community ophthalmology lecture series lecture Ⅲ

Community Ophthalmology Lecture Series

Lecture Ⅲ

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

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.

1. Comprehensive eye care camps

2. Mass cataract camps

In mass cataract camps the prime

emphasis is on cataract surgery. No other

services are routinely provided.

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.

Example:-

Identifying corneal disease, cataracts,

refractive errors, glaucoma, squints,

Eye infections, allergies, trauma and other common eye conditions.

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.

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.

Corrective measures for those

identified conditions are usually

undertaken either at the camp or after

referral to the base or main center.

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.

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.

Work

Screening for visual defects using Snellens chart and examination for obvious anomalies

IOP checking using Shiotz tonometer

Refraction

Personnel

Trained Ophthalmic

- Nurse / Medical

officer

Trained Ophthalmic

- Nurse / Assistant

Refractionist / Trained

- Ophthalmic

assistant

Work

Drug distribution

Diagnosing, treating and referral

Health education

Logistics

Personnel

Trained Ophthalmic assistant

Ophthalmologist

Nurse /FHW / Ophthalmic assistant

Camp organizers

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.

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.

Indicators should be based on

1. Measuring the progress

2. Finding whether the set targets are achieved

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.

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.

1. Patient examination

A) 20 patient examinations and treatment (Vision checking, anterior segment examinationFunduscopy)

B) 5 refractions(Dry / cycloplegic)

1 Unit

1 Unit

Indicators suggested Performance in units

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

2. 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

3. Screening procedures only

A) 50 school children

B) 50 community members

1 Unit

1 Unit

4. Health education

A) 25 people given education (lecture/leaflet/posters)

B) 1 film show / video presentation

1 Unit

1 Unit

5. Rehabilitation

A) Rehabilitation of 1 blind patient 1 Unit

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.

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.

Eye camps are an essential component

in prevention of blindness activities in the

countries where community ophthalmology

is not an established discipline.

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.

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.

Eye camp No. attended

Camp 1

Camp 2

Camp 3

Camp 4

Camp 5

74

163

117

270

142

Total 766

Fin

ding

s of

eye

cam

ps

cond

ucte

d fo

r pa

st s

ix

mon

ths

Analysis of camp activities and earned unit values

Activity Camp Total number

% Total

units

earned

C-1 C-2 C-3 C-4 C-5

Medical treatment at the campAchieved unit values

06

0.3

33

1.65

17

0.85

28

1.40

24

1.2

108 14.0

5.4

Refraction at the campAchieved unit values

08

1.6

51

10.2

40

8.0

111

22.2

70

14.0

280 36.5

56.0

Activity Camp Total number

% Total

units

earned

C-1 C-2 C-3 C-4 C-5

NAD 02 01 01 08 03 15 1.9

Referred for surgeryAchieved unit value

07

0.7

35

3.5

18

1.8

43

4.3

20

2.0

123 16.0

12.3

Referred for further examinationAchieved unit value

51

1.7

43

1.4

41

1.3

80

2.6

25

0.8

240 31.3

8.0

Activity Camp Total number

% Total

units

earned

C-1 C-2 C-3 C-4 C-5

IOP CheckingAchieved unit value

- 90

4.5

- 148

7.4

24

1.2

-

13.1

Total numberTotal units achieved

74

4.3

163

21.3

117

12.0

270

38.0

142

19.2

766

94.8

This table provides the information about

the activities done at the camp sites and

the number of units earned through the

performance indicators.

Analysis of activities at the base and earned unit values

Event Camp Total

number

% Total

unitC-1 C-2 C-3 C-4 C-5

Cataract surgeries performedUnit value

2

1.0

19

9.5

4

2.0

8

4.0

2

1.0

35 28.4n=123

17.5

Followed up at the clinicUnit value

27

2.7

2

0.2

22

2.2

26

2.6

2

0.2

79 32.9n=24

07.9

Total numberTotal units achieved

29

3.7

21

9.7

26

4.2

34

6.6

4

1.2

114 31.4

25.4

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 .

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.