One year after school- and community-based screening initiated, many hospitals identified low referral rate and referral update rate in SiB Shanxi CHEER project although a two-way referral networks was established for referral from screening to hospitals and low vision/ rehabilitation at different levels, to early educational intervention in schools and at home (Figure 1). This networks aims to provide children holistic eye health services in terms of prevention, treatment, rehabilitation and early education. How to strengthen the networks became a critical issue and a top topic between hospitals and NGOs at project meetings. We are addressing this issue through following strategies:
Train head teacher in school screening or hold health talks among head teachers to improve low referral rate: It has proved that head teachers were much more accountable than physical & education teachers who were assigned for schoolchildren’s health by education system. Every class has one head teacher who is in charge of coordination between student and the school/parents.
For addressing low referral rate from village screening: We invited hospital staff to visit peer hospital to learn how to effectively conduct screening training, and participate in home visit in order to understand how functional assessment and early educational intervention can help children with visual or multiple disabilities. Then they became confident and proactive in convincing key informants to find and refer cases. Also, we encourage hospitals to identify one lead key informant who loves and dedicates in village screening to be role model to others. School children also played important role in referring non-children in their community
Multi-sectors professionals work together to strengthen the referral networks. We took multi-sectors staff (e.g. medical professionals, teachers, and rehabilitation workers) to visit children with visual or multiple disabilities for hands-on training and demonstrating how to work together. Different subspecialty ophthalmologists, particularly paediatric, retina, glaucoma, neurologic ophthalmology, were sensitized on how low vision service could help patients they could not treat. Special educators were also trained to make sure every child in the special/blind school had appropriate eye examination to avoid neglecting children whose vision can be improved by medical treatment or low vision service. We also planned to train ophthalmologists, refractionists, low vision staff, and resource teachers to work as a team in next quarter..
Constant eye health promotion also helped strengthen referral networks because it gradually raised awareness of children, educators, and families. We used IEC materials such as leaflets, posters, short video on popular social media (WeChat), and eye health talks on TV and at schools, etc.. Eye health education was embedded into most regular work, including screenings, clinical work, support groups (e.g. parents groups, teachers groups, special educators groups, project management groups, etc.) on social media, and so on.