Brien Holden Vision Institute, Durban, South Africa.
BMC Health Serv Res. 2013 Sep 27;13:361. doi: 10.1186/1472-6963-13-361.
In South Africa, the health service is based on a Primary Health Care (PHC) philosophy with the District Health System (DHS) as the locus of delivery. However eye care services, particularly primary eye care, refractive error and low vision, have not been prioritised accordingly. Hence the aim of the Giving Sight to KwaZulu-Natal (GSKZN) project was to integrate the delivery of eye care services into the district health system, with emphasis on addressing the need for uncorrected refractive error and low vision services.The project was implemented in the KwaZulu-Natal province, South Africa, to scale up the delivery of refractive error services utilising a four pronged approach; including advocacy, human resource development, equipment provision and research.
This paper is a description of the project and a retrospective analysis of data received through the course of the project from July 2007 to June 2011. Data were collected from training registers, equipment schedules and service delivery reports from institutions. Reports from the data base were then analysed and achievements in training and trends in service delivery were determined.
Over a four year period (July 2007 and July 2011) 1004 persons received training in rendering eye health services appropriate to their level of deployment within the DHS. During the course of the project, these 1004 persons examined 1,064,087 patients. Furthermore, the total number of clinics offering primary eye care, refractive error and low vision services increased from 96 (10%) to 748 (76%). With increased numbers of PHC Nurses trained in primary eye care, a subsequent decrease of 51.08 percent was also observed in the number of patients seeking services at higher levels of care, thus streamlining eye health service delivery.
This project has shown that scaling up can occur in delivering eye health services within a health district, through a multi-faceted approach that encompasses focused training, advocacy, development of appropriate infrastructure and the development of referral criteria with clear guidelines for the management of patients.
在南非，医疗服务基于初级卫生保健（PHC）理念，以地区卫生系统（DHS）为服务提供中心。然而，眼科保健服务，特别是初级眼科保健、屈光不正和低视力，并未得到相应的优先重视。因此，给予夸祖鲁-纳塔尔省视力项目（GSKZN）的目的是将眼科保健服务纳入地区卫生系统，重点解决未经矫正的屈光不正和低视力服务需求。该项目在南非夸祖鲁-纳塔尔省实施，旨在利用四管齐下的方法扩大屈光不正服务的提供：包括宣传、人力资源开发、设备供应和研究。
本文介绍了该项目，并对 2007 年 7 月至 2011 年 6 月期间通过该项目收到的数据进行了回顾性分析。数据来自机构的培训登记册、设备时间表和服务提供报告。然后对数据库报告进行分析，确定培训成果和服务提供趋势。
在四年期间（2007 年 7 月至 2011 年 7 月），1004 人接受了在 DHS 内部部署级别提供眼部保健服务的培训。在项目期间，这 1004 人检查了 1064087 名患者。此外，提供初级眼科保健、屈光不正和低视力服务的诊所总数从 96 个（10%）增加到 748 个（76%）。随着接受初级眼科保健培训的 PHC 护士人数的增加，寻求更高层次护理服务的患者人数也相应减少了 51.08%，从而简化了眼科保健服务的提供。
该项目表明，通过多方面的方法，包括重点培训、宣传、适当基础设施的发展以及转诊标准的制定，并明确患者管理指南，可以在卫生区提供眼科保健服务，实现服务规模的扩大。
