• Training of primary health care workers: 60 people in 3 project regions. Knowledge improved by at least 50% on pre- and post-training assessmentKnowledge of glaucoma among patients and relatives
• Total of more than 10.000 screenings
• Referral compliance: increased from 41% to over 60%
  
   

• Situational Analysis to make an informed choice regarding the two additional implementation sites (apart from Kilimanjaro region)
• Procure, install and distribute AI system
• Operationalise AI-assisted DR screening in the Kilimanjaro region and the two newly selected government led programmes
• Review and update (as appropriate) Tanzania’s national guidelines for the management of DR
• Training and education of diabetes staff at basic healthcare level expand the community engagement activities in the Kilimanjaro region and implement similar activities in the two newly selected implementing regions
• Retinal laser training course for Tanzanian ophthalmologists
•  ‘Training the trainer’ - two Tanzanian ophthalmologists will be trained to deliver the retinal laser course as trainers in future
•  Training and equipping staff in eye health centres and developing a glaucoma care network
• Evaluating impact of training, of equipment and of glaucoma care network
• Baseline study to develop the most effective way for patients and relatives to understand and apply knowledge about glaucoma
• Developing and using information and teaching material for patients and relatives about glaucoma
• Evaluating impact of education material and methods
• Disseminating research results
   

Tanzania is actively committed to enhancing its digital health capacity as outlined in the MoH Strategy (2019-2024) and is making substantial ongoing investments into non-communicable diseases (NCD) care. This project therefore integrates well into the country’s broader health strategy.  

The National Eye Care Program Manager at the Tanzanian MoH has led the development of Tanzania’s DR services, in partnership with the International Center for Eye Health (ICEH), for the last 10 years. Her central role in this project is therefore integral to the sustainability of this project. Furthermore, the involvement of the regional eye care co-ordinators will ensure the engagement of local government officials responsible for eye care services in the project regions.

The Head of the Eye Department at KCMC, has led the Kilimanjaro DR screening service since 2012 and will oversee the integration of AI-assisted screening into the Kilimanjaro programme. He is also responsible for the training of ophthalmology residents at KCMC and therefore his involvement in the retinal laser training course will facilitate its sustainability beyond this project.

The core costs required for the programmes to continue at the end of the project are the human resources costs. All the clinical staff involved and trained through the project will be existing employees of the hospitals involved and paid by either KCMC or the government. This will ensure continuation of project activities beyond the three years. The project will cover the one-off costs of hardware and installation of the AI system, therefore ongoing costs in relation to the AI software will be minimal.

The use of artificial intelligence (AI) for Diabetic Retinopathy screening offers an innovative and exciting opportunity to address a lack of specialist eye care staff. AI-supported DR screening automates the grading of retinal photographs for DR meaning specialist staff are not needed to grade the retinal images. Several of these AI systems now have regulatory approval to be used as medical devices having been shown to be equivalent, or indeed superior, to human graders.