Department of Ophthalmology, KCM College, Tumaini University, Moshi, Tanzania.
Kilimanjaro Centre for Community Ophthalmology, PO Box 2254, Moshi, Tanzania.
Public Health. 2014 Jan;128(1):96-100. doi: 10.1016/j.puhe.2013.10.007. Epub 2013 Dec 17.
Primary health care in Tanzania is provided at two types of health units, the dispensary and the health centre. Theoretically, primary health workers (with knowledge of primary eye care [PEC]) are ideally placed to identify people in need of eye care services. In Tanzania, they are expected to be able to identify, treat, or correctly refer a number of eye conditions including cataract, trauma, presbyopia, and the 'red eye'. They are also expected to be able to measure visual acuity correctly and to educate the community about prevention.
The objective was to determine the effect of enhanced supervision of health workers on PEC knowledge and skills in Kilimanjaro Region, Tanzania.
This was a quasi-experimental, cluster randomized intervention study of an enhanced supervisory method compared to a routine supervisory method; 36 dispensaries were randomly allocated into the two groups.
Health workers based at government dispensaries in Mwanga District.
Participants were interviewed pre and post intervention and the information was recorded using a standardized pretested questionnaire.
Mean scores of knowledge in healthcare workers was higher in the intervention group (score = 6.43, 80.4% improvement) compared to the non-intervention group (score = 4.71, 58.9% improvement). The ability to describe and demonstrate vision testing was better (score = 1.8) in the enhanced supervision group compared to the routine supervision group (score = 0.88, P = 0.03). There was a high level of attrition (24%) within one year from the time of baseline survey, especially amongst clinical officers (44%).
During the pilot study, enhanced supervision improved PEC knowledge and skills of health workers compared to health workers with routine supervision.
Training in PEC needs revision to become more practicum-based. There is need to revise supervision guidelines (to be skills-based) and the supervision skills of district eye coordinators (DECs) need to be enhanced. There is a huge need to improve governance (accountability and rule of law) of health staff.
坦桑尼亚的初级卫生保健由两种卫生单位提供，即诊所和卫生中心。理论上，初级卫生工作者（具备初级眼保健知识）最适合识别需要眼保健服务的人群。在坦桑尼亚，他们应该能够识别、治疗或正确转诊包括白内障、创伤、远视和“红眼病”在内的多种眼部疾病。他们还应该能够正确测量视力，并向社区宣传预防知识。
确定增强卫生工作者监督对坦桑尼亚乞力马扎罗地区初级眼保健知识和技能的影响。
这是一项准实验、集群随机干预研究，比较了增强监督方法与常规监督方法；36 个诊所被随机分配到两组。
位于姆万扎区政府诊所的卫生工作者。
参与者在干预前后接受了访谈，信息使用标准化的预测试问卷进行记录。
干预组卫生保健工作者的知识平均得分较高（得分=6.43，提高 80.4%），而非干预组得分较低（得分=4.71，提高 58.9%）。增强监督组描述和演示视力测试的能力更好（得分=1.8），而常规监督组得分较低（得分=0.88，P=0.03）。在基线调查后的一年内，尤其是临床医生（44%）的流失率很高（24%）。
在试点研究中，与常规监督相比，增强监督提高了卫生工作者的初级眼保健知识和技能。
初级眼保健培训需要修订，使其更注重实践。需要修订监督指南（使其成为基于技能的），并增强地区眼协调员（DEC）的监督技能。迫切需要改善卫生人员的治理（问责制和法治）。
