Can we scale up a comprehensive school-based eye health programme in Zambia?
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Published on: April 6, 2016
Ai Chee Yong1, Anne Buglass2, Godfrey Mwelwa3
1Centre for Public Health, School of Medicine, Dentistry and Biological Sciences, Queen's University Belfast, Northern Ireland, UK.
Insights
Scaling up Zambia's School-based Eye Health Programme (SEHP) is feasible with adequate funding. Careful adaptation to local contexts is crucial for successful expansion of this child vision care initiative.
Area of Science:
- Public Health
- Ophthalmology
- Health Systems Strengthening
Background:
- 19 million children globally suffer from preventable vision impairment due to limited access to eye care services.
- Approximately 50,000 school children in Zambia require spectacles, highlighting a significant need for intervention.
- School-based Eye Health Programmes (SEHP) are recognized as effective strategies for preventing childhood blindness.
Purpose of the Study:
- To assess the scalability of the School-based Eye Health Programme (SEHP) in Zambia.
- To identify essential components, roles, capacities, and environmental factors for effective SEHP scale-up.
- To estimate resource needs and propose strategies for expanding SEHP.
Main Methods:
- Utilized ExpandNet-WHO's Nine Steps for Developing a Scaling-Up Strategy, assessing five key elements.
- Conducted a literature review on childhood blindness prevention and SEHP in resource-limited settings.
- Employed document review, questionnaires, and stakeholder interviews, analyzed using a 20-question worksheet.
Main Results:
- Zambia's SEHP model incorporated additional components, enhancing its credibility and relevance.
- A competent resource team from the pilot project is available for scale-up; however, political instability, supply chain issues, and funding instability pose risks.
- SEHP aligns with Zambia's National Eye Health Strategic Plan, supporting its integration into the School Health and Nutrition Programme; district-level replication is recommended over provincial.
Conclusions:
- Scaling up a comprehensive SEHP in Zambia is achievable with sufficient financial investment.
- Adapting the scale-up pace to the local context is essential to maintain the integrity of all SEHP components.
Background:
Globally, 19 million children have preventable vision impairment simply because refractive and eye health services are inaccessible to most of them. In Zambia, approximately 50,000 school children need spectacle provision. The School-based Eye Health Programme (SEHP) has been identified worldwide as a proven strategy to address childhood blindness. Given its great benefits, the Zambian government intends to scale up the programme. This scalability assessment aims to identify and evaluate the essential components of an effective SEHP, determine roles, assess existing capacities within user organisations, identify environmental facilitating and inhibiting factors, and estimate the minimum resources necessary for the scaling up and their proposed scale-up strategies.
Methods:
Five elements (innovation, user organisation, resource team, environment, and strategies for horizontal and vertical scaling-up) were assessed guided by the ExpandNet-WHO Nine Steps for Developing a Scaling-Up Strategy. Literature review on proven strategies to reduce childhood blindness and the credibility of SEHP implemented in resource-limited settings, document review on the pilot project, questionnaires, and stakeholders' interviews were conducted to collect data for this assessment. Subsequently, twenty questions in the Worksheets for Developing a Scaling-up Strategy were used to report the assessment outcome systematically.
Results:
Additional components of SEHP incorporated in Zambia's model enhanced the innovation's credibility and relevance. The resource team was relatively competent in the pilot project, and the same team will be employed during the scaling-up. Potential change in political parties, the lack of supply chain, and unstable financial support were identified as inhibiting factors. The objectives of SEHP were aligned with the National Eye Health Strategic Plan 2017-2021, which supports the institutionalisation of the SEHP into the existing School Health and Nutrition Programme. For the pace of expansion, replicating SEHP to another district rather than a province will be more realistic.
Conclusion:
Scaling up a comprehensive SEHP in Zambia is feasible if sufficient funding is available. Additionally, the pace must be adapted to the local context to ensure that every component within the SEHP is intact.
