In Ghana, 301,000 people have visual impairment (1.07% of population). The lead cause of this is refractive error (44.4%). 95% of Ghanaians who require glasses do not have access to them. Few public health facilities in urban areas provide basic eye care services. Eye screening and glasses is not insured. A focus on school children has a spill over effect on educational outcomes and wellbeing.
The main objective is to achieve better health and education outcomes for children in two districts in northern Ghana through a reduction in the prevalence of visual impairment (VI). This we intend to achieve through
1. Improvement in the availability and accessibility of Primary Eye Care (PEC) services
2. Improvement in eye health knowledge and awareness among children and teachers to inspire timely and appropriate eye health seeking behaviour
3. Improvement in infrastructure for PEC and refractive error services.
1. 60% increase in eye health knowledge and awareness among school children and teachers
2. 20% of children who receive glasses under the project who demonstrate improved school attendance and academic performance.
3. No. of vision centres established and strengthened
- No. of health personnel trained in PEC and eye health promotion and awareness-raising disaggregated by sex
- No. of vision centres established or strengthened to provide eye care services
- No. of primary level health centres strengthened to provide primary eye care services
- No. of teachers trained in eye health promotion and awareness raising.
- No. of people (children and adults) screened at schools, outreach and health centres
- No. of people who failed eye screening and are referred for secondary eye care (5% of total screening)
- No. of children with significant Refractive Error who need corrective eyeglasses (1% of total children screened)
- No. of children who received spectacles for distance vision (1% of total children screened)
- No. of adults who received eyeglasses (11% of total adults screened)
- No. of children who received eye drops / medications for allergies and conjunctivitis (5% of total children screened)
- No. of adults who received eye drops / medications for allergies and conjunctivitis (21% of total adults screened)
- No of children receiving support for surgery and other tertiary care
The proposed model is to support the integration of PEC into the existing PHC system, in line with the guidance in the WHO World Report on Vision (2019) which advocates that eye care is embedded within health systems and based on strong primary health care which is people centered and seen as “the care model of choice”. This approach also prevents large numbers of patients traveling to distant and often overstretched secondary and tertiary hospitals, thereby increasing local sustainability. The project is deliverable basically in partnership with government through a well-structured and accessible PHC systems and supported by government’s commitment to PEC. By training and upskilling existing cadres of PHC nurses to deliver eye screenings, we are following the best practices set by WHO Eye Health Action Plan 2014-19 which states, “there is ample evidence that comprehensive eye care services need to become an integral part of PHC” and also states that primary level interventions to address uncorrected refractive error (URE) are “highly cost-effective”. We are also using the internationally recognized WHO PEC training manual localized to the Ghanaian context. VAO will also leverage on existing relationships and the cooperation agreement signed by the Ghana Health Service (GHS) to integrate PEC into the primary health care system by:
▪ Integrating reading glasses and basic eye medications into the existing medicines supply chain to District Hospitals and Community Health Posts and
▪ PHC nurses and eye health professionals assuming full responsibility for maintaining and financing all PEC services on a long-term sustainable basis.
The approach makes it possible for PHC nurses to refer patients who require higher level care to Secondary eye care (SEC) facilities which will help strengthen the referral system between PEC and SEC and beyond. Again, the establishment of a vision Centre will make it possible to reduce the waiting time to receiving eye care services including the provision of glasses as prescriptions will no longer be sent to Accra for glasses to be made for clients.
The capacity building component of the project targets personnel who are already employed by the GHS and the GES (Ghana Education Service) who will continue to deliver their work with their newly acquired skills well into the future. The training of trainers is intended for the GHS and GES to be able to expand the training to cover other staff in other districts and regions in the long term.
The project uses the Peek vision software to capture data which can be seen and monitored by the programme managers in real time. Embedded in this software is a referral reminder to all clients that have been referred and research has shown this to be an effective way of improving referral uptake. Clients will also have a one-stop eye care centre through the vision centre that will be setup and, or a shorter time within which to receive their prescription glasses.