Dr. Priya Morjaria (Co-Lead Educator)
Assistant Professor in International Eye Health - Optometrist
PhD exploring innovative and efficient ways of delivering school eye health programs at the London School of Hygiene & Tropical Medicine
Location London
Activity
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@LoriPacheco thank you for sharing this important lesson. Always remember that even those that are not able to read/write perform near vision tasks.
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@KISHOREKUMARSANJIVABHANDARY this is a longstanding problem and not a recent problem and one that requires very complex behaviour change.
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@LoriPacheco can you think of strategies for educating parents and disseminating this information to them.
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@PrativaDevkota the issue of spectacle compliance is extremely important. With all the work done around setting up a programme, ensuring effective screening, it is important to understand the reasons for non-compliance and address them in each context.
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@KISHOREKUMARSANJIVABHANDARY if it is a part of the school curriculum, how would you ensure parents also get the information?
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An important point - in fact universal health coverage also assumes that those who need spectacles have access to it.
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@NiamhBrowne very important point. The importance of data on met and unmet need. This evidence can help both for advocacy and planning of the programme.
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@MuhammadismailKhan I agree with you about raising awareness - what are your thoughts on the 'screening camps' - there are several models of this. As the course goes on - keep this at the back of your mind and we can revisit the idea of screening camps.
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Dr. Priya Morjaria (Co-Lead Educator) made a comment
Welcome everyone! I look forward to meeting all you and learning about your experiences. In these challenging global times, it has become even more important that we continue to connect and share our knowledge and experiences. Please do introduce yourselves so we can celebrate the global participation on this course.
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Welcome everyone to Week 1. I look forward to meeting all you and learning about your experiences. In these challenging global times, it has become even more important that we continue to connect and share our knowledge and experiences.
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@EstherE thank you for your engagement and comments throughout the course. We are really glad you enjoyed the course - please do recommend to your colleagues.
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@EstherE one of the principles highlighted in the World Report on Vision is the need to include 'Monitoring and Evaluation' as part of programme timelines and also to budget for this at the outset.
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@EstherE the difficulty with such an analysis might be that it is not representative of what is happening. It would be a useful exercise to evaluate service delivery over time - they can be random and unannounced.
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@EstherE 'willingness to pay' is a complex concept as you rightly imply. There are a number of studies around the concept but still a difficult thing to really understand as human behaviour when it comes to accessing health services is not so straightforward.
A paper that you might find useful when it comes to economic evaluations is this one here...
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@LizBrogan you are right - it is a very difficult thing. But my experience has taught me that it is about finding a 'champion'. THat can be a teacher as you suggest or even a parent that understands the benefits etc.
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@EstherE there is a really good point you raise 'Surveillance has to be acceptable and not intimidating from the senior level.' It is important to remember that data on clinical outcomes and/or services should not be collected to police anyone. It is collected to monitor and evaluate and to measure progress for individuals/hospitals etc. If data is collected...
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@ErinSieck to maintain an inventory that can meet the needs of the majority of patients will as you say require 'varying powers'. This is why good record keeping/databases are important to keep track of the most common prescriptions both for adults and children.
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@EstherE the last point you raise is a very good one and there have been many instances when planning a new programme or increasing targets this has come up. Often times it is seen as those providing the services as being resistant to increasing the volume. However, when planning programme it is important to have that balance between providing quality services...
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@EstherE behaviour change is a very complex and difficult process. And the example you give is a great one - while it was 25 years ago, it is still valid in that as clinicians, service delivery personnel that whenever we ask someone to change a way of thinking or doing something it will always feel painful and be difficult initially. The key is to be persevere...
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@PeaceAnyoha you raise an interesting point about writing objectives for long term. Sometimes it can be broken down in a different way - having a few goals that can then lead to planning for the long term.
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@EstherE thank you for sharing your SWOT. The 'weakness' you mention is a very common one in many settings. Organisations have come up with creative solutions to this - do you have any examples of how to do this?
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@ChrisA hope this helps to clarify:-
If CSC eyes is greater than CSC persons, then a large number of bilateral operations have been carried out. And if CSC persons is greater than CSC eyes, then single eyes have been done, mainly, and this will reduce the prevalence of blindness, as per the World Health Organization classification.
When CSC persons is...
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@EstherE comments on points that you raised
My key questions
1/ how many people can I service with my staffing?
Best way to calculate this is to break it down to how many seen annually, then how many over 40 weeks (average number of working weeks per year), then per week and finally per day.2/Finance- cost statement for set up, predicted ongoing...
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@EstherE yes testing for vitamin A deficiency would involve a blood test. So it is requires different skill set and healthcare professional.
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@EstherE absolutely, sustainability is key. However, important to keep in mind there has to be a fine balance between 'mobile clinics' which are temporary and in some cases short term solutions to meet current or an imminent need.
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@EstherE can you think of any other way to prioritise the backlog and new patients? What other methodology can you use for this? I agree with you in that where there is no pre-existing system you must include all stakeholders to ensure there is ownership of the programme.
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@JudithShongwe Public-Private Partnerships are very interesting - and have worked in some places very well. It all depends on how they are set up and how each partner is perceived and how they benefit from it. In the situation you describe - can you think of how each party can 'benefit' from the partnership?
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@EstherE pretty much :) a good comparison! Always good to know where you want to get to so that you can monitor progress and assess whether you are on track.
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@PeaceAnyoha absolutely - the use of donated/recycled spectacles is something that should not be happening anymore.
Here is a position paper on recycled spectacles from IAPB https://www.iapb.org/wp-content/uploads/Position-Paper-on-Recycled-Spectacles.pdf -
@EstherE @PeterMacIntosh @PeaceAnyoha
Here is the paper that it is being referred to for the trends in myopia https://www.aaojournal.org/article/S0161-6420(16)00025-7/fulltext
Another great resource for myopia trends and global variations is https://bjo.bmj.com/content/100/7/882.long
Myopia is a complex process and it has many factors - environmental...
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@EstherE all very good points and there are many studies out there about the challenges in spectacle compliance but also the importance of including parents/decision makers in the conversation so that they are able to understand what it means when a child has a refractive error.
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@PeaceAnyoha some of the work that I explored for my PhD was exactly around this. If there is no perceived benefit of any intervention then it is not something that will be accepted. The spectacles also have to look good! They have to be aesthetically pleasing and the child has to like them or they will not wear them.
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@PeaceAnyoha you are right - the screening threshold has to be adjusted if required to match the capacity of the system to deal with the increase in refractions.
A useful document is the Comprehensive School Eye Health Guidelines, available in many languages here is the link https://www.iapb.org/resources/school-eye-health-guidelines/ -
@EstherE there are some school health programmes that conduct ear, teeth and eye check-ups at the beginning of every academic year. One such national example is from Indonesia.
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'See well - be well' or 'See well - feel well' but I do like 'See well to read well'. Brilliant idea to send children home with messages.
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@OnwuchekwaChimezie this is such a global problem. It is important these false beliefs are addressed in each community. In order to do this it has to be a community effort more than anything else. Understanding how these beliefs occur and then working with the community to debunk them is important.
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@EstherE thank you for sharing this
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@JudithShongwe good way of putting it - task shifting is something we need to be open to at all levels of the health system.
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@EstherE all very valid and very important to think all these through when planning a programme. This is all so context specific and one size will never fit all.
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@JudithShongwe correct hence the importance of having all the right stakeholders at the planning stages of a programme.
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@EstherE role models are very important for children. In India Bollywood actors and cricket players are setting the example.
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@EstherE you have a good point - as we increasingly use technology to communicate and stay in touch globally. Also we use smartphones for many daily transaction e.g. mPesa in Kenya.
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@princeemekaohanele agreed in that the majority of the population will have to deal with presbyopia. However the issue is how many of those will have access to an appropriate pair of spectacles.
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@EstherE 'vision screeners' I prefer to use the term 'eye health screeners' should be trained efficiently and effectively and the ability to pick up 'malingerers' should be part of the training.
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@PeterMacIntosh this is a valid point - not all school aged children are school going children. This has to be dealt with using context specific measures. The first thing to find out is the proportion of children that are enrolled at school vs. those that are out of school. If there is a large proportion that is not at school (data usually available through...
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@ManishaGahatraj this is a very common problem - how are parents informed to bring the children to the hospital? Or is it that only school principals are informed?
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@EstherE this is great - are there any open access databases that show data from this programme?
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@StephanieNeratPam thanks for responding. Is this something that you think that can be introduced so that other staff can be trained for task shifting?
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@EstherE agreed - and as we talk about the ageing population and changing demographics this is set to increase.
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@EstherE good points - it is also important because spectacle compliance is low in all settings. Here is a link to an abstract that you might find useful https://www.tandfonline.com/doi/abs/10.1080/09286586.2019.1628282
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@EstherE using teachers as screeners works in different settings - can you think of pros and cons of this?
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@EstherE you have summed it up well - patients need to be feel confident in the service and the treatment they will receive.
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@ErinSieck that is a potential solution - how would we make this a sustainable solution? Can you think of potential solutions?
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@PeaceAnyoha you have raised a very crucial point. There are patients in some settings who are waiting for their vision to reach perception of light before accessing services, while in some places at 6/18 seems to be the threshold. And this is something that should be thought through - what would you suggest could be done?
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@EstherE that is a very good point - children can be agents of age when they are given the right information. Do you have any examples in your setting of where children have been involved in educating others in the community?
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@JudithShongwe a very valid point. The IAPB Vision Atlas that can be found at this link http://atlas.iapb.org/ and the World Report on Vision https://www.who.int/publications-detail/world-report-on-vision are both good sources of data to understand where things are at. But yes it would be great to see the 'before and after' for all countries.
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It is great to read about all the examples that you are sharing on the impact that VISION 2020 has made in your settings. Now that we are in the year 2020 - can you think of what next would be a way forward building on the momentum that Vision 2020 created?
The World Report on Vision was launched last year - you can find it on this link:-...
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@ChinyereNnadi you and Judith above make the same point about governments making eyecare a priority. What strategies do you think worked to get malaria, polia, HIV/AIDS etc to become a priority?
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@JudithShongwe I agree about making a eye care a priority - can you think of examples or share from your experience how best to approach this and strategies that have worked maybe for other conditions to help governments make it a priority.
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@EstherE when you refer to access in here, do you mean access to the infrastructure or access in terms of reaching the service?
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@StephanieNeratPam can you think of any examples in your setting where training other healthcare personnel in eyecare has changed the way services are provided?
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@ErinSieck can you explain a bit more about what the challenges are with 'medical insurance'. Are eye care services included in the insurance? Which eye care services are included and excluded?
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@PeterMacIntosh you raise a valid point. Geographical proximity does not always translate into access. In the example, the idea is to start with the barriers that are visible at the onset. Then, once you can address these as you point out important to understand the context and do more research around what drives health seeking behaviour.
This is an... -
@EstherE you raise a good point. Mentorship programmes are a good way to continue teaching and learning. Can you share any examples of outcomes of mentorship programmes from your setting? And are they formal or informal? Do you think that whether they are formal or informal makes a difference?
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Dr. Priya Morjaria (Co-Lead Educator) made a comment
Hello and welcome to the course! I am so pleased to see so many of you from different parts of the world. I am looking forward to the discussions and hearing about your experiences in different settings.
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@IbrahimYusuf And how about quality?
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@OrdiaAnthony really interesting to note that you are able purchase ready made bifocals. I have not come across these yet. What is the average cost of these?
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@IbrahimYusuf are the presbyopic corrections that are available in the market cheaper than those in the eye clinic and outreach?
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@OrdiaAnthony just to clarify - the ready readers are bought by those at all levels but the 'elite' also use them and will go see a doctor if the experience other vision problems?
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A recent article in Ophthalmic Epidemiology does an analysis of predictors of spectacle wear in children and reasons for non-wear. Do have a read of it as it will help to better understand this issue with non-compliance of spectacles in children. https://www.tandfonline.com/doi/full/10.1080/09286586.2019.1628282
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@OrdiaAnthony it sounds like you have a programme in place already. Are the school and church visits done regularly? Or is this dependent on funding? Do you have a financing model in place that is sustainable?
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@DR.AJAYRANA there are also other control strategies for myopia that are suitable along with lenses. This issue of the Community Eye Health Journal is a good read https://www.cehjournal.org/myopia-a-serious-condition-that-needs-our-attention/
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@OrdiaAnthony you have raised some very good points.
Re: strabismus you say it right. This has to be done at pre school. Which is different from school aged children. Is this something that is done in your setting? If so, please share the details and the tests that are done. I would also be interested in knowing the prevalences of conditions at pre-school....
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@DrHimalKandel agree with you - refractive error is on top of the agenda for many national eye programmes at the moment. Look forward to the discussions this week.
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@NarendraKumar in your opinion what is the strength of programmes such as those that are implemented by Aravind Eye Hospital? If there was a key learning from it what would that be?
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@DavidFrancisFullonChan thank you for sharing your reflections on this and your experience. I specifically want to highlight your point on 'champions'. More and more it has become important that we do not just speak to other ophthalmologists or eye care professionals. We need to include others in the Ministry of Health that can take the case for avoidable...
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@OrdiaAnthony it is great to see the work that is done around WSD. However, I am curious are there other 'outreach' activities that happen throughout the year to harness on the momentum from WSD.
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@OrdiaAnthony you said it well. Moving from a 'project oriented approach'. How do you suggest we do this? Your point about national policy is very crucial. Do you have any examples from your setting?
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@EishaGrant good summary. Are there any examples from your setting in programmes where this multi-sectoral has worked or not worked?
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@EishaGrant you make a valid point. However, there has to be a task shifting along with task sharing. Re: surgeries this has to be regulated and those conducting it have to be competent and accredited for it.
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@NarendraKumar I think my comment might have confused you - I was merely highlighting the reasons why it has been difficult to get regulation of optometry in India.
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@PETERNSIAH have you had a look at the Vision Atlas to see how Zimbabwe compares regionally http://atlas.iapb.org/global-action-plan/gap-implementation/gap-implementation-eye-health-workforce/
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@BarileeAbueh while funding NGOs has been the model in a number of places, what do you think about the sustainability of these programmes? And how can we best ensure that these activities continue beyond NGO funding.
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@NarendraKumar this sounds very much like task shifting - in your opinion is the optometrists only that can screen for cataracts? Can this task be done by other personnel in your setting and if so who? And what sort of training would they require?
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@NarendraKumar optometry and refraction has been controversial for a very long time now. The lack of standardised training and regulation is is a key reason. This combined with different organisations not collaborating to make optometry a united profession.
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@RuthLennox you raise a good point the professional/political barriers exist in many settings. Can you think of any ideas on how to overcome this?
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@JudyKaragania you are right - it involves everyone including all members of the community right up to tertiary care. Can you share any examples from your setting of any specific programmes that have done this or attempted?
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@RuthOgochukwuNwoye even when all the control strategies are implemented patients still do not take the final step and access the service or comply with the treatment. Is that also the case tin Nigeria? Can you share your experiences around that?
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@BeverlySmith one useful tip is to print it out and laminate it so that staff have easy access to it. Maybe even small postcard sized one so they can carry them around.
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Welcome @PETERNSIAH whereabouts in Zimbabwe do you practice?
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Welcome to the course @HaseenaMajid - health financing models are an important topic. Good to know you sit on the public health committee at AFCO - I look forward to the discussions.
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Welcome to the course @KojoEssel-Amoah where in Ghana are you based?
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Dr. Priya Morjaria (Co-Lead Educator) made a comment
Hello and welcome to the course! I am so pleased to see so many optometrists from all over the world on the course. I look forward to hearing about all your experiences and sharing how optometry can contribute to public health in your setting.
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@HakeemAfful great to have you on here - what part of Zimbabwe do you work in?
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Hello everyone - and welcome to the course. Very excited to be learning and sharing experiences with all of you. Apologies for being a little late in welcoming you - I have been at the International Agency for Prevention of Blindness Council of Members meeting in Tanzania and look forward to sharing key messages from the meetings. And a very special welcome to...
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@AbdikaremMohamoud Welcome to the course - I am really looking forward to learning from your experiences in Somaliland and how we can exchange different lessons learnt.
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It would be good to know some more about how you share and communicate individual level surgeon data in your setting.
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A very good point - how is it that the public is made aware of the skills of the personnel at the two centres? Is it from word of mouth?
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Yes word of mouth in the community is an important awareness strategy
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Thank you for sharing your experience. Can you tell us a bit more about 'patient feedback forms' and how you have used these.
