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Once the goals and objectives of the programme have been clearly stated, it is time to reflect on the activities and operational procedures of the programme. Evidence-based protocols should be  chosen based on available personnel (eg WHO screening implementation guidelines, REACH,  WCO Paediatric resource).

A circular diagram with "School eye health programme" in the centre, surrounded by bubbles for protocol, dispensing, referral pathway, health promotion activities, management & governance, workforce, location, and frequency & timeline.

Key elements to consider in planning

  • Provision of spectacles:
    • An efficient mechanism must be in place to procure affordable high quality spectacle frames and lenses. Spectacle frames should be acceptable to boys and girls of different age groups and be of the correct size. An inventory of frames and lenses must be in place, with a large enough stock available at all times to meet the demand.
  • Treatment of non-visual impairing conditions (NVIC):
    • Basic medication should be made available during screenings to avoid unnecessary referral to eye hospitals. Delivery of these medications should be done by a competent health professional in accordance with the country’s legislation, and based on the child’s symptoms and examination. School or ophthalmic nurses can be useful resources to provide counseling and treatments at the school site (e.g for allergies and minor ailments).
  • Referral mechanisms and tracking update of referral:
    • Children whose vision do not improve with refraction should be referred to specific eye hospitals or departments with the capacity to manage them. It is important to track whether these children attend following referral and systems should be in place for this. This may entail using referral slips and a register at the hospital, or electronic systems could be used. Ideally, collaboration between the hospitals and the schools should develop into a permanent partnership that could ensure a continuous pathway of care for children who would need it.

Resources needed

Based on the previous steps, resources should be estimated for each component of the programme.

A diagram categorising resources into human, financial, and material resources. Human resources include screeners and managing team, financial resources include budget for pilot, implementation, scaling, and monitoring & evaluation, and material resources include equipment and health promotion material.

 

Human resources

  • Screeners
    • Teachers are sometimes a cost-effective workforce, but they need constant training and motivation, which can be one of the most expensive components in screening programmes. Community-level workers such as allied health workers or school nurses show better outcomes for screening. Consideration for integrated screeners who can screen other health areas like hearing and oral health.
  • Eye care providers
    • When available, eye care professionals are a great addition to the screening teams. Ophthalmologists, optometrists or optometry students can provide detailed examinations on site based on their competencies and national legislation (retinoscopy, refraction, cycloplegia, binocular vision). Delivery of eye care in school minimises drop out in attendance of referrals but comes with a cost. If such professionals are not available for school screenings, trained health professionals such as vision technicians, refractionists, allied ophthalmic personnel or ophthalmic nurses can do a triage following initial screening and refer as appropriate.
  • Managing team
    • All programmes will need to be well managed. Managers with clearly defined roles and responsibilities should provide oversight of implementation, and manage the financial, human and other resources. Managers will be responsible for reporting on progress and for financial accountability to donors, Ministries and other stakeholders. They are also usually responsible for initiating midterm reviews and end of programme evaluations. The overall processes and procedures of the programme will have to be governed in a manner that ensures the provision of quality eye health services to children in a way which promotes equity.

Financial resources

  • The different components of the plan should be costed, and funding sought from the government, non-governmental organizations, community based and service organisations and commercial enterprises willing to support the programme.

Material resources

  • Child-specific material, with locally-affordable instruments, technologies, topical medications and spectacles based on the selected protocol
  • Health promotion material : locally-relevant material should be developed. Community, parents, teachers and children should be involved in health promotion activities to ensure compliance after screenings.

The design of your school health intervention will impact the materials and resources required, the training needs and human resources and the extent of service provision being offered during different phases of the program. For example, an integrated screening day may include screening and some basic provision of services such as glasses as well as referral but a school eye health program may only include the delivery of eye health awareness by teachers and basic screening, with children referred to trained services if needed.