‘Bridging strategies’ key to achieving Vision 2020 goals

Programs that create a strong link between hospitals that provide clinical services and the communities that need those services are key to realizing the goals of Vision 2020, a study in sub-Saharan Africa suggests.

Susan Lewallen and colleagues at the Kilimanjaro Centre for Community Ophthalmology and other institutions analyzed two programs in rural east Africa that have been successful in meeting Vision 2020 goals, in order to determine how they achieved those goals. Administrators at the Kwale District Eye Centre program and the Kilimanjaro regional Vision 2020 program were interviewed to compare the methods used to increase the volume of cataract surgery in those regions.

Based on their findings, the study authors said “the development of ‘bridging strategies’ that create a strong link between hospitals providing clinical service and communities needing these services is a key component to realizing Vision 2020 goals in sub-Saharan Africa.”

Vision 2020 is a global initiative to eliminate avoidable cataract blindness by 2020. To achieve the goals of the program, the cataract surgical rate should be between 2,000 and 5,000 per million people per year. In most sub-Saharan countries, the figure is less than 500 surgeries per million per year, according to the study authors.

The Kwale district has a population of about 600,000 and is predominantly rural; the Kilimanjaro region has a population of about 1.4 million and is also predominantly rural. In both areas, cataract accounts for about 50% of blindness, the study authors said.

Both areas had community-based eye care programs, but both initiated new programs when they realized Vision 2020 goals would not be met with their existing models. Both areas were able to increase the number of cataract surgeries performed — to 1,583 in the Kwale district and 1,165 in the Kilimanjaro region.

The study authors looked for elements that the two programs had in common that may have contributed to their success in raising cataract surgical volume. They found that programs in the communities and at the hospitals were closely linked so that they could increase capacity together; community programs were “patient friendly,” able to provide service in one stop; the examination team included people with enough skill to provide treatment and decide who is operable so that patients were not transported needlessly; and community-based visits were selected according to population distribution and were performed according to a regular schedule.

About 30% of people with cataract in the Kwale district decline surgery, even though the patient would not be required to pay for the service, the authors noted. In Kilimanjaro, most patients pay the full fee after counseling. There is a mechanism in place to serve those who cannot pay, but it is not mentioned in the advertising, the authors reported. They said they believe some patients without the necessary funds simply opt to go outside the Kilimanjaro area.

“We also note that the proportion of patients with operable cataract who attend sites in Kwale is about twice that in Kilimanjaro,” the authors said

The study is published in the October issue of the British Journal of Ophthalmology.