Community Ophthalmology Lecture Series Lecture

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Community Ophthalmology Lecture SeriesLecture ?
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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

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• 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.
• Comprehensive eye care camps
• Mass cataract camps

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• In mass cataract camps the prime
• emphasis is on cataract surgery. No other
• services are routinely provided.

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• 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.

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Example-

• Identifying corneal disease, cataracts,
• refractive errors, glaucoma, squints,
• Eye infections, allergies, trauma and other
  common eye conditions.

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• 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.

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• 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.

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• Corrective measures for those
• identified conditions are usually
• undertaken either at the camp or after
• referral to the base or main center.

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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.

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• 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.

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• 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.

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• 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.

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Indicators should be based on

• Measuring the progress
• Finding whether the set targets are achieved

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• 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.

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• 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.

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Indicators suggested
Performance in units

• 1. Patient examination
• A) 20 patient examinations and treatment
  (Vision checking, anterior segment
  examination Funduscopy)
• B) 5 refractions
• (Dry / cycloplegic)

• 1 Unit
• 1 Unit

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• 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

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• 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

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• Screening procedures only
• A) 50 school children
• B) 50 community members

• 1 Unit
• 1 Unit

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• Health education
• A) 25 people given education (lecture/leaflet/p
  osters)
• B) 1 film show / video presentation

• 1 Unit
• 1 Unit

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• Rehabilitation
• A) Rehabilitation of 1 blind patient

• 1 Unit

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• 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.

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• 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.

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• Eye camps are an essential component
• in prevention of blindness activities in the
• countries where community ophthalmology
• is not an established discipline.

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• 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.

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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.

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Findings of eye camps conducted for past six
months
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Analysis of camp activities and earned unit values
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• This table provides the information about
• the activities done at the camp sites and
• the number of units earned through the
• performance indicators.

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Analysis of activities at the base and earned
unit values
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• 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 .

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• 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.