County hospitals in China maintain the sustainability of services after training

Working with CHW to organize screening ”A National Pilot Program of Comprehensive Training for Eyecare Teams at China’s County Hospitals”, one of Seeing is Believing projects in China started from 2016. Over 50 county hospitals joined the training project, total 127 eye doctors, 75 nurses, and 47 refractionists from county hospitals in Shandong, Sichuan, Shandong and Hebei provinces were trained so far. Through the eye care personnel team training, the primary eye care service for cataract and refraction in the county hospital has been set up. After training, the county hospitals have different strategies to maintain the sustainability of the service, it can be summarized as below:

The leaderships of the county hospital are crucial for the eye department development, only the county hospitals whose leaderships, both hospital director and eye department director are supportive can be enrolled in the project, which ensure the young eye doctor have chance to continue study in the provincial training centers, and support them to organize the screening when they go back to their hometown hospital, in order to collect enough patients to invite the trainers to come to do hands-on training, until the surgery skills were completely mastered. Good quality cataract service will be the key element of sustainability of the eye department in county hospital. It is better to choose the county hospital which cover enough population, over than half million, to ensure enough patient volume.
Rely on existing medical joint venture between the tertiary hospital and the county hospital, to achieve the purpose of strengthening the capacity of county hospital the county hospital. Through the project, the long-term relationship can build up, it makes the training and instruction from the provincial training center could maintain in long run, even after project ending, the instruction and cooperation between tertiary hospital and county hospital still carry on, which will help the county hospital develops step by step, make the hospital sustainable in local area. Two-way referral system, remote counselling system are established gradually, and county hospital could have stable patient flow to maintain sustainability.
County- community- village/township network building is important to maintain the patient volume in local area. More and more county hospitals start to think how to mobilize the resource, to train the CHWs and village doctors some basic eye disease detection skills. The functional network could help find and referral patients, is more cost-effective than organizing outreach screening by county hospital, especially in current insufficient human resource situation for the county hospital.