How capacity leads to sustainability: training government health staff in primary eye care in Pakistan
Our project “A New Vision for Eye Health in Pakistan’s Khyber Pakhtunkhwa Province” (a partnership between Sightsavers, the Fred Hollows Foundation and the Provincial Comprehensive Eye Care Cell/ PICO) is continuing its activities to reduce the incidence of avoidable blindness in four districts of Pakistan’s Khyber Pakhtunkhwa province. Before the project started, a situational analysis revealed gaps in human resource capacity, in particular in capacities needed to identify eye diseases at the community level.
In Pakistan, Lady Health Workers (LHWs) are the official and widely accepted health force at the community level. The female health workers have easy access to the individual households to provide basic health services including awareness raising around general health issues. The project has trained LHWs in four districts in “Primary Eye Care” with a focus on the early detection of eye diseases and referrals to Basic Health Units (BHU). Simultaneously, at the BHU Level, non-eye care staff such as medical officers and medical technicians have also received training on “Primary Eye Care” and referral of eye patients to the secondary level for further eye examination and treatment. Both LHWs and primary health care cadres have been equipped with screening kits, training manuals and referral slips.
Since the trainings took place, our project data (measured as Key Performance Indicators) shows an increase in trained health staff utilizing their new skills to screen eye patients at the community and BHU level. Patients who require advanced treatment are also referred to the secondary level of the health care system for service delivery. The project is directly contributing to the establishment and strengthening of referral pathways from the community to the secondary level, which supports the sustainability of our approach after the project closure. It is anticipated that trained local health staff will continue to support the eye health services in the long run, as this is integrated into their routine work. This project has partnered with the office of the Director General – Health – KPK and the Provincial Program Implementation Unit to support eye health activities in targeted districts. All screenings and referrals of eye patients are performed by local health staff who do not receive any additional monetary incentives in this project. It is rather their increased motivation due to the trainings and the increased ownership of the eye departments which drives their work. It is therefore very likely that the screening of eye patients will continue after the project end.
The project has deployed eight trained optometrists to government hospitals which were not available before the inception of the project. This measure has significantly strengthened the screening and refractive services at the district hospital level and eased the work of the ophthalmologists who were overburdened with a high number of patients when the project started. The Provincial Comprehensive Eye Care Cell/ PICO is also lobbying with the provincial health department for sanctioning the posts of optometrists on a permanent basis at the District Headquarter hospitals of KPK province. It is anticipated that the project supported optometrists will be included in the permanent cadres once the positions of these staff are approved by the relevant authorities.
The Fred Hollows Foundation
Pakistan Country Office
Itfaq Khaliq Khan
Sightsavers Pakistan Country Office