This presentation will probably involve audience discussion, which will create action items. Use PowerPoint to keep track of these action items during.

This presentation will probably involve audience discussion, which will create action items. Use PowerPoint to keep track of these action items during your presentation In Slide Show, click on the right mouse button Select “Meeting Minder” Select the “Action Items” tab Type in action items as they come up Click OK to dismiss this box This will automatically create an Action Item slide at the end of your presentation with your points entered. INFORMATION ON WESTERN AREA EYE CARE PROJECT FOR SIGHTSAVERS INTERNATIONAL COUNTRY REVIEW IN SIERRA LEONE. [DR. MATTHEW J. VANDY]

1.PROJECT AREA Project located in the Western Area of Sierra Leone
Smallest region in Sierra Leone Sierra Leone Situated in West Africa Bordered on West by the Atlantic Ocean On North and North East by Republic of Guinea. On South and South East by Republic of Liberia. Divided into four administrative regions - Western Area - Eastern Province - Southern Province - Northern Province Provinces are divided into 12 Administrative Districts and 13 Health Districts. Districts are subdivided into Chiefdoms Chiefdoms are further divided into Sections, Towns and Villages. 1.1 WESTERN AREA Divided into Western Rural and Western Urban Community called province of Freetown Mountain ranges thickly forested, rises almost 900 meters(3,000 feet) above sea level Used for settlement in Africa of black poor freed from slavery Capital located in Western Area Freetown founded in 1792

1.1.1 WESTERN URBAN 1.1.2 WESTERN AREA
Divided into 8(eight) wards and 65 sections:- - Central 1 - Central 2 - East 1 - East 2 - East 3 - West 1 - West 2 - West 3 1.1.2 WESTERN AREA Peninsula Ranges of mountains Lowland area is in the form of raised beaches Well connected with hinterland by highway Well connected with arts of Freetown but not centrally located.

1.2. POPULATION Total population – 950,924 inhabitants (Census 2004)
Western Rural Male = ,187 Western Rural Female = ,837 =========== Total = ,024 ============ Western Urban Male = ,754 Western Urban Female = ,083 Total = ,900 Grand Total Western Area Male = ,941 Grand Total Western Area Female = ,083 Total ,924 ============= Administratively manned by Local Councillors Tribal Heads

2. PROJECT TITLE: - WESTERN AREA EYE CARE PROJECT
3. OBJECTIVES OF THE PROJECT 3.1 wider Objectives: To ensure the eye health of the population and reduce the burden of visual impairment, blindness and eye disease of the Western Area People. To control the major causes of avoidable blindness To enhance efforts towards sustainability To develop the necessary manpower 3.2 Specific Objectives: To establish a programme administrative structure which takes care of the coordination, implementation and monitoring and review. To provide urban comprehensive community focused eye care. To provide community based activities, which seek to integrate eye care education rehabilitation in the urban community. To train and equip well motivated staff. To target major causes of blindness and reduce the prevalence of blindness due to cataract by at least 45% in the Western Area. To target special population groups in Western Area. To put in place income generation and cost recovery for sustainability. To mobilize all groups, partners and agencies to participate in the implementation. To provide appropriate and affordable technology, i.e. LPED, Spectacles, equipments and mobility.

4.1 EYE CARE The structure of the eye care unit will be as follows.
At Community level there will be an integrated services. Primary Eye Care will involve:- Promotion of eye health Prevention of eye disease and blindness Treatment of eye disease Identification of refractive errors and provision of glasses Registration of the blind and visually impaired. Recruitment of curable blind and visually impaired for referral for curative services, surgery, glasses or others. Referral of incurable blind adult and children for education and rehabilitation. Community members will be trained in simple Primary Eye Care Services. 4.2 SECONDARY LEVEL The Eye Care Services will be provided by State Enrolled Community Health Ophthalmic Nurses who will be in charge of a special area or population. 1 SECHN Ophthalmic to 100,000 people.

At this level services provided will be training support, monitoring and supervision and
provision of supplies to the community workers. Establish School Eye Health Programme Establish and ensure the running of programmes for the most deprived group in their catchment area. Run clinic at base Screen, select the curable blind, and accumulate same for surgery Prepare for and act as an outreach recipient here for cataract surgery and other referrals NGOs in their catchment area. Optical services, a refractionist will join the SECHN Ophthalmic at the Secondary level to form a team, he or she will receive training in Primary Eye Care and share the responsibility of promotion and prevention for the catchment population of 100,000. Outreach Services Where a SECHN Ophthalmic is in the outreach post an outreach team consisting of Ophthalmologist/Cataract Surgeon, SECHN, interim and a student nurse will go out to the secondary level to provide outreach support, supervision, supplies, services and training. * Where an SECHN Ophthalmic does not exist, a team consisting of a driver, two SECHN Ophthalmic, one referactionist and a technician. * Surgical outreach will also be adopted.

Since the project will be implemented at a number of levels there will be a strong
supervisory element through schedule visit. Annual review and planning meetings will be held at project level by keeping the staffs involved and keep the project and the National Programme on course. A mid-term review and final evaluation will be carried out. 4.3 The project will be managed by the project management committee consisting of the following:- * District Hospital Board Chairman – Western Area * District Medical Officer – Western Area * District Health Sister – Western area * Project Manager – Western Area Eye Care Project – Secretary * Ophthalmologist, Department of Ophthalmology, Connaught Hospital * Hospital Care Manager – Connaught Hospital * Representative each of all NGOs involved in eye care services related activities in Western Area.

2. technical Advice to District Hospital Board
4.4 FUNCTIONS 1. Advocacy 2. technical Advice to District Hospital Board Through District Health Management Team, Western Area the management structure will be integrated into the existing health structure in a vertical and horizontal manner. The vertical line will provide the requisite technical and maintenance of standards. The horizontal line will ensure integration into the general health and administrative structure and supervision. 4.5 ORGANOGRAM DISTRICT HOSPITAL BOARDS WESTERN AREA EYE CARE PROJECT MANAGEMENT COMMITTEE PROJECT MANAGER DISTRICT MED. OFFICER - HOSPITAL CARE MANAGER CONNAUGHT HOSPITAL DISTRICT OPHTHALMOLOGIST SOMA/CATARACT SURGEON OMA/DON SECHN/OPHTHALMIC INTEGRATED EYE CARE WORKER

5. COLLABORATING PARTNERS
5.1 DEVELOPMENT - Rotary Club International - UN Agency - Local Council 5.2 EYE - Sightsavers International - Christofell Blinden Mission (CBM) - United Methodist Church (UMC) - Southern Province Eye Care Project - National Eye Care Programme - Eastern Province Eye Care Project - Choitheram Memorial Hospital - Kissy Eye Hospital - Sierra Leone Association of the Blind - Community Based Rehabilitation Project

5.3 HEALTH - Ministry of Health & Sanitation - Council of Churches of Sierra Leone through CHASL - Leprosy/TB Control Programme - HIV/AIDS Project - WHO - National Onchocerciasis Control Programme 6. RESOURCES USED ON THE PROJECT 6.1 HUMAN(STAFF) – From the Ministry of Health & Sanitation Ophthalmologist - 1 SOMA/Cataract Surgeon - 2 Ophthalmic Nurses - 9 Refractionist - 2 Optical Technicians Cleaners - 3

- Drivers - 2 - Record Clerks/Receptionists - 2 - SECHN - 1
- Account Clerk - 1 - Maintenance Officer - 1 6.2 EQUIPMENTS - From Government and - Sightsavers International 6.3 FINANCE FROM: - Government of Sierra Leone – Staff salaries - Sightsavers International – Running cost and top-up salaries 6.4 TRANSPORT - One 12 seater Mini Bus from Sightsavers International, grounded a year ago - One 13 seater Landcruiser van from Sightsavers International currently serving the project.

NATURE OF SUPPORT FROM SIGHTSAVERS INTERNATIONAL
6.5 LOGISTICS - Drugs - Consumables - IOL - Frames and Uncut Lenses - Rebuilding of Department of Ophthalmology, Connaught Hospital. NATURE OF SUPPORT FROM SIGHTSAVERS INTERNATIONAL - Training of Human Resources - Financial – running cost and top-up salaries - Provision of Equipments and instruments - Provision of drugs, consumables, IOLs, Frames and Uncut lenses - Reconstruction of the Department of Ophthalmology, Connaught Hospital. 8. ACTIVITIES - Provision of Eye Care Services, Static, Outreach and Mobile clinics

- Impatient services for 18 patients
- Surgical Services – twice a week - Optical Services – refraction, prescription, glazing, fitting and dispensing of glasses. - School screening for childhood eye conditions and refractive error - Training of Primary Health Care Workers in Primary Eye Care - Training of Primary School Teachers in Primary Eye Care - Training of pupil and student nurses - Attachment of post-registration medical officers and residents from West Africa Post-graduate Medical College in Family Medicine. - Revision classes for Ophthalmic Staff - Participate in workshops and meeting organised by Ministry of Health & Sanitation and other Organisations, e.g. National Oncho Control Programme, Community Based Rehabilitation of Blind, Integrated Education Programme, Health Task Force meeting, Sightsavers Partners meeting, Hospital Management meetings, etc. - Cataract Campaign Camps

4. IMPLEMENTING ORGANIZATION
The Ministry of Health & Sanitation through the National Eye Care Programme. The project Will incorporate the promotion of good eye health through improved community level awareness, the prevention of blindness, through early intervention and community- to-tertiary Referrals, and the reversal of blindness through an accessible treatment system. The project will also ensure that anyone who has irreversible blindness can access suitable Educational or community-based rehabilitation support. The implementation will be built on partnership with National Eye Care Programme, ensuring The close participation of the community in accessing services and maintaining it own eye health and through ensuring that gender-related constraints on participation and access are addressed. The SECHN Ophthalmic will be working from central clinics within the Western Area and will Will perform the following:- Sensitisation of village authorities, influential persons and community based field workers. Use of traditional communication in disseminating of eye health messages, i.e. Harmful traditional practices, high risk of eye conditions, e.g. conjunctivitis of the new born and availability of eye care services. Inclusion of eye care into all community awareness raising activities Improvement of environmental sanitation Early identification, referrals and assistance of person with eye problems. Monitoring of traditional practitioners by village and district chiefs. Collaboration between eye care, community based rehabilitation and other service providers. Identification and training of a Community Eye Care Person each village sector The Senior Ophthalmic Medical Assistant (SOMA) or Cataract Surgeon will be responsible for the eye health of the population of The district, base clinics and outreach surgery, screening, training and supervision. The SOMA/Cataract Surgeon will work closely With the Traditional structures, the health team, and locally active NGO. He or she will be supervised by Ophthalmologist. The regional unit e handle the referrals cases. The regional Ophthalmologist is responsible for planning, implementation, monitoring and reporting at regional levels. He will be answerable to the district hospital board but receive technical and Supervision support from the National Coordinator of the National Eye Care Programme. 4.1 EYE CARE The structure of the eye care unit will be as follows:- At Community level there will be an integrated services. Primary Eye Care will involve: Promotion of Eye Health Prevention of Eye disease and blindness Treatment of eye disease Identification of refractive errors and provision of glasses Registration of the blind and visually impaired Recruitment of curable blind and visually impaired for referral for curative services, surgery, glasses or others. Referral of incurable blind adult and children for education and rehabilitation Community members will be trained in simple Primary Eye Care Services.

RESOURCES Human (Staff) – from the Ministry of Health & Sanitation
Ophthalmologist - 1 SOMA/Cataract Surgeon - 2 Ophthalmic Nurses - 9 Refractionists - 2 Optical Technicians - 2 Cleaners - 3 Drivers - 2 Record Clerks/Receptionists - 2 SECHN - 1 Account Clerk - 1 Maintenance Officer - 1 EQUIPMENTS From Government and Sightsavers International

Finance from:. Government of Sierra Leone – Staff Salaries
Finance from: * Government of Sierra Leone – Staff Salaries * Sightsavers International – Running Cost and Top-Up Salaries. TRANSPORT One 12 seater mini bus from Sightsavers International, grounded a year ago One 13 seater Landcruiser Van from Sightsavers International currently serving the project. LOGISTICS Drugs Consumables IOL Frames and uncut lenses Rebuilding of Department of Ophthalmology, Connaught Hospital. NATURE OF SUPPORT FROM SIGHTSAVERS INTERNATIONAL Training of human resources Financial – running cost and top-ups salaries Provision of 2 vehicles Provision of drugs, consumables, IOLs, Frames and uncut lenses Reconstruction of the Department of Ophthalmology, Connaught Hospital.

ACTIVITIES Provision of Eye Care Services – static, outreach and mobile clinics Inpatient services for 18 patients Surgical Services – twice a week Optical services – refraction, prescription, glazing, fitting and dispensing of glasses. _ School screening for childhood eye conditions and refractive error Training of Primary Health Care Workers in Primary Eye Care Training of Primary School Teachers in Primary Eye Care Training of pupil and student nurses Attachment of post-registration medical officers and residents from West Africa Post-graduate medical college in family medicine. Revision classes for ophthalmic staff. Participate in workshops and meetings organised by Ministry of Health and sanitation, community based rehabilitation of blind, integrated Education Programme, Health Taskforce meeting, Sightsavers partners meeting, Hospital Management meetings, etc. Cataract Campaign Camps.

COLLABORATING PARTNERS
Development - Rotary Club International - UN Agency - Local Council Eye - Sightsavers International - Christoffel Blinden Mission(CBM) - United Methodist Church (UMC) - Southern Province Eye Care Project - National Eye Care Programme - Eastern Province Eye Care Project - Choitheram Memorial Hospital - Kissy Eye Hospital - Sierra Leone Association of the Blind - Community Based Rehabilitation Project Health - Ministry of Health & Sanitation - Council of Churches of Sierra Leone through CHASL - Leprosy/TB Control Programme - HIV/AIDS Project - National Onchocerciasis Control Programme 4.1 EYE CARE The structure of the eye care unit will be as follows:- At Community level there will be an integrated services. Primary Eye Care will involve: Promotion of Eye Health Prevention of Eye disease and blindness Treatment of eye disease Identification of refractive errors and provision of glasses Registration of the blind and visually impaired Recruitment of curable blind and visually impaired for referral for curative services, surgery, glasses or others. Referral of incurable blind adult and children for education and rehabilitation Community members will be trained in simple Primary Eye Care Services.

9.1 OUTPUTS/ACHIEVEMENTS

OUTPUTS/ACHIEVEMENT CONTINUES 9.2 SCHOOL EYE HEALTH SCREENING
Years Total No. of Schools Screened No. of Pupils/Students , , , , ,734 No. of Staff/Teachers Tot.No. of Teachers Trained Grand Total , , , , ,545 9.3 OUTREACH/MOBILE CLINIC No. of People Seen , , ,168 No. of People Treated = , , ,168 No. of Communities Visited = 9.4 HUMAN RESOURCE DEVELOPMENT No. of Ophthalmic Nurses Trained = 3 No. of Cataract Surgeon Trained = 2 No. of Refractionists Trained = 6 No. of Optical Technicians Trained = 4 No. of Primary Health Care Workers Trained in Primary Eye Care = 40 No. of Teachers Trained in basic Primary Eye Care = 30 No. of CBR Workers Trained = 16

No.of Residents Received for
Attachment in Ophthalmology = 2 No. of Pupil Nurses Trained = 600 No. of Student Nurses Trained = 200

10.0 CONSTRAINTS/CHALLENGES
1. Inadequate trained manpower - Sensitisation/advocacy among students from school of Nursing and Medical College has been going on. - Training of personnel like Cataract Surgeons, Ophthalmic Nurses, Primary Health Workers, Refractionists, Optical Technicians, etc. 2. Inadequate supply of quality instruments and equipments - - Eye Instruments were received in 2004 and needs replacement - Order has not been done, as there is no budgetary allocation for this. 3. Other Eye Care providers not still collaborating with Ministry of Health & Sanitation. - Due to reactivation of National Eye Care Programme Steering Committee, there has been significant improvement in collaboration and coordination among Eye Care providers. 4. Inadequate supply of Drugs and Consumables - Local Production of Eye Drops in Bo and Local Purchase of Drugs and consumables improved the situation.

11.0 LESSONS LEARNT FROM THE PROJECT
We have learnt from the project the following:- To manage with the resources that are available Management and monitoring of optical centre, now we can keep our optical records properly The importance of the Community in developing project document for funding Using the community structure to identify the poor of the poorest. The importance of link of project document to National Development Plan of the country for both development and Poverty Alleviation. That Eye Camps can be used as advocacy tool. Finance Management and accountability – Basic Accounting Procedures were learnt and we can now keep our project books of account up-to-date. That Monitoring of disease pattern and outpatient can be used as data for planning of prevention of Blindness Programme/Project in a country. Barrier to uptake of cataract surgery The importance of comprehensive eye health service in attaining Millennium Development Goals.

12.0 RECOMMENDATIONS/IDEAS FOR THE FUTURE
That a Ophthalmic Training School be established within the Faculty of Nursing, College of Medicine for Diploma in Ophthalmic Nursing, and another training school be established in Bo for Training of Community Ophthalmic Nurses. 12.2 That Local Production of Eye Drops Unit be set up in Freetown. 12.3 That quality instruments and equipments be purchased rather than cheaper or second-hand things. 12.4 That Cataract Campaign can be continued to be part of project activity. 12.5 That the Ministry of Health and Sanitation formulate policy on Eye Health in Sierra Leone. 12.6 That Ophthalmologists, Cataract Surgeons and Ophthalmic Nurses be trained in Community Eye Health.

Map of Sierra Leone

Western Area

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