Policy support is crucial for sustainable and effective school eye health programmes

GBM roundelThere are many barriers to children in low- and middle-income countries (LMIC) accessing eye health services. School health programs provide a unique opportunity to screen vision and/or provide comprehensive eye health services to potentially more than 700 million children worldwide . However, there is limited information on how to strengthen and improve access to school eye health services, particularly in LMICs.

A review of school eye health interventions

To understand the factors that affect children’s access to eye care services within schools in LMICs, a systematic review of interventions in the education sector was conducted by the Brien Holden Vision Institute, supported by the World Bank Group and Global Partnership for Education .

What factors contribute to the acceptability of school eye care services and spectacle wear?

“Spectacle compliance” can be improved by reducing misconceptions and stigma about spectacles. Additional approaches include facilitating support networks within schools, training teachers and providing curriculum-based eye health education which address negative perceptions regarding spectacles or eye care.

What affects the availability of sufficient eye care services?

Communication between health services and schools, the commitment of schools in scheduling screenings, and the support of schools and parents, are key factors in successful school-based eye care interventions. Simple referral pathways between education and health systems, and clear processes that aid follow-up, provision of spectacles and continuity of care, are also crucial facilitators.

What economic factors affect access?

The cost of spectacles for children was identified as a significant barrier in many settings. Factors associated with a higher willingness to pay for spectacles were previous/current ownership of spectacles, regular spectacle wear, a recognised need for spectacles, or an understanding that vision improves with spectacles. Opportunities to reduce programme costs include, sourcing instrumentation from local tertiary institutions, use of school personnel such as health counsellors or teachers, and appropriate spectacle correction protocols to avoid over-prescribing.

What factors affect quality of care?

The use of teachers to conduct vision screenings can be a cost-saving measure for programmes. While studies have found adequate sensitivity and specificity among teachers conducting screenings, training improved teachers’ performance, and increased confidence in vision screening. Other strategies to consider include involving all teachers in vision screening, a greater emphasis on accurately measuring visual acuity, and involving ophthalmologists in training to increase motivation. Lastly, financial incentives may encourage teacher participation and increase spectacle compliance.

Concerns about quality of spectacles and the inability to replace them have been associated with an unwillingness to pay or wear them. Several studies have found that ready-made spectacles are acceptable to many children and can be a cost-effective and appropriate strategy to reduce clinician and dispensing time.

Policy-based support is required for sustainable and effective school eye health programmes

While the provision of school eye health is challenging and reliant on economic, sociocultural, geographic and policy-based determinants, school eye care has great potential to reduce ocular morbidity and developmental delays caused by childhood vision impairment and blindness.

Overall, policy-based support, with a strong emphasis on advocacy targeting government health and education ministries, is required for sustainable and effective programs. Programmes are often successful when different agencies and local customs and beliefs in eye care are incorporated into planning. The uptake and execution of school health in national eye care plans and the inclusion of eye health in school health programmes, are crucial for continued access to eye care.

While the provision of school eye health is challenging and reliant on economic, sociocultural, geographic and policy-based determinants, school eye care has great potential.

Screening in Cambodia; by the Brien Holden Vision Institute

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