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Community Ophthalmology

Lecture Series

Lecture Ⅲ
Monitoring and assessment of
activities of outreach eye camps
• Dr.Saman Wimalasundera
MBBS, DO, PhD
Senior lecturer in Community
Medicine & Community
Ophthalmologist
Department of Community
Medicine,
Faculty of Medicine, University of
Ruhuna,
PO Box 70, Galle, Sri Lanka
Eye camp concept is a highly
desirable and accepted strategy in
providing eye health services to the
populations in remote and underserved
areas of developing countries.

Eye camps are generally of two types.

1. Comprehensive eye care camps


2. Mass cataract camps
In mass cataract camps the prime
emphasis is on cataract surgery. No other
services are routinely provided.
Comprehensive eye care camps are
concerned with primary eye care
approach providing several types of
services for many ocular or systemic
conditions that lead to visual disability or
blindness if left untreated.
Example:-

Identifying corneal disease, cataracts,


refractive errors, glaucoma, squints,
Eye infections, allergies, trauma and
other common eye conditions.
Most eye camps are organized by non
governmental organizations. They have a
major role in organization and conducting
eye camps. Technical inputs are provided
by the institutional ophthalmic team where
the eye surgeon is the team leader.
The camp organizers should be highly
motivated, devoted and committed to the
cause and the community participation is
a very important factor in making an eye
camp a success.
Corrective measures for those
identified conditions are usually
undertaken either at the camp or after
referral to the base or main center.
Manpower and Duties

In addition to routine eye care workers


(Eye surgeon, Ophthalmic nurses and
refractionists) several other health
personnel are required in such programs
including ophthalmic assistants, public
health workers and nurses.
Distribution of work during an eye camp
has to be very clearly defined before the
commencement.
Work should be assigned to
different personnel on their qualification
and experience.
Work Personnel

Screening for visual Trained Ophthalmic


defects using Snellens - Nurse / Medical
chart and examination officer
for obvious anomalies

IOP checking using Trained Ophthalmic


Shiotz tonometer - Nurse / Assistant
Refraction Refractionist / Trained
- Ophthalmic
assistant
Work Personnel

Drug distribution Trained Ophthalmic


assistant

Diagnosing, treating Ophthalmologist


and referral

Health education Nurse /FHW /


Ophthalmic assistant

Logistics Camp organizers


For the improvement of camp services,
Monitoring of activities, finding the
constraints and evaluating the
effectiveness are major important
feedback mechanisms.

Recommended follow up activities


should also be carefully monitored for the
fulfillment of the concept of eye camps.
Monitoring and evaluation provide a
feedback on camp activities as well as
information on the impact of the services
provided.

Some indicators are needed for this


assessment.
Indicators should be based on

1. Measuring the progress


2. Finding whether the set targets are
achieved
Different performance of eye camps are
the easiest measures to use as the
indicators.

It must be comprehensive and cover all


aspects of eye camp services. In using
performance indicators a minimum
manpower requirement should be
finalized.
The team should consist at least one
ophthalmologist, one optometrist and two
ophthalmic assistants/nurses.
Performance unit for each activity are
expected to increase with the increase of
manpower.
Indicators suggested Performance in units

1. Patient examination

A) 20 patient examinations and 1 Unit


treatment (Vision checking,
anterior segment examination
Funduscopy)

B) 5 refractions
1 Unit
(Dry / cycloplegic)
C) 20 IOP checking 1 Unit

D) 10 cataract referrals for 1 Unit


surgery

E) 30 referrals to base for 1 Unit


follow up / investigation
2. Intervention at the camp / base

A) 5 removal of superficial foreign 1 Unit


bodies
B) 5 any other minor procedure 1 Unit
C) 1 cataract extraction at the camp 1 Unit
D) 2 cataract extraction at the base 1 Unit
E) 10 investigations and follow up at 1 Unit
the base
3. Screening procedures only

A) 50 school children 1 Unit

B) 50 community members 1 Unit


4. Health education

A) 25 people given education 1 Unit


(lecture/leaflet/posters)

B) 1 film show / video presentation 1 Unit


5. Rehabilitation

A) Rehabilitation of 1 blind patient 1 Unit


Progress of a camp can be assessed
using those set indicators and their
performance units. Total number of units
for each camp can be compared with
another same type of a camp for each
activity or for overall activities.It may be
compared with a gold standard or set
goals for a single camp too.
This procedure would provide an
opportunity for the organizers and the
authorities to assess their own
performances, which could be compared
with other similar activities of the country.

This ensures whether the planned


procedures are on track and indicate the
deviations allowing the adoption of
corrective measures.
Eye camps are an essential component
in prevention of blindness activities in the
countries where community ophthalmology
is not an established discipline.
In such situations if a national program
is planed for the prevention of blindness,
these indicators could be used targeting
certain number of unit values for different
activities or overall unit value for total
events at different levels for peripheral
mobile units and central mobile units
separately to achieve in a given time
period.
An example for performing
evaluation of eye camp
activities
Five eye camps were conducted in
different parts of a country for a period
of six months.
Findings of eye camps Eye camp No. attended

conducted for past six Camp 1 74

months Camp 2 163

Camp 3 117

Camp 4 270

Camp 5 142

Total 766
Analysis of camp activities
and earned unit values
Activity Camp Tota % Total
C-1 C-2 C-3 C-4 C-5 l units
num earn
ber ed
Medical 06 33 17 28 24 108 14.0
treatment
at the camp
Achieved 0.3 1.65 0.85 1.40 1.2 5.4
unit values

Refraction 08 51 40 111 70 280 36.5


at the camp
Achieved 1.6 10.2 8.0 22.2 14.0 56.0
unit values
Activity Camp Tota % Total
C-1 C-2 C-3 C-4 C-5 l units
num earn
ber ed
NAD 02 01 01 08 03 15 1.9
Referred for 07 35 18 43 20 123 16.0
surgery
Achieved 0.7 3.5 1.8 4.3 2.0 12.3
unit value
Referred for 51 43 41 80 25 240 31.3
further
examination
Achieved 1.7 1.4 1.3 2.6 0.8 8.0
unit value
Activity Camp Total % Total
C-1 C-2 C-3 C-4 C-5 numb units
er earn
ed
IOP - 90 - 148 24 -
Checking
Achieved 4.5 7.4 1.2 13.1
unit value

Total 74 163 117 270 142 766


number
Total units 4.3 21.3 12.0 38.0 19.2 94.8
achieved
This table provides the information about
the activities done at the camp sites and
the number of units earned through the
performance indicators.
Analysis of activities at the
base and earned unit values
Event Camp Total % Tota
C-1 C-2 C-3 C-4 C-5 num l
ber unit
Cataract 2 19 4 8 2 35 28.4
surgeries n=123
performed
Unit value 1.0 9.5 2.0 4.0 1.0 17.5
Followed 27 2 22 26 2 79 32.9
up at the n=240
clinic
Unit value 2.7 0.2 2.2 2.6 0.2 7.9
Total 29 21 26 34 4 114 31.4
number
Total units 3.7 9.7 4.2 6.6 1.2 25.4
achieved
This table shows the amount of work
performed at the base in relation to
individual camp. Units achieved at the
base are added to the camp site units in
finding the total unit achievement .
Total unit value achieved for past six
months by performing eye camps and
subsequent follow up and rehabilitative
procedure equals to unit value of 120.2
units. Average single camp value was
24.4 units. The total value or individual
unit values could be used in comparison
or assessment of camp activities. It may
be useful in self-assessment too.