Planning and organising trichiasis surgery in the community

In trachoma endemic areas, trichiasis surgery can be provided at static units, through outreach campaigns, and by individual surgeons on motorbikes travelling to the most hard-to-reach communities.

The first step in planning a district level trichiasis surgery service is mobilising the community to raise awareness and estimate how many trachomatous trichiasis (TT) patients there are in the catchment area (the TT backlog).

Trachoma programme managers then use this estimate to determine the surgical output target. This is the number of surgeries that must be done in the district to reduce the prevalence of trichiasis to < 0.2% in adults aged 15 years and above. Ideally, this target is set at the national level in a Trachoma Action Plan.

Once the surgical output target is known, the manager can then determine:

• The number and composition of the surgery teams required in the district
• The requirements for consumables and number of instrument sets to prepare
• The number of days to be spent at each outreach.

To achieve the surgical output target the manager, surgery teams and community stakeholders work together to:

• Determine the locations for outreach campaigns and appropriate community mobilisation
• Reach and manage the surgery location
• Undertake clinical assessment, counselling and surgery for each individual patient
• Undertake and make arrangements for post–surgical- and follow-up care for patients
• Feed back to the community.

As you watch the video, consider the possible challenges to maintain and manage surgical outputs in outreach settings.