There are almost twelve million children (<18 >years) in Mozambique with minimal access to eye care. [1] Annual screening of school children by teachers for uncorrected refractive error is one of the most cost effective health interventions in Sub Saharan Africa.[2] The International Agency for the Prevention of Blindness (IAPB) has recommended that child eye health interventions be incorporated into National School Health Initiatives.[3]

In view of the IAPB position this presentation sets out to identify and discuss the main considerations in the design of a child eye health strategy, for the province of Nampula, Mozambique, which aligns itself with broader child health and education strategies.

The considerations discussed are relevant to organisations and institutions involved in the provision of primary child eye care through school screening.

Methods:

A review of published articles and white papers around current international trends in child eye health was performed. The Mozambique national, provincial and district educational and health systems were examined through the 2007 census and other published statistics. Interviews were conducted with representatives of the provincial health and education systems and an external bilateral aid representative. Local potential stakeholders in the child eye health programme were identified and interviewed; these included primary school principals, teachers and representatives from NGOs working locally and nationally.

Results:

Considerations will be discussed under the following headings: Social; Educational; Community; Health. A School Health policy exists in Mozambique but the implementation of the policy is not consistent in each province. The main considerations in Nampula are the lack of resources in education and health and the extreme poverty in which most children live. Potential areas for positive integration of child eye health were identified in several government run school and community health and education schemes.

Conclusion:

Highlighting potential barriers and opportunities to programme design ensures that it is sustainable and appropriate to the local setting. Familiarity and engagement with stakeholders in existing child health and educational systems in Nampula, as outlined in this presentation, will inform in the design of a child eye health programme and has the potential enlighten child eye health programme design in other countries.

References:

1. UNICEF - Mozambique - Statistics. 2012 16/11/2012]; Available from: http://www.unicef.org/infobycountry/mozambique_statistics.html.

2. Baltussen, R. and A. Smith, Cost effectiveness of strategies to combat vision and hearing loss in sub-Saharan Africa and South East Asia: mathematical modelling study. BMJ, 2012. 344: p. e615.

3. Gilbert, C., IAPB Briefing Paper: Integrating eye health into school health programmes, 2011, International Centre for Eye Health, London School of Hygiene and Tropical Medicine.

Introduction: The appropriate education for eye health workers is a key determinant of sustainable eye health care systems, and the solution to avoidable blindness and visual impairment. The Mozambique Eye care Project (MEP), is developing the country's first indigenously trained optometrists using a competency-based education curriculum.

Aims: The principal aim is to evaluate the exit clinical competencies of the first optometry graduates in Mozambique and to inform the evaluation of the competency curriculum.

Methods: Using UK based competencies as a benchmark; nine final year students were examined to assess competences in six core subjects.Further information about factors relating to their performance in these competencies was gained through semi-structured interviews with course developers and lecturers.

Results: All the students were competent at communication, professional conduct and methods of ophthalmic examination. None were competent at visual function and only four at ocular anatomy and binocular vision.

Conclusions:

a) Student learning experience: Lecturer background and training influenced student training as all the lecturers had trained in different countries. A clinical training protocol need to be implemented to optimise clinical competencies.

b) Existing healthcare context:Enhanced training needs should be addressed in clinics with more support staff and time to deal with complex patients.

c) Student capacity: Students that are more suitable for the course should be selected.

Optometric education and resources are drastically deficient in most of Africa, more so in Lusophone Africa where the problem is compounded by language barriers which isolate these countries from related developments in Africa and/or the developed world.

The Mozambique Eyecare Programme is a multi-partner collaboration between The International Centre for Eyecare Education (ICEE), Universidade Lúrio in Mozambique, Dublin Institute of Technology, and the University of Ulster in Ireland, designed to address the need for optometric education in Lusophone Africa.

AIM

This paper aims to document the current situation with regards to human resource development in eyecare in Mozambique and offer analysis of the status and challenges facing the only programme addressing the problem of uncorrected refractive error and low vision in Lusophone Africa through education.

METHODS

The extent of uncorrected refractive error and existing optometric services in Nampula Province will be extrapolated from the results from a Rapid Assessment of Refractive Error and a situational analysis.

The challenges faced by the Mozambique Eyecare Programme will be analysed using results from a baseline survey of students, key informant interviews and analysis of optometric resources available that are published in Portuguese.

RESULTS

The research into the implementation of the Mozambique Eyecare Programme is ongoing. Results are currently unavailable, but relevant data and analyses emerging from current research within the next 6 months will be presented at the conference.

CONCLUSION

Human resource development for refractive service delivery in Lusophone Africa is key to the achievement of VISION 2020 goals in this region. Innovative models of education need to take into account the local need, legislative boundaries and situational constraints in order to successfully achieve desired outcomes within specified timeframes.

One of the solutions to creating sustainable eye care structures is education of personnel. Mozambique currently has only 17 ophthalmologists for a population of 21 million and 34 trained Ophthalmic Technicians, the only two providers of refraction services within the local health system. There are no optometrists. The Mozambique Eyecare Project is funding the training of the country’s first optometrists at the University of Lurio in Nampula, Mozambique. Their core competencies will be evaluated with a view to creating best practise in education in a developing world environment.

Method:

This is a longitudinal evaluation of the refraction competencies of the first intake of 16 students. Data was compiled from questionnaires, interviews and exam results in the first two years and clinical patient exams to assess clinical competencies in the third year.

Results:

• Lecturer support and feedback seems to have the greatest effect on student performance.
• The evaluation has helped the partners to recruit and retain multilingual lecturers and to ensure they understand the importance of supporting students.
• It has assisted the module writers to develop international curriculum for developing countries where few students if any have any knowledge of Optometry.

.

The first students will graduate in December 2012 and have their clinical competencies assessed in relation to World Council of Optometry competencies.

Conclusions:

Evaluations on their clinical skills will assist the course coordinators on how to better the course as the student’s progress. Continuous quality control of student learning and experience is of value both to the course funders and the university implementing the course.

One of the solutions to creating sustainable eye care structures is education of personnel.The Dublin Institute of Technology (DIT) with ICEE (International Centre of Eyecare Education) is developing and implementing a sustainable model for optometric education and eye care service delivery in Unilurio in Mozambique.The Mozambique Eyecare Project aims to train Mozambique’s first professional optometrists who will provide a sustainable and comprehensive eye-care system as an integral part of the national health system. Mozambique currently has only 15 ophthalmologists for a population of 21 million and 34 trained Ophthalmic Technicians the only providers of refraction services within the local health system.

Purpose

Evaluate the confidence levels, knowledge and core competencies of the ophthalmic technicians in refraction to provide a better understanding of the existing situation.

Method

i) Background questionnaire to obtain data on their years of experience and what training they had received.

ii) Investigative tools: Confidence levels questionnaire, oral refraction quiz and a refraction competency assessment

Results

The OT’s were trained in 2 different institutions, some in Cuba some in Mozambique. The Cuban trained OT’s had studied refraction to different levels but due to lack of equipment had never practised basic retinoscopy or subjective. They were not competent in performing refractions unsupervised.

The ones trained in Mozambique had not studied refraction hence were not competent in performing refractions at all.

Conclusion

By identifying strengths and weaknesses of the OT’s refraction knowledge and skills, training and continuing education can be tailored accordingly. This information would also allow ICEE and DIT to compare and contrast refraction training for both the student Optometrists and the existing OT’s to improve overall refraction service provision in Mozambique.

Purpose

Approximately 314 million people worldwide live with low vision and blindness.145 million people's low vision is due to uncorrected refractive errors¹.One of the solutions to creating sustainable eye care structures is education of personnel².

The Dublin Institute of Technology (DIT) with ICEE (International Centre of Eyecare Education) is developing and implementing a sustainable model for optometric education and eye care service delivery in Unilurio in Mozambique.The Mozambique Eyecare Project aims to train Mozambique’s first professional optometrists who will provide a sustainable and comprehensive eye-care system as an integral part of the national health system³. Mozambique currently has only 17 ophthalmologists for a population of 21 million and 34 trained Ophthalmic Technicians (OCO) the only two providers of refraction services within the local health system⁴.

The purpose of this research is to evaluate the confidence levels, knowledge and core competencies of the ophthalmic technicians in refraction to provide a better understanding of the existing situation.

Method

i) Background questionnaire to obtain data on their years of experience and the training they had received.

ii) Investigative tools: Confidence levels questionnaire, oral refraction quiz and a refraction competency assessment

Results

The OCO’s were trained in 3 different institutions, in Cuba, Mozambique and Malawi. The Cuban trained OCO’s had studied refraction to different levels but due to lack of equipment had never practised basic retinoscopy or subjective refraction for astigmatism. They were not competent in performing refractions unsupervised.The ones trained in Mozambique and Malawi had not studied refraction hence were not competent in performing refractions at all.

Conclusion

By identifying strengths and weaknesses of the OCO’s refraction knowledge and skills, training and continuing education can be tailored accordingly. This information would also allow ICEE and DIT to compare and contrast refraction training for both the student Optometrists and the existing OCO’s to improve overall refraction service provision in Mozambique.

Ms Diane Wallace BOptom, MPA

University of KawZulu Natal, South Africa

Purpose

The Mozambique Eyecare Project (MEP) is a unique institutional collaboration in a programme for the development, implementation and evaluation of a regional optometry training model for Portuguese-speaking Africa. The Project was initiated in February 2009 with the first cohort of undergraduate students beginning classes at Lúrio University in Northern Mozambique. This is the first Portuguese-language optometry program in Africa, and with no professionally qualified optometrists locally, faculty had to be recruited from outside the continent. To date, nine optometrists, either Portuguese or Spanish speaking, were recruited from Spain, Portugal and Colombia. This paper will present data related to recruitment of faculty, their interest in joining the Project, experiences and challenges on the Project as well as benefits gained from the experience.

Methods

Semi-structured interviews were conducted with five expatriate faculties who spent time on the Project between May 2010 and October 2011. Data from all nine faculty was qualitatively analysed for common themes around faculty experiences on the Project.

Results

Faculty were recruited though professional networks, website postings or word-of-mouth. Five of the nine faculty were Spanish-natives, two Columbian with Spanish as a first language, and two were Portuguese nationals. Only three of the nine faculty had prior university teaching experience, with eight of the nine having post-graduate qualifications. Of these, five were Masters qualified and three had PhD qualifications. Recruits signed either a one year renewable contract or offered short-term availability of one to three months. Only one recruit has extended the one year contract with the majority of stays being three months or less. Experience on the project was described as professionally stimulating and rewarding. The difference in scope of practice, skills and regulation of optometry in the countries represented by faculty presented some challenges in delivering a unified curriculum approach which may be different to one’s own training or experience. Locally, bureaucratic structures and difficulties with transportation were some of the frustrations experienced.

Conclusions

As optometry is still a developing profession in Portugal, it is difficult to find Portuguese-language optometrists with university teaching experience who are available for long term contributions to such challenging assignments. All faculty noted, however, the personal satisfaction and sense of contribution from working on the project, despite the challenges. Those who had never worked in academia or development before, also acquired a new skills set they could carry into their future careers.