treat etc
  • We need to know the current status of the problem

The following resources provide you a brief understanding of the problems in Paediatric Eye Care Service Delivery with the issues listed above and how they can be addressed.

Resources: Magnitude of the Problem:
Abstract:

This report summarizes various topics in Paediatric Eye care with the epidemiology and magnitude of the problem, challenges in paediatric eye care, management of various diseases and disorders in children etc.

Foster Abstract

This article briefs on the magnitude and causes of the problem, control priorities and research opportunities that could be adopted to reduce the childhood blindness.

  • Childhood Blindness in India
http://v2020eresource.org/files/Childhood_Blindness_final.pdf

Abstract

A report on the present situation and background of the problem, etiology, and data on childhood blindness in India.

  • Childhood Blindness India prepares to deal with it!
http://v2020eresource.org/files/CB_Strategy_India_ORBIS.pdf

Abstract:

This report provides a brief focus on the problem of childhood blindness in India and the steps to taken to prevent it.


Social and Economic Impact
Abstract:

This document provides a list of thirteen articles with abstract, author and the journal in which published related to this topic.

  • New issues in childhood blindness

http://v2020eresource.org/files/new_issues.html

An article from Journal of Community Eye Health by Clare Gilbert, MD MSc FRCOphth

Abstract:

This article focuses on the prevalence and incidence of childhood blindness, magnitude, causes and the vision 2020 priority issues in this regard.

Clinical Aspects (Causes and Types):
  • Booklet on Childhood Blindness
http://v2020eresource.org/files/Childhood_blindness.pdf

A booklet published by Aravind Eye Care System.

Abstract:

This booklet provides information on the clinical updates on the various treatment options available for Childhood diseases.


Various Articles on Childhood Cataract:
  • Childhood Cataract: Magnitude, Management, Economics and Impact BR Shamanna and R Muralikrishnan
http://v2020eresource.org/files/childhood_cataract_murali.html
  • Technology for VISION 2020 - Measuring Vision in Children, Petra Verweyen
http://v2020eresource.org/files/technology_measuring_vision.html
  • Surgery for Congenital Cataract, David Yorston FRCS FRCOphth
http://v2020eresource.org/files/surgery_congenital_cataract.html
  • Evidence Based Eye Care - Evidence for the Effectiveness of Interventions for Congenital, Infantile and Childhood Cataract, Richard Wormald MSc FRCS FRCOphth
http://v2020eresource.org/files/evidence_based_eyecare.html
Solution
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Having identified the problem, we need to identify the solution for the problem. This is in the form of various interventions at the clinical level, preventive and curative care and also at examining what we have to do at the community level to educate the people. Besides knowing the solutions rather we need to have standardized well-defined indicators or benchmarks for all these interventions made and also find out the success of the outcome.

    The main subject matter covered under this area are:
  • Interventions (Clinical and Community)
  • Outcome Benchmarks

Resources
Clinical:
Preventive Interventions
  • Sight and Life Guidebook on Vitamin A in Health and Disease
http://v2020eresource.org/files/GBeng_sightandlife.pdf Abstract:

A booklet for health workers and others for understanding of the basic facts and most recent advances in the field of Vitamin A, a major disorder in paediatric eye care service delivery.

Curative Interventions:
  • Sight and Life manual on Vitamin A Disorders
http://v2020eresource.org/files/VADD_sightandlife.pdf
Abstract:

This handbook is useful for those working in the "vitamin A front line" in developing countries who need an information tool that presents the complexities in a clear and understandable fashion without trivializing or oversimplifying the issues. Particularly when used together with the slide set, the handbook will serve as an aid to further education and in prevention campaigns.

  • Running lights - a use in Ophthalmology

http://v2020eresource.org/files/running_lights.pdf

An article from Illumination Journal of Aravind Eye Care System


Abstract:

This article illustrates how running lights can be used in the treatment of childhood problems, a new way of approach to it.

  • Optical services for visually impaired children
http://v2020eresource.org/files/Optical_services_visuallyimpaired.html

An article from Journal of Community Eye Health by Lynne Ager BSc MSc MCOptom



    Abstract:

    This article discuses the role of optical services in the management of children with low vision, how to enhance vision using non-optical and optical devices etc.

    • Children in Blind schools: what condition should be treated
    http://v2020eresource.org/files/children_blindschools.html

    An article from Journal of Community Eye Health by Dr. P Vijayalakshmi MS

    Abstract:

    This article discuses the ways to adopt for the treatment of children in blind schools.

    Community
    • The need and process of IEC (Information, Education and Communication) Development in Delivering Paediatric Eye Care Services

    http://v2020eresource.org/files/IEC_article.pdf

    Article by Mr. Abraham Gnana Pradeep and Ms. Sheela Devi



    Abstract:

    This article provides information on how to develop a communication tool like IEC which combines strategies, approaches and methods that enable individuals, families, groups and organizations to play active roles in achieving health seeking behaviour to improve the quality of life of the communities.


    Outcome Benchmarks:

    A worksheet providing all the indicators in assessing the output and outcome of an Paediatric Eye Care program

    Abstract:

    This worksheet is a tool to be used to assess the output of their Hospital based, Community based and Preventive services they have undertaken.


    Resources
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    To implement the solution or to overcome the problem, we need to avail the variety of resources namely:

    • Infrastructure
    • Human resources specifically interms of skills and competent required,
    • Equipment and instrument and
    • Other utilization benchmarks to be followed

    We tried to provide the possible resources under each of these categories and also the link to open up them.


    Resources
    Infrastructure

    An excel worksheet developed by Aravind Eye Care System


    Abstract

    An automated excel worksheet which automatically calculates the output on you capacity of the infrastructure based on the input data you provide.


    Human Resource Development:
    • Training Ophthalmologists for Childrens Eye Care Centres

    http://v2020eresource.org/files/training_ophthalmologists.html

    An article from Journal of Community Eye Health, by Anil K Mandal MD,

    Abstract

    This article focuses the need for training ophthalmologists in Childhood problems with the objectives of the course, training format to followed, evaluation format etc.

    • Training and human resources requirement for a Paediatric Eye Care Unit
    http://v2020eresource.org/files/human_resources_paediatric.xls
    Abstract:

    This worksheet provides details on the number of eye care personnel needed for each area of a Paediatric Eye Care unit. Also this provides the training requirement for the human resources involved in Paediatric eye care service delivery, and eligibility criteria for an eye hospital to start a Paediatric unit of their own.


    Skills and Competence
    • Guidelines for Setting up a Low Vision Programme for Children

    http://v2020eresource.org/files/guideline_lowvision.html

    An article from Journal of Community Eye Health by Hasan Minto Dip Opt FAAO

    Abstract

    This article focuses the ten guidelines for developing a low vision program for children.

    • Directory of Teaching and Information resources for Blindness prevention and Rehabilitation

    http://v2020eresource.org/files/directory_teaching_centres.pdf

    A book published by International Centre for Eye Health, by Sue Stevens

    Abstract

    Provides greater information on the resources available for the rehabilitation and blindness prevention from 27 organizations.

    Equipments and Instruments:
    • Standard List of Medicines, Equipment, Instruments, Optical Supplies and Educational Resources for Primary and Secondary Level Eye Care Services 2004 / 2005

    http://v2020eresource.org/files/standardlist_equipments1.pdf

    Published by International Centre for Eye Health

    Abstract:

    The list has been produced to assist project managers and medical personnel who are involved in providing eye care services. It aims to cover the essential equipment, instruments and supplies for primary and secondary (district) level eye care.

    • Equipments needed for setting up a Paediatric Unit
    http://v2020eresource.org/files/equipments_paediatric.xls
    Abstract:

    A worksheet giving required equipments for a paediatric unit with the type, model, cost and purpose of the equipment etc.


    Utilization benchmarks:
    • Return on Investment Tool
    http://v2020eresource.org/files/return_on_investment.xls

    An automated excel worksheet developed by Lions Aravind Institute of Community Ophthalmology

    Abstract:

    To find out the pay back period for the investment made on the paediatric eye department based on its workload and also helps you to estimate the annual patient load required to sustain the project.

    An automated excel worksheet developed by Lions Aravind Institute of Community Ophthalmology

    Abstract

    This tool will help to set targets for paediatric surgeries and also to assess the resource utilization of the department. Also to estimate the income sources and the cost of services and other expenses incurred by the department.

    Barriers
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    In eye care even though well defined solutions are in place, it often seems that the utility of those services continued to be very low. This is attributed to valid barriers. The barriers could be from the perspective of the receiver or a client/patient. The barriers could also be from the perspective of the provider, which are in terms of lack of infrastructure, quality or competency.

    Hence in terms of Barriers we want to provide the resources from both receiver and provider perspective:


    Receiver Perspective:
    • Childhood Cataract: Home to Hospital

    http://v2020eresource.org/files/childhood_home_hospital.html

    An article from Journal of Community Eye Health by Mohammad A Muhit MBBS MSc(Ophth) MSc(CEH)

    Abstract:

    This article explains the major barriers for children and parents to approach the hospital for availing paediatric treatment services.

    • Engaging families in health services research on childhood visual impairment: barriers to, and degree and nature of bias in, participation

    http://v2020eresource.org/files/engaging_families.html

    An abstract of the article from Journal of Community Eye Health by J S Rahi, I Manaras, H Tuomainen, G Lewando Hundt

    Abstract:

    This article investigate the barriers to, and degree and nature of bias in participation in health services research by parents of children with visual impairment.


    Provider Perspective
    Infrastructure and Quality:
    • Providing appropriate medical treatment for childhood cataract in remote tribal regions of India

    http://v2020eresource.org/files/remote_triable_india.html

    An exchange provided by L S Jhala in Journal of Community Eye Health

    Abstract:

    This document exchanges the experiences of a hospital while providing treatment for childhood cataract in the tribal regions of India.

    • Experiences in quality assurance at Bawku Hospital Eye Department, by Ghana An exchange provided - Isaac Baba, Eye Co-ordinator, Bawku Presby Hospital, Ghana in Journal of Community Eye Health
    http://v2020eresource.org/files/experiences_quality.html
    Abstract:

    This is a view exchanged by the Bawku Hospital while taking a survey at the community.

    Strategies
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    Solutions do not lend by themselves to implement because of the challenges post by the barriers. Hence various strategies have been attempted in order to overcome the barriers and facilitate reaching of the solution to the people with the problem. In this context a wide variety of successful case studies and interventions will be looked at.

    There are two types of Strategies that could be looked in:

    • Current Strategies
    • Innovative Strategies

    The current strategies provide the description of the present strategies adopted to prevent blindness due to Childhood problems with some case studies from various Eye Hospital including Aravind.


    Currently Used Strategies:
    • Childrens Eye Care centre at Sadguru Netra Chikitsalaya
    http://v2020eresource.org/files/CECC_SNC__Article.pdf
    • Chittagong Eye Infirmary and Training Complex (CEITC)
    http://v2020eresource.org/files/CEITC-Paediatric%20Ophthalmology%20Info-21Mar05.pdf
    Innovative Strategies
    • Prevention of Childhood Blindness Teaching Slides

    http://v2020eresource.org/files/teaching_slides.html

    A set of 24 slides with a teaching booklet from Journal of Community Eye Health

    Abstract:

    This image/text Teaching Set provides a practical tool for teaching health workers how to recognise, treat and/or refer children with eye disease. It also sets out the measures necessary for prevention of these diseases, such as immunisation, health education, improved nutrition and sanitation.


    Health Education for Community

    A lot of Health Education materials have to be developed to instruct people about the eye disorders and diseases which should be simple and understandable for them to have a clear idea about them. Hence in this section we present a set of Patient Education materials for using in the various areas of an Eye Hospital.

    • Healthy Eyes Activity Book

    http://v2020eresource.org/files/Healthy_eyes_activity.pdf

    A guide book from Sight And Life

    Abstract:

    Teaches children how to look after their eyes. For primary school pupils and teachers, it contains class and home activities as well as class discussion topics and health messages.


      Brochures on Paediatric Health Education:

      Posters

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