加入一个强大的、前所未有的联盟,让大家的眼睛更健康。
加入IAPBYong Ai Chee, Anne Buglass, Godfrey Mwelwa, Ronnie Graham, Hannah Faal and Ving Fai Chan
In 2017, Vision Action piloted a school-based eye health programme (SBEHP) in Kafue district, 赞比亚. After screening 18713 children, 3.33% had vision-impairing uncorrected refractive errors, and 17% had non-refractive eye conditions, showing that there are critical unmet eye health needs among Zambian children. These findings are essential for future planning since there were no reliable national estimates on vision impairment among children.
The SBEHP aligns with the Zambian National Health Strategic Plan 2017–2021 and the National Eye Health Strategic Plan 2017–2021. The National School Screening Programme Protocol 2020 was also developed through the pilot. All the learning from the Kafue Pilot Programme points us to the need for upscaling the programme interventions in 赞比亚. The question is, how can it be done systematically to ensure its effectiveness and sustainability?
At the conclusion of the Pilot Programme, Vision Action conducted a robust upscaling assessment1 using the WHO-ExpandNet framework to determine the potential to upscale the SBEHP, the scope of SBEHP, partner organisations’ roles, responsibilities and capacities, the resources needed to operationalise SBEHP and the facilitators and inhibitors for scaling up.
Two issues remain. One, the Mobile Eye Clinic approach may be effective in reaching the community in the short term, but we will need to address its sustainability issue in the long run. Two, there is still a large number of out-of-school children who are not reached through the SBEHP. Both issues highlighted the need to invest in 赞比亚’s primary eye care and vision centres, the two key components of a successful school eye health programme. A reliable supply of eye drops for conjunctivitis is to be prescribed and supplied by the nearest Heath Centre/Health Posts. A supply of spectacles from the nearest Vision Centre is to obviate the need for outreach.
Despite school eye health being included in the Zambian National Health Strategic Plan and National Eye Health Strategic Plan, concrete action was not highlighted or emphasised. Integration of the comprehensive SEHP into the existing School Health and Nutrition Programme is crucial, and this formal institutionalisation secures government funding, and therefore programme sustainability can be ascertained. An implementation study in Zanzibar also showed that an integrated school eye health programme is more cost-effective and performs better than a standalone programme.2 Continued efforts such as constant engagement with the government and working closely with strong advocates within the government departments will contribute to the integration’s success. A similar scaling assessment has also since been conducted by Vision Action in 埃塞俄比亚. Although it faced some additional challenges 由于 civil conflict in the region, there were many similarities in terms of enabling and inhibiting factors to scaling up SBEH.
Zanzibar’s school eye health programs traditionally took a vertical approach, often led by non-governmental organizations. This method, while offering strong technical and financial control with focused objectives1–3 in a limited timeframe4, frequently halted abruptly when funding ceased. In low-resource settings, school health programs are closely linked to feeding initiatives 由于 high child malnourishment rates.5 While effective in improving attendance, reducing dropouts, and enhancing literacy,1,2 we argue that addressing only nutritional needs may be insufficient. Even well-nourished children may experience eye health issues, negatively impacting children’s wellbeing.
Recognizing the shared characteristics of high burden,3,6 negative educational impact, demonstrated positive outcomes7,8 and cost-effectiveness9–11, our team piloted an integrated program in 2016 in Zanzibar. This initiative combined eye health into nine schools with an existing feeding program in Zanzibar and compared its performance12 and cost-effectiveness13 to a traditional vertical school eye health program in ten schools. The study also identified the contextual factors influencing successful integration.14
In the vertical model (VM), only eye health interventions were implemented, involving an awareness program through teachers, Information, Education, and Communication materials. This was followed by teacher-led eye health screenings and referral of identified pupils to the nearest vision center. Conversely, the integrated model (IM) included eye health interventions in the existing school feeding program, encompassing feeding, deworming, sanitation awareness through teachers, and anthropometry measurements to identify and refer children with nutritional issues for appropriate management.
The findings show that IM achieved higher coverage (96%; n=5992/6257) than VM (90%; n=5142/5713) within four months, with increased voluntary engagement in seeking eyecare services (IM=63.6%; n=77/121 vs VM=46%;n=46/100) and better compliance with wearing eyeglasses (IM=71%; n=22/31 vs VM=13.3%; n=4/30).12 IM also proved more cost-efficient, with the cost per child screened at USD1.23 for IM and USD1.31 for VM, and the cost per child identified at USD24.76 for IM and USD51.75 for VM.13
Six key contextual factors impacting the integration of eye health into the school eye health program were identified. Stakeholders/political factors highlighted the importance of ministry coordination, defined roles, and resource mobilization. Institutional factors emphasized the need for coordination, clinic space, human and financial resources, and strategic advocacy. The physical factor focused on challenges related to long travel distances. Cultural factors underscored low awareness of eye health among parents, teachers, and children. The delivery system factor called for a practical approach, using teachers as screeners and addressing workload issues. Lastly, the “Others” category emphasized the importance of comprehensive training materials, effective delivery, improved curriculum, teacher selection, supervision, and incentives.14
In conclusion, adopting a holistic whole-school approach that encompasses nutrition, health, and addresses eye health issues is vital for fostering the academic performance and overall well-being of children, especially in low-resource settings. This approach provides a strategic, pragmatic, and cost-effective method for delivering essential eye health services to children in such resource-constrained environments.