Community Ophthalmology Lecture Series Lecture Ⅲ
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Transcript of Community Ophthalmology Lecture Series Lecture Ⅲ
Community Ophthalmology Lecture Series
Lecture Ⅲ
Monitoring and assessment of activities of outreach eye camps
• Dr.Saman Wimalasundera MBBS, DO, PhD
Senior lecturer in Community Medicine & Community
Ophthalmologist Department of Community
Medicine,Faculty of Medicine, University of
Ruhuna, PO Box 70, Galle, Sri Lanka
Eye camp concept is a highly
desirable and accepted strategy in
providing eye health services to the
populations in remote and underserved
areas of developing countries.
Eye camps are generally of two types.
1. Comprehensive eye care camps
2. Mass cataract camps
In mass cataract camps the prime
emphasis is on cataract surgery. No other
services are routinely provided.
Comprehensive eye care camps are
concerned with primary eye care
approach providing several types of
services for many ocular or systemic
conditions that lead to visual disability or
blindness if left untreated.
Example:-
Identifying corneal disease, cataracts,
refractive errors, glaucoma, squints,
Eye infections, allergies, trauma and other common eye conditions.
Most eye camps are organized by non
governmental organizations. They have a
major role in organization and conducting
eye camps. Technical inputs are provided
by the institutional ophthalmic team where
the eye surgeon is the team leader.
The camp organizers should be highly motivated, devoted and committed to the cause and the community participation is a very important factor in making an eye camp a success.
Corrective measures for those
identified conditions are usually
undertaken either at the camp or after
referral to the base or main center.
Manpower and Duties
In addition to routine eye care workers
(Eye surgeon, Ophthalmic nurses and
refractionists) several other health
personnel are required in such programs
including ophthalmic assistants, public
health workers and nurses.
Distribution of work during an eye camp
has to be very clearly defined before the commencement.
Work should be assigned to
different personnel on their qualification
and experience.
Work
Screening for visual defects using Snellens chart and examination for obvious anomalies
IOP checking using Shiotz tonometer
Refraction
Personnel
Trained Ophthalmic
- Nurse / Medical
officer
Trained Ophthalmic
- Nurse / Assistant
Refractionist / Trained
- Ophthalmic
assistant
Work
Drug distribution
Diagnosing, treating and referral
Health education
Logistics
Personnel
Trained Ophthalmic assistant
Ophthalmologist
Nurse /FHW / Ophthalmic assistant
Camp organizers
For the improvement of camp services,
Monitoring of activities, finding the
constraints and evaluating the
effectiveness are major important
feedback mechanisms.
Recommended follow up activities
should also be carefully monitored for the
fulfillment of the concept of eye camps.
Monitoring and evaluation provide a
feedback on camp activities as well as
information on the impact of the services
provided.
Some indicators are needed for this
assessment.
Indicators should be based on
1. Measuring the progress
2. Finding whether the set targets are achieved
Different performance of eye camps are the easiest measures to use as the indicators.
It must be comprehensive and cover all
aspects of eye camp services. In using
performance indicators a minimum
manpower requirement should be
finalized.
The team should consist at least one
ophthalmologist, one optometrist and two
ophthalmic assistants/nurses.
Performance unit for each activity are
expected to increase with the increase of
manpower.
1. Patient examination
A) 20 patient examinations and treatment (Vision checking, anterior segment examinationFunduscopy)
B) 5 refractions(Dry / cycloplegic)
1 Unit
1 Unit
Indicators suggested Performance in units
C) 20 IOP checking
D) 10 cataract referrals for surgery
E) 30 referrals to base for follow up / investigation
1 Unit
1 Unit
1 Unit
2. Intervention at the camp / base
A) 5 removal of superficial foreign bodies
B) 5 any other minor procedure
C) 1 cataract extraction at the camp
D) 2 cataract extraction at the base
E) 10 investigations and follow up at the base
1 Unit
1 Unit
1 Unit
1 Unit
1 Unit
3. Screening procedures only
A) 50 school children
B) 50 community members
1 Unit
1 Unit
4. Health education
A) 25 people given education (lecture/leaflet/posters)
B) 1 film show / video presentation
1 Unit
1 Unit
5. Rehabilitation
A) Rehabilitation of 1 blind patient 1 Unit
Progress of a camp can be assessed
using those set indicators and their
performance units. Total number of units
for each camp can be compared with
another same type of a camp for each
activity or for overall activities.It may be
compared with a gold standard or set
goals for a single camp too.
This procedure would provide an
opportunity for the organizers and the
authorities to assess their own
performances, which could be compared
with other similar activities of the country.
This ensures whether the planned
procedures are on track and indicate the
deviations allowing the adoption of
corrective measures.
Eye camps are an essential component
in prevention of blindness activities in the
countries where community ophthalmology
is not an established discipline.
In such situations if a national program
is planed for the prevention of blindness,
these indicators could be used targeting
certain number of unit values for different
activities or overall unit value for total
events at different levels for peripheral
mobile units and central mobile units
separately to achieve in a given time
period.
An example for performing evaluation of eye camp
activities
Five eye camps were conducted in
different parts of a country for a period of six months.
Eye camp No. attended
Camp 1
Camp 2
Camp 3
Camp 4
Camp 5
74
163
117
270
142
Total 766
Fin
ding
s of
eye
cam
ps
cond
ucte
d fo
r pa
st s
ix
mon
ths
Analysis of camp activities and earned unit values
Activity Camp Total number
% Total
units
earned
C-1 C-2 C-3 C-4 C-5
Medical treatment at the campAchieved unit values
06
0.3
33
1.65
17
0.85
28
1.40
24
1.2
108 14.0
5.4
Refraction at the campAchieved unit values
08
1.6
51
10.2
40
8.0
111
22.2
70
14.0
280 36.5
56.0
Activity Camp Total number
% Total
units
earned
C-1 C-2 C-3 C-4 C-5
NAD 02 01 01 08 03 15 1.9
Referred for surgeryAchieved unit value
07
0.7
35
3.5
18
1.8
43
4.3
20
2.0
123 16.0
12.3
Referred for further examinationAchieved unit value
51
1.7
43
1.4
41
1.3
80
2.6
25
0.8
240 31.3
8.0
Activity Camp Total number
% Total
units
earned
C-1 C-2 C-3 C-4 C-5
IOP CheckingAchieved unit value
- 90
4.5
- 148
7.4
24
1.2
-
13.1
Total numberTotal units achieved
74
4.3
163
21.3
117
12.0
270
38.0
142
19.2
766
94.8
This table provides the information about
the activities done at the camp sites and
the number of units earned through the
performance indicators.
Analysis of activities at the base and earned unit values
Event Camp Total
number
% Total
unitC-1 C-2 C-3 C-4 C-5
Cataract surgeries performedUnit value
2
1.0
19
9.5
4
2.0
8
4.0
2
1.0
35 28.4n=123
17.5
Followed up at the clinicUnit value
27
2.7
2
0.2
22
2.2
26
2.6
2
0.2
79 32.9n=24
07.9
Total numberTotal units achieved
29
3.7
21
9.7
26
4.2
34
6.6
4
1.2
114 31.4
25.4
This table shows the amount of work
performed at the base in relation to
individual camp. Units achieved at the
base are added to the camp site units in
finding the total unit achievement .
Total unit value achieved for past six
months by performing eye camps and
subsequent follow up and rehabilitative
procedure equals to unit value of 120.2
units. Average single camp value was
24.4 units. The total value or individual
unit values could be used in comparison
or assessment of camp activities. It may
be useful in self-assessment too.