REACHING THE UNREACHED Community-Based Eye Care Outreach in Developing Nations by R. Meenakshi Sundaram edited by Julie D. Johnston Aravind Eye Care System (India) provides this material, in collaboration with Seva Foundation (USA), for educational and illustrative purposes only. It is not intended to represent the only or best method or procedure in every case, nor to replace the judgement of local professionals. It is the responsibility of the physician, manager or other professionals to determine applicable federal status of each drug, device, material or process he or she wishes to use, and to use them in compliance with applicable law(s). Aravind Eye Care System and Seva Foundation have made their best efforts to provide accurate information at the time of printing. Aravind Eye Care System and Seva Foundation, the author, the editor, contributors and the publisher disclaim all responsibility and liability for any and \ injury, and for damages or loss of any kind whatsoever, resulting directly or indirectly, whether from negligence or otherwise, from the use of the recommendations or other information in this manual, from any undetected printing errors or recommendation errors, from textual \ Aravind Eye Care System and Seva Foundation own the copyright to Reaching the Unreached: Community-Based Eye Care Outreach in Developing Nations and encourage others to copy, reproduce, translate, or adapt to meet local needs, any or all parts of this manual, including the illustrations, without permission from the author or publisher, provided the parts reproduced are !" Seva Foundation as the source when using or adapting this document. Copyright © 2016 Aravind Eye Care System and Seva Foundation. Reaching the Unreached: Community-Based Eye Care Outreach in Developing Nations is an open access manual distributed under the Creative Commons Attribution License (nc), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited and only for noncommercial purposes. This manual can be improved with your assistance. If you have ideas or suggestions for ways that Reaching the Unreached could better meet your needs, please write to the Outreach Department c/o Aravind Eye Care System. We welcome your comments and experiences. Thank you for your help. Reaching the Unreached: Community-Based Eye Care Outreach in Developing Nations Outreach Department Aravind Eye Hospital 1, Anna Nagar, Madurai 625 020, Tamil Nadu, India #$%&'*+'3*4&7789;#$%&'*++*37%<' Email: [email protected] Aravind Eye Care System =>?> Lions Aravind Institute of Community Ophthalmology, India Seva Foundation, USA Printed at: Leo prints, Madurai October 2016 DEDICATION This manual is dedicated to Dr. G.Venkataswamy, founder of Aravind Eye Hospitals and the founding chairman of Aravind Eye Care System, who was the pioneer of eye care outreach in India. His tireless efforts, along with those of the Aravind team, have grown into the sophisticated array of community outreach activities Aravind has in place today. Although Dr.V passed away in 2006, I believe he would have enjoyed reading the synthesis of his outreach work presented in this book along with the growing number of examples from other parts of the world. AUTHOR’S STATEMENT The unreached must be reached. The inaccessible must become accessible. Community outreach plays a vital role in extending awareness of eye problems and their solutions into communities not normally served by eye hospitals, eye care clinics and ophthalmology practices. Outreach also helps an eye care institution attain its social mission and meet its potential, because it promotes the services of the institution while meeting the needs of the community. Community outreach must be a holistic part of what an eye care institution provides - a central and ongoing aspect, not a one-time or occasional activity. Outreach is simply part of the way that eye care programmes should do business. - R. Meenakshi Sundaram Mr. R. Meenakshi Sundaram (“RMS” to his friends and colleagues) is the Senior Manager of Community Outreach at Aravind Eye Care System, based in Madurai in southern India. He joined &%<3!!J&%<< >&%%&JSPJQJPJXJYZ[- PJPJS manual, which delineates systems and logistics for management of hospital-based outreach activi- ties, eye camp planning, communications, and report generation. In addition to his management \J" twice a year at Lions-Aravind Institute of Community Ophthalmology (LAICO), in Madurai. ACKNOWLEDGEMENTS This manual on ‘Reaching the US guidance and commitment of Dr. G.Natchiar, who has been the force behind our outreach work in eye care at Aravind Eye Hospitals. Her dedication and compassion continue to inspire us all, and I would like to express my deepest gratitude to her. Dr. Venkataswamy initiated community-based eye care right from day one, when Aravind was &%]4>&%%<^_ ophthalmologist in her own right. Since then, Dr. G. N. (as she is known) has been the person S cataract-focused outreach to comprehensive outreach for all. It was her idea to initiate outreach programmes in ophthalmic specialties, and she has guided us through monitoring and evaluation `; ^_S" wanted to create a practical guide on planning and organising outreach for everyone engaged in eye care around the world. I also want to acknowledge the other Senior Leaders of Aravind Eye Care System for having ^_! Emeritus of AECS, and Mr. R. D. Thulasiraj, Executive Director of LAICO and AECS, for their guidance. I would also like to thank the staff of outreach department across the Aravind Eye Care System. I sincerely extend my gratitude to the staff of Aravind Eye Hospitals and LAICO for 88 q>">?_+7+78zP?P ^Z8>8_{? 8!"^"| Gilbert from Seva Foundation. Special acknowledgement and thanks from the author go to the editor, Julie Johnston, for her wonderful contribution in shaping this manual. THE EDITOR J~^~\J"P &%%'SS" then, she has visited another four times and is the editor of the Quality Cataract Surgery Series, a sustainable cataract surgery programmes in a developing nation context. Julie lives in British Columbia, Canada where she works with children and is a sustainability educator with GreenHeart Education (www.greenhearted.org). PREFACE The intention of this manual is to help ophthalmic programmes in developing nations to plan, design, execute and evaluate 21st century outreach activities and strategies in eye care to reach the unreached. >>SPQ! System, or AECS) during over four decades of active efforts to identify and overcome barriers to eye care. It is based largely on the experiences of AECS in developing a programme of high quality, ; the provision of these services, especially through outreach to the rural poor. OBJECTIVES OF THIS MANUAL # to show ways that community outreach activities can contribute to high quality, large \ especially in the context of nations with developing economies # to describe the purposes, activities and challenges to consider when designing an outreach programme for eye care # to record lessons learned in the implementation of a variety of ophthalmic outreach activities through an eye care institution # to provide an educational resource on community outreach in ophthalmology WHO THIS MANUAL IS FOR # someone already involved in ophthalmic outreach who would like their outreach activities to be more systematic, structured and strategic # someone with no experience in ophthalmic outreach who wants to start a programme for their hospital, clinic or ophthalmology practice WHAT WILL BE FOUND IN THIS MANUAL Examples and case studies from around the world are embedded throughout the manual to illustrate important aspects of community outreach in ophthalmology. Interactive activities and resources are available at www.v2020eresource.org. This manual consists of the following chapters: # An Introduction and Overview of Community Outreach (Chapter 1) # Designing Community Outreach Initiatives (Chapter 2) # P\?Q!3X # !Q!'X # Vision Centres and Other Approaches to Outreach (Chapter 5) # J?Q!4X # 9!>!?Q!]X # J?Q!<X # !?Q!%X # The Future of Outreach in Eye Care (Chapter 10) CONTENTS Chapter 1 INTRODUCTION AND OVERVIEW 1 # What is Community Outreach? # The Rationale for Community Outreach # `"!?! - VISION 2020 – The Right to Sight {9q>Q+77%X # `!? - Contributing to Society - Community Involvement and Health Education - Marketing of Services and Demand Generation - Staff Training # Examples of Community Outreach Initiatives in Eye Care # History and Evolution of Outreach in Eye Care # Models Cited in this Manual Chapter 2 DESIGNING COMMUNITY OUTREACH INITIATIVES AND ACTIVITIES 9 # Targets ` - Epidemiology 101 - Target Setting # Approaches # Resources # Organisation - Who, What, When, Where, How? Chapter 3 HUMAN RESOURCES FOR COMMUNITY OUTREACH IN EYE CARE 25 # Barriers to Adequate and Effective Human Resources in Eye Care Outreach 1. Increasing the Number of Eye Care Workers in Developing Nations 2. Ensuring Equitable Distribution of Eye Care Workers 3P`"QqX '[" # Human Resources in an Outreach Department # Coordination and Communication Within and Outside the Department # The Role of Job Descriptions # # Staff Motivation, Morale and Retention Chapter 4 EYE CAMPS - A VITAL STRATEGY FOR REACHING THE UN REACHED 56 # Three Evolutions in Eye Camps # Comprehensive Eye Care in Outreach # Types of Eye Camps # ">! ! - Camp Day Activities ! - Camp Follow-up Activities # !? # Monitoring and Evaluation of Eye Camps # Financing an Eye Camp # ! Chapter 5 VISION CENTRES AND OTHER