kilimanjaro centre for community ophthalmology (kcco) tumaini university/kcmc po box 2254 moshi,...
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Kilimanjaro Centre for Community
Ophthalmology (KCCO)
Tumaini University/KCMC
PO Box 2254
Moshi, Tanzania
www.kcco.net
Kilimanjaro Centre for Community
Ophthalmology (KCCO)
…dedicated to the elimination of avoidable blindness through the integration of programmes, training, and practical research focusing on the delivery of sustainable and replicable community ophthalmology services
Manpower Infrastructure
Patients
Community Ophthalmolog
y
Karibuni Macho
• Creating capacity for high-volume cataract surgery while improving financial & organizational sustainability– Computerized record & management information
system– Accounting system– Financial planning for sustainability– Training to build human resource management
capacity– Capacity building for nurses
Indicator 2001 2004# cataracts
( # total surgeries)
752
(1,420)
1,968
(2,934)
Regional CSR 402 1124
Cataracts/staff surgeon
188 492
Collaboration between partners
Non-existent; duplication & lack of trust
MoH, KCMC Hospital, CBR, Lions working together
Outreach to community
Campaign mode Integrated; reaching all communities
Kilimanjaro Region, Tanzania
Childhood Cataract
• Training of district health staff in promotion and recognition of children with congenital or developmental cataract
• Promotion throughout northern Tanzania to improve early recognition and referral
• Free surgery and free spectacles post operation (subsidized transport, if necessary)
• Integration within regional Vision 2020 plans• Also: assessment for development of regional
low vision programme
Congenital/developmental cataract surgeries at KCMC
Girls BoysGirls Boys
2001 (n=60) 2003 (n=99)
2004 (Oct)= 121
Kilimanjaro Regional Vision 2020 Programme
• Overall strategy for addressing cataract (also trichiasis & childhood cataract) needs in the region
• Creation of a partnership to implement regional programme (MoH, CBR, KCMC, Lions, others)
• KCCO coordinates activities• District health authorities decide on places for direct referral
sites (DRS) • DRS are held on a regular basis to ensure trust in the
service• Every village linked to a DRS• (Arumeru district of Arusha region added June 04)
Critical components• Partnership
– All partners with the same target/goal and complementary strategies
– Engages religious centres, schools and village leaders in programme
• Sustainability– Moving from externally supported activities to locally
supported (Lions Clubs, local businesses, others)– Using community optometry to help support programme
• High quality of service– Examiner has enough skills to provide final diagnosis (avoid
bringing patients unnecessarily)
Critical components• Reliability/trust
– Builds trust among community members by returning to same site– Never cancel date– Always provide a full range of services (eye medicines,
spectacles, etc.) – Patients brought back for surgery that day, surgery the following,
taken back the following day– Counseling of patients and family members done in the field
(increasing utilisation among women).
• Meeting needs of patient– No specific visual cut off for deciding on surgery– Village helps decide patients “too poor to pay”
Kilimanjaro Region
Population 1.4 million
DRS
Cataract surgery at KCMC by 6 months
01002003004005006007008009001000
1997 1997 1999 1999 2000 2000 2001 2001 2002 2002 2003 2003
Start of Kilimanjaro Regional Vision 2020 plan
Kilimanjaro Region
(1.4 million)
CSR by district for 2004
1,168
1,263
1,008
1,426
1,115
884
Hospital
CSR = 1,165
Kilimanjaro Region
(1.4 million)
Male:Female CSR by district for 2004
0.91:1
1.59:1
1.28:1
1.10:1
0.90:1
1.19:1
Hospital
Male:Female ratio = 1.12:1
Regions without ophthalmologist or cataract surgeon
Tanzania
Ophthalmologist15
Cataract surgeon
6
Tanzania
in training
Cataract Surgical Rate
(2002)
Tanzania = 323
Tanzania
227
34
700
143
428
257
317
201
37
216
724
180
198
736
340
240
88
182
421
118
234
1st priority
2nd priority
Manpower Infrastructure
“Bridging strategy”
Community Ophthalmolog
y