Blindness in children :Community Strategies: finding

and referring patients

Some factors that hinder children from accessing services at the hospital

• Long distance to hospital• Cost (direct and indirect)• Awareness of service available• Poor mother’s socio-educational status & lack of

influence in decision making• Beliefs and perceptions:

– “White spots” will go by themselves– Going to the hospital can be risky– Afraid that the child’s vision could be worse after surgery– Belief that for cataract surgery, need to remove the eye– Perception of the institution providing the service

Determining need & Setting targets

• Determine the magnitude of need –data can be collected from CEHTF– Determine number of children benefiting from

the current service provision? Surveys, etc– Estimate the number of children with unmet

need (use WHO estimates)– Set targets

• Number of children to be identified and referred

• Number to benefit from surgery

• Proportion of children to attend follow up

Community Strategies that have been attempted ?

• Eye camps - very low number of children

• Routine school screenings – ineffective and majority of blind/SVI children do not attend school

• Health education messages-knowledge does not necessarily lead to parents taking action

• CBR programmes

• The Key Informant method

Who are Key informants

• Key Informants-village members, and nominated by village leaders, are willing to identify blind and visual impaired children

• KI attend minimal training: however they: – Can identify children at community level

• One per every 1000-5000 population

– Can bring children to agreed centres– Can help with follow up of children

Childhood blindness Coordinator (CBC)

Role in finding and referring children

Planning for the KI training

• Meeting with all stakeholders • Mapping project area and determine number of

children, length of time needed to cover area • Selection of key informants • Training

– Field assistants

– Key informants

• Venue & length of training

Community Engagement

• Awareness about the project– Radio programme/announcements about project– Television– Health education materials

Outreach and Follow up

• When and where to screen the identified children

• Who should go?

• Referring to CEHTF

Strategies implemented by CBC

• Subsidize cost of children’s services (free surgery, free glasses)

• Transport reimbursement • Counselling for those identified • Improving communication through reminders

(phone calls, texts)• Proactive case finding methods

– Organising Training for key informants to identify blind and visual impaired children

Monitoring and Evaluation

• Monitoring– Report writing about the training and screening

sessions

– Reports about children attending the CEHTF

– Reports about number of surgeries performed, glasses prescribed and low vision devices dispensed.

• Evaluation– How can the programme be improved/done better?

Results after 2 years (2006-2008)

Key informants

Health workers

Total

Number trained197 63 260

Number kids collected by screener

549 22 571

Productivity (kids/screener) 2.78 0.03

Key informants were more productive than health workers

Results after 2 years (2008-2010)-Tanzania

Male Female Total

Number Kis trained 235 123 358

Number kids screened 511 444 955

Latin America

• Can this strategy or elements of this strategy be adapted to Peru, El Salvador, Guatemala, Paraguay, Latin America?