Primary Eye Care and Community Participation

Dr. Saman Wimalasundera MBBS, DO, PhD Senior lecturer in community medicine & community ophthalmologist Community Ophthalmology center Department of community medicine P.O.Box 70, Galle Sri Lanka

Primary eye care and community participation

Delivery of primary eye care has its specific roles and targets in the community and good community participation is an essential component in the successful prevention of blindness program.

Primary eye care is the primary health care approach to the prevention of blindness.

Essential components of primary eye care 1. Promotive 2. Preventive 3. Curative 4. Rehabilitative

(1) Promotive eye care

1.Creating and awareness of the blinding diseases existing in the community and the ways of preventing or curing it. 2.How to use the available recourses to overcome the problems.

(2) Preventive eye care

1.Motivation of individuals and their communities to participate in blindness prevention activities. 2.Social and community development that promotes health 3.Change of behavior and environment

Examples  Provision of adequate safe water. construction of latrines &refuse pits  maintenance of environmental hygiene.

 Consumption of food rich in vitamin A.  Care for individuals at risk.

 Prevention of measles, malnutrition and diarrhea in children  Protection of eyes against injuries.

 Immunization (E.g. Measles)  Screening of antenatal mothers for sexually transmitted diseases.

 Family planning

(3) Curative activities

1. To carry out treatment procedures for simple common diseases that lead to blindness or impaired vision if not treated e.g. corneal ulcers, refractive errors etc.

2. First aid treatment for eye injuries. 3.Timely referral to secondary level.

4.Identification of potentially blinding disease conditions for proper management 5.Identification of curable blinding diseases e.g.cataract and referral for treatment

(4) Rehabilitative activities

Target group:

Incurably blind people What can the primary eye care workers do to them ?

They should be assured that they are not completely useless

 Some carefully selected appropriate training should be given to them to acquire some skills  Make them functional and do not allow to depend on the others totally.

Development of primary eye care program A good primary Eye care Program will depend on : (1) existing health care services and availability of trained health care workers (Manpower) (2) Political and professional motivation

(3) Resources for training, to conduct programs and to monitor it.

(4) Supplies for primary eye care workers.

(5) Funding for capital and recurrent expenditure.

(6) Close liaison with secondary and tertiary centers (7) Careful Planning and evaluation

Basic equipment essential for PEC program • Snellens chart and pinhole • Hand magnifying lens • Good source of light (Torch with batteries) • Eye dressings • Teaching materials

Different Types of Primary Eye care Programs that can be used in the community • Depend on the need of the local community and available resources 1. Need assessment Programs 2. Screening for blinding diseases 3. Comprehensive care Eye camps 4. Out reach Surgical Camps 5. Health Education Programs

Sustainability of the PEC programs Depend on the following areas 1. Technical sustainability :- Training of technical staff 2. Financial sustainability :- Continuous allocation of funds necessary 3. Operational sustainability :- Monitoring of the activities regularly.

Community Participation

Ottawa charter and health promotion In 1986 an international conference called Ottawa charter adopts five principal elements that improve health promotion.

The Five principals are 1. Healthy public policy 2. Personnel skills development 3. Community participation 4. Healthy and supportive environment 5. Re-organization of health services Community participation is a major emphasis in eye health promotion.

The promotion of eye health and to reduce the risk of blindness though community ophthalmology needs good community participation

Community participation is influenced by 1. Community beliefs and perceptions 2. Motivation of people in the community 3. Awareness of the problems related to blindness

Community participation can be improved by 1. Encouraging the people with early symptoms by their families to attend to available health services

2. By creating and awareness through health education programs - Mass media programs - Through volunteers or community health workers by small group discussions - Through community leaders - Self help groups - Improving education of children through schools

Community participation enhances eye health 1. By attending to the community health programs for early detection 2. By following treatment procedures until full recovery

3. By adopting changes in life style that encourages eye health 4. By improving the living environment in the communities to reduce the risk of transmission of eye diseases 5. By creating a community demand by the people of the community to develop infra structure facilities by policy makers that improves eye care services.

There is a high demand for a community based approach in the prevention of blindness. That needs proper community participation.