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 camps2. 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 wherethe 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 usuallyundertaken 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 qualificationand experience.

Work

Screening for visual defects using Snellens chart and examination for obvious anomalies

IOP checking using Shiotz tonometer

Refraction

Personnel

Trained Ophthalmic - Nurse / Medical officer

Trained Ophthalmic - Nurse / Assistant

Refractionist / Trained - Ophthalmic assistant

Work

Drug distribution

Diagnosing, treating and referral

Health education

Logistics

Personnel

Trained Ophthalmic assistant

Ophthalmologist

Nurse /FHW / Ophthalmic assistant

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 progress2. 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.

1. Patient examination

A) 20 patient examinations and treatment (Vision checking, anterior segment examinationFunduscopy)

B) 5 refractions(Dry / cycloplegic)

1 Unit

1 Unit

Indicators suggested Performance in units

C) 20 IOP checking

D) 10 cataract referrals for surgery

E) 30 referrals to base for follow up / investigation

1 Unit

1 Unit

1 Unit

2. Intervention at the camp / base

A) 5 removal of superficial foreign bodies

B) 5 any other minor procedureC) 1 cataract extraction at the campD) 2 cataract extraction at the baseE) 10 investigations and follow up at

the base

1 Unit

1 Unit1 Unit1 Unit1 Unit

3. Screening procedures only

A) 50 school children

B) 50 community members

1 Unit

1 Unit

4. Health education

A) 25 people given education (lecture/leaflet/posters)

B) 1 film show / video presentation

1 Unit

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 ophthalmologyis 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.

Eye camp No. attendedCamp 1

Camp 2

Camp 3

Camp 4

Camp 5

74

163

117

270

142

Total 766Find

ings

of e

ye c

amps

co

nduc

ted

for p

ast s

ix

mon

ths

Analysis of camp activities and earned unit values

Activity Camp Total number

% Total

units

earned

C-1 C-2 C-3 C-4 C-5

Medical treatment at the campAchieved unit values

06

0.3

33

1.65

17

0.85

28

1.40

24

1.2

108 14.0

5.4

Refraction at the campAchieved unit values

08

1.6

51

10.2

40

8.0

111

22.2

70

14.0

280 36.5

56.0

Activity Camp Total number

% Total

units

earned

C-1 C-2 C-3 C-4 C-5

NAD 02 01 01 08 03 15 1.9Referred for surgeryAchieved unit value

07

0.7

35

3.5

18

1.8

43

4.3

20

2.0

123 16.0

12.3

Referred for further examinationAchieved unit value

51

1.7

43

1.4

41

1.3

80

2.6

25

0.8

240 31.3

8.0

Activity Camp Total number

% Total

units

earned

C-1 C-2 C-3 C-4 C-5

IOP CheckingAchieved unit value

- 90

4.5

- 148

7.4

24

1.2

-

13.1

Total numberTotal units achieved

74

4.3

163

21.3

117

12.0

270

38.0

142

19.2

766

94.8

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

number

% Total

unitC-1 C-2 C-3 C-4 C-5

Cataract surgeries performedUnit value

2

1.0

19

9.5

4

2.0

8

4.0

2

1.0

35 28.4n=123

17.5

Followed up at the clinicUnit value

27

2.7

2

0.2

22

2.2

26

2.6

2

0.2

79 32.9n=24

0 7.9

Total numberTotal units achieved

29

3.7

21

9.7

26

4.2

34

6.6

4

1.2

114 31.4

25.4

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.