A Comprehensive Eye Care System

What is a comprehensive eye care system ? It is a system that provides a combination of services from patient eye exams to additional services regarding vision such as : promoting eye health, prevention, diagnosis and treatment of all relevant eye diseases as well as rehabilitation and social inclusion of patients who are irreversibly blind or vision-impaired.

Through the development of comprehensive eye care systems, OPC first and foremost provides its expertise to establish the situation of the current eye health system and quantifies their needs.
OPC then finds the necessary resources to organize the training of ophthalmologic health personnel already living in the countries being assisted and additionally manages the continuing education. Furthermore, OPC provides the equipment, supplies and vehicles used to treat the most isolated villagers.

Finally, OPC installs mechanisms for the sustainability of these activities, evaluates the whole programme and makes any necessary corrections or improvements. OPC helps the establishment and functioning of comprehensive eye care systems allowing partner countries to become autonomous.

The foundation of a comprehensive eye care system consists of cascade training on the premise of establishing a patient referral system : the ophthalmologist trains the Senior Ophthalmologic Technicians (Techniciens Supérieurs en Ophtalmologie or TSOs). The TSOs then form the community health agents. OPC then provides the necessary equipment which allows the formation of local doctors (training of trainers, retraining and training on equipment).

To gain access to this healthcare, each patient must make a contribution, allowing the sustainable operation of the system.

This system is made up of three levels :



1st level (Primary healthcare) : Village community
At this level, community health agents are in charge of screening patients in order to allow early diagnosis of eye diseases, prevention against eye diseases and disorders including those that can infect newborns and awareness such as hygiene education and promotion of annual eye examinations for diabetic patients.
After an initial diagnosis, community workers will be able to provide primary care to patients with affected by injuries or conjunctivitis and in the case that they are unable to provide sufficient services to the patient ; the community health agent can refer the patient to a secondary healthcare facility for further diagnosis or even a cataract operation.
2nd level (Secondary healthcare) : Health centre
At this level, the TSOs diagnose patients, provide necessary first aid to patients and/or perform simple operations such as the one for repairing the eyelids of a patient who requires surgery for trachomatous trichiasis. The health centre has an operating theatre and therefore the majority of cases can be treated at this level.
If the patient cannot be treated at the health centre, the TSO may refer the patient afflicted with diseases such as cataract or glaucoma to district or regional hospital as required. Indeed, hospitals, the institutions of level 3, have trained ophthalmologists who are capable to take care of the patient.
The reference system also applies to general practitioners who, once trained, are required to refer any diabetic patient to an ophthalmologist in order to prevent diabetic retinopathy.

3rd level (Tertiary healthcare) : Hospital
At this level, whether at the regional or district level, the hospital will have ophthalmologists on staff who are capable of performing any operations that patients could not receive at the primary or secondary level. Once the patients have been operated on, the ophthalmologist sends the patient to one of the lower levels to receive any postperative treatment.
If the patient represents a difficult case for one reason or another - lack of adequate equipment, for example - the patient is then referred to the national reference level where specialists in ophthalmology can be found.

Mobile Eye Surgery Unit
To support remote and marginalized populations by offering quality care, OPC encourages the development of a mobile strategy called the Mobile Eye Surgery Unit.
The mobile unit is made up of a surgical team consisting of an ophthalmologist, a TSO and a driver. This team travels to extremely isolated health centres often in extreme conditions. The vehicle features a functional operating theatre which consists of a portable operating microscope and all necessary medical supplies.

With this mobile unit, TSOs and ophthalmologists are able to reach village communities and health centres in order to provide adequate treatment as well as refer patients who require a more delicate operation to the proper physician.

Fundamentals of OPC’s Intervention
OPC is opposed to giving handouts and seeks that its programmes are implemented by health professionals in its partner countries.
OPC aims to provide the most direct path for quality care of patients from diagnosis to curative treatment.
OPC makes sure that at each level of intervention, patients are receiving quality care.
OPC monitors the implementation of programmes with the civil society in partner countries.
OPC and civil society in partner countries shall ensure the proper use of funds.
OPC aims to empower and retain specialized personnel, streamline costs and ensure the continuation of its activities.
OPC submits its programmes to be evaluated in the presence of donors, ministries of health, civil society and the WHO.
OPC submits its accounts to be audited annually with full transparency.