Creating a sustainable spectacle delivery solution - Haydom Project

Globally today there are 37 million blind people and a further 124 million people with serious visual impairment. Of these, uncorrected refractive error - the need for a pair of glasses - accounts for up to 6 million blind and 100 million with significantly impaired vision. If urgent action is not taken these numbers will almost double over the next 20 years. This is unacceptable both from a humanitarian and socio-economic point of view.

Africa is in crisis, with rates of blindness up to seven times higher than the rest of the world. African countries are desperately in need of Eyecare personnel but they lack the infrastructure to train and support them. In developed countries there is approximately one Eyecare practitioner for every 10,000 people, Africa often has only one practitioner per 500,000 people, and the situation is much worse in many rural areas, where there may be no care-giver at all. This lack of Human Resources is amplified by a lack of access to affordable spectacles.

Affordability needs to be considered within a broader context than the cost of the spectacles. The total cost to the patient must be examined, which would include transport costs, often for an escort also; loss of productivity at the homestead; loss of income for the escort. The cost of the spectacles is thus not the major factor in determining affordability. Even a free pair of spectacles could prove to be unaffordable, if the patient has to return to the clinic many times in order to collect it.

Budgetary limitations faced by African government and NGO’s results in eye care programs competing for funding with other health programmes. Often these programmes are equally important and more politically appealing. The challenge for blindness prevention in general and refractive error programs in particular thus lies in effective utilisation of the limited resources available. This translates into two specific challenges; affordability to patients and sustainability for service providers.

ICEE has developed the OptiShop concept to address these two key challenges of affordability and sustainability. The development of in-house optical workshops which are able to deliver a same day service, for the majority of patients is critical in delivering a truly affordable spectacle delivery service. Further the utilisation of the Global Resource Centre as a bulk purchasing mechanism will reduce input costs to the service provider thus allowing a sustainable pricing strategy incorporating cost recovery.

OptiShop

ICEE have developed a simple, effective model for incorporating dispensing services, including provision of affordable spectacles; into Public Hospitals in Africa. This is a cost recovery project.

Key Objectives

1. Create affordable spectacles
2. Job creation and skills transfer for local personnel
3. To build capacity for sustainable delivery systems for refractive services and spectacles
4. Further the strategic aims of Vision 2020 in Refractive Error and Low Vision specifically and blindness prevention generally.

Scope of Project

ICEE, in collaboration with partners, will work to establish Optical Workshops in Hospitals in Africa. These centres will provide made to order spectacles, dispensing and lens edging services. In addition the Optical Workshop will also provide affordable ready made spectacles and Low Vision devices.

Each Opti Shop will include:

A workshop for cutting and fitting lenses, to ensure a ready and affordable supply of glasses. The workshop will employ the following personnel:

• A qualified lab technician (for initial training period only)
• One trainee local technician. 

Dispensing Unit. The Dispensing Unit will be fully equipped and includes the following personnel:

• Fully qualified Optometrist (for initial training period only)
• One local practice manager and dispenser (to be trained)

A skills evaluation and, if required, refresher training for all the personnel will be provided once every six months. This will be applicable in the first year then afterwards will taper down to once a Year.

Expected outcomes

1. Affordable spectacles and low vision devices for patients
2. Development of local capacity in providing refractive error services.
3. Promotion of Vision 2020 objectives
4. Development of a regional Procurement Centre

This concept is being piloted by ICEE at Haydom Lutheran Hospital in collaboration with the Norwegian Optometric Association, a group of final year optometry students from Norway and Haydom Lutheran Hospital.

The Norwegian Optometry Association funded the optometrist’s post, donated a laptop, other equipment and the services of its president, Bjorn Westerfjell. The optometry students donated the equipment for the workshop, prepared the training manual for the technician, set up the equipment on site and conducted the training of the technician. The students were also involved in clinical rotations during their visit.

ICEE provided the clinic with initial stock of frames, lenses and readymade glasses and provided a consultant to develop and implement administration, stock control, data collection and Standard Operating Procedures. The unit will be supplied with stock by the Global Resources Centre which utilises the combined purchasing power of eye-care NGO’s and governments to reduce the cost of appliances and their components. The optometrist will also be trained in the delivery of Low Vision services.

An initial visit in February 2006 to plan the program was conducted by ICEE Director Prof. Kovin Naidoo and Bjorn Westerfall of the Norwegian Optometric Association. The partners, structure and key tasks were agreed upon.

In Mid-April Haydom Lutheran Hospital was visited by Kesi Naidoo: ICEE Service Development Manager; Bjorn Westerfjell: President of The Norwegian and six final year Optometry students from Norway. The purpose of this visit was to set up the workshop, train the relevant staff, implement systems and Standard Operating procedures.

About Haydom

Haydom Lutheran Hospital is situated in the south west corner of the Mbulu district of Tanzania, about 80 km south-west of district headquarters and 300 km from Arusha the main town and regional centre. It also services the adjoining districts of Hanang, Iramba, Singida Rural and Meatu thus is serving a population of approx 390 000. Mbulu and Hanang are rural districts situated in the Northern highland of Tanzania, largely 1500-2000 m above sea level, south of the famous Ngorongoro crater. The main ethnic groups residing there are Iraqw and Tatog; others in small numbers are Iramba, Nyaturu and Hadza.

The hospital was first built by the Norwegian Lutheran Mission in 1953 at the request of the then existing government authorities, the administration of the hospital was handed over to the local church, the Evangelical Lutheran Church of Tanzania,(ELCT), Mbulu Synod in 1963.

The eye team consists of : Dr Brian Savage, Ophthalmologist; Mr Sadikiel Kaay, Clinical Officer Eye Assistant; Emmanuel Santuri, Optometrist; Sr Emiliana Kingu, Nurse Midwife Eye Assistant; Sr Margaret Sarwat, Nurse Midwife; Mr Jackson Daudi, General Assistant; Mrs Fausta Sampson, Nurse Assistant; Mr Ezekiel Tahhani, Ward Attendant.

Since September 2004, the eye team at Haydom have made a significant impact on the problems of people with eye diseases in Mbulu and Hanang districts, and have been responsible for over 300 operations, mainly sight restoring cataract surgery. However the lack of an optometrist and affordable glasses has severely hampered efforts to deliver Refractive Error and Low Vision services.

This new initiative will enable the eye team at Haydom to deliver an Affordable Refractive Error and Low Vision service to its patients.

Optometrists wishing to volunteer services at sites such as Haydom should please contact Kesi Naidoo at General Enquiries.

Kesi Naidoo, Kovin Naidoo, Brian Savage & Bjorn Westerfall