Blindness in children : Community Strategies: finding and referring patients

Presentations 1 st Part : Khumbo Kalua –Research findings on factors that hinder children accessing services and attempts made to address challenges and meet targets 2 nd Part: Fortunate Shija –Role of Childhood blindness coordinator and use of key informants as a community strategy to find and refer patient; and monitoring and evaluation of programme

Some factors that hinder children from accessing services at the hospital Long distance to hospital Cost (direct and indirect) Awareness that services are 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, et.c –Estimate the number of children with unmet need (can 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 yield of children Routine school screenings –ineffective and majority of blind/SVI children do not attend schooling 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 population Can bring children to agreed centres Can help with follow up of children

Childhood blindness coordinator (CBC) role in regards to finding and referring children Fortunate Shija

Planning for the KI training Meeting with all stakeholders involved 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 & lengths of training

Community engagement Awareness raising 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 Subsidisising cost for 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 ( ) Key informants Health workers Total Number trained Number kids collected by screener Productivity (kids/screener) Key informants were more productive than health workers

Results after 2 years( )- Tanzania MaleFemaleTotal Number Kis trained Number kids screened

Results after 2 years( )- Madagascar MaleFemaleTotal Number KIs trained Number kids screened

Impact of the work ( ) Years of life without blindness Cataract screened YearsTotal Tanzania( 4 years) * Madagascar (2 years) 3535* Total