Planning services in low resource settings

A programme to manage diabetic retinopathy (DR) should include the following:

• A good understanding of the current and projected prevalence of DR, to make it possible to plan services for prevention, screening, and treatment
• Clinical guidelines with a simple classification system, recommended examination intervals, and suggestions for treatment
• A way of finding patients with diabetes and DR
• Retinal examination methods that take into account available equipment and human resources
• Creation or identification of laser treatment centres for timely treatment
• An education and prevention programme that reaches the whole population
• Advocacy to secure the support of the authorities, educators, general practitioners, endocrinologists, and so on.

Long-term sustainability, using cost recovery or subsidies

One of the challenges in managing DR is that it requires partnerships with many different health care workers – both to find people with diabetes and to provide the eye care they need. DR programmes have to forge alliances with physicians, podiatrists, dieticians, pharmacists and all the other health workers and policy makers involved in the care of patients with diabetes. to encourage their patients to have annual eye examinations. DR programmes must return the favour by encouraging their patients to maintain good control of their diabetes and blood pressure and by reaching out to other health workers. It is by building and maintaining networks and alliances amongst health care professionals that we can prevent blindness from DR.

There is no single solution to DR that can be applied to every community worldwide. The best results will be achieved by developing programmes at district level that take into account local conditions and resources.

There is one single message: Diabetes and diabetic eye disease are everybody’s business. We must not leave it just to the specialists, in diabetes or in retinal disease. In future, every single health worker will have to contribute to preventing, detecting, and managing diabetes and its complications, including diabetic retinopathy.

Excerpt adapted from Hall, A. (2011). Recognising and managing diabetic retinopathy Comm Eye Health, 24(75), 05 – 09

In this interview with Dr Mathenge, we discuss the challenges faced in Africa and the approaches that can be used to address them. Health providers need to work actively to strengthen local diabetic eye care services. As you watch this video consider your view on Dr Mathenge’s vision of having at least one centre of excellence in every low resourced country to manage the complex treatment of DR?