Case study: Establishing an ROP screening programme in Brazil

In this video ophthalmologist and ROP expert Dr Andrea Zin shares the experience from Brazil, a huge country which has been through a long process to develop and expand its ROP programme.

Brazil ROP progamme: Lessons learned

Extensive advocacy built the momentum to develop ROP programmes in Brazil and screening is now fully integrated into the state and municipal levels of Brazil’s health system. The ophthalmologists are recruited and employed by the health system and receive a regular salary. This means that screening is sustainable and can be expanded to other states and municipal health services. This is a valuable lesson for other countries as, in many settings, few ophthalmologists are willing to screen voluntarily. The only way to expand coverage and provide a sustainable high quality ROP programme is for it to be fully integrated into the health system.

Highly complex projects such as this have multiple elements, partners and activities and require a management team and financial management with expert input from eye care and neonatal care.

Lessons to take on board from Brazil’s ROP programme include:

• Advocacy initially with the professionals – ophthalmologists, neonatologists and nurse – then bringing in the state level government and the ministry of health which has led to ROP screening services being fully integrated and sustainable.
• Excellent clinical training and support: High quality ROP screening services require motivated and committed ophthalmologists who have had hands-on, practical clinical training by ophthalmologists with expertise in examining and treating ROP. They also need to be trained in how to set up, run and manage a service, as in this project. The ongoing support, supervision, mentoring and problem solving by the trainers in this project is a model of best practice, maintaining quality as well commitment.
• Health management information systems for ROP that are integrated into government systems are likely to be used more regularly and have more an impact than stand-alone monitoring systems. This also means that information is used to formulate and update guidelines for screening ROP
• Financial sustainability requires consideration from the beginning, ideally as an integrated programme within the health system.
• Leadership: The Brazil ROP programme has benefited significantly from having consistent support from Dr Zin who has championed it from 1998 to date.

As you watch the video, consider what the main takeaway lesson is for you about establishing and managing ROP screening services?