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Researches Community health care

 Vũ Thị Minh Hạnh, Trần Thị Hồng Cẩm, Trần Vũ Hiệp,

Hoàng Thị Mỹ Hạnh, Vũ Thị Mai Anh, Hoàng Ly Na
Place of publication: Health Strategy and Policy Institute
        ORBIS International in Hanoi
Year of publication: 2010

1. Explore child eye care awareness, attitude and practice;
2. Describe access to child eye care;
3. Recommend solutions to improve behavioral change communication for child eye care and ophthalmic care in general in Thuathien-Hue province. 
Methods: rapid assessment, employing quantitative and qualitative data collecting methods.
Key findings
Awareness on eye diseases and eye care:  70% of respondent reported having heard/known about eye diseases (higher than the country average of 65.1%, but much lower than that in Ninh Binh province – 75.5%). The percentage of people knowing specific eye diseases, however, was very low (13% knowing 5 diseases; 17.8% knowing 4 diseases), and much more lower for child eye disorders (6.9% knowing 5 diseases; 14.2% knowing 4 diseases).: Only 3.2% of respondents knew infant retinal detachment. About 45% knew  how to take care of their eyes , much lower than rate of  having hearing/knowing about eye diseases, and also much lower than in other areas (Ninh Binh – 59.3%; Haiphong – 56%; Thai Nguyen – 53.9%). 15% of them knew causes of blindness attributed to preterm infant retinal disorders (Ninh Binh – 13.4%; Thai Nguyen – 14.2%; Haiphong – 12.8%). People well informed of where to go to for eye care in the province (Hue Ophthalmology Hospital) add up to a low ratio 38.6% (Thai Nguyen – 51.1%; Ninh Binh – 46.4%; Haiphong – 42.2%). People having correct awareness of the need for regular eye check-ups remain low in percentage (12.3%), especially among women (10.8%). Women knowing all the five ways to take care of the child’s eyes account for a very low percentage (< 10%).
Eye care practice 
Eye diseases prevention: Measurements of eye care preventive behaviors are in general much lower than expected. Only 30-40% of local people using direct eye care means (wearing sunglasses, reading at the right distance and under adequate lighting, and so on). Regular eye examinations show a very low percentage. Notably, at the time of this survey, 58.6% of adults and 59.4% of children never had a clinical eye examination. Few people know their own visual acuity (14.8%), and even fewer children (11.8%) know it.
Eye diseases management:  Eye disease incidence is not very high (19%) compared to the country average of 30.7%. The eye disease pattern here is comparable to that of the country. People having the right behaviors when acquiring eye diseases are high in percentage, with 84.5% of adults and 84.6% of children seeking clinical care (compared to the country level of 72.3%). It often takes 1-3 days for people to seek clinical care after detecting the symptoms (83.3% of adults, and 93.4% of children????), which is more responsive than the country level (64%). Commune health centers are the point of service of choice for 26.5% of children and 28.5% of adults (compared to the country average of 20%). 
Current situation of the eye care and blindness prevention program: The eye care and blindness prevention program basically covers the entire province and has achieved impressive progress in community-based eye care, as well as provision of eye care services. The program receives strong commitments and support from the local Party committees, governments, line agencies and also international organizations through various effective efforts. 
Human resources: meeting the essential needs, with slightly better composition and quantity of eye care staff over the country level; 
Equipment: fairly good at the province level and appropriate with health workers’ skill levels; much less satisfactory at the district level, as only half of the districts now have enough eye care equipment named in the required list, and most districts lack equipment to practice on-site extra-capsular cataract surgery.
Funding: mostly dependent on the state budget and donor support, among others; lower expenditure norm than the country average (VND 4,000/person/year compared to VND 5,200???).  
Service provision capacity: higher at the province level than the country average, though some techniques are not yet available; very limited at the district and commune levels, while a high percentage of patients choose the commune for eye care. Cataract surgeries achieve 70% the recommended level of Vision 2020, which is higher than the country average (< 50%).
Access to eye care services: Regular access to eye check-ups is low, with only 20% of the population has the latest eye examination in less than six months from the time of this survey. The remaining has the last check-up more than 6 previous months (8.6%), over one year (19.6%), and do not remember (> 50%). Examination and treatment of common eye diseases take place at the commune health center (68.2% of children and 61.6% of adults) against a background of extensive equipment deficiency at the centers. Most people only take an eye exam when unusual signs with the eyes occur (74.3% of children and 81.4% of adults). Regular eye check-ups are only taken seriously by a few (> 10%). The common distance from the home to an eye clinic is less than 5 km (> 80%) since the service outlet of choice is the commune health center. Exams and waiting do not take too much time (on average > 20 minutes and > 15 minutes respectively). The average costs for a check-up is about VND 100,000, of which 80% is on medication. Most of the costs are funded by health insurance and the households’ reserved cash (> 59% and > 42% respectively).
Needs and hobbies in access to eye care communication: A relatively high percentage of people want to hear/know about eye diseases and proper eyes care, at 86.5%. What people are interested in from communication sessions mostly are how to take care of the eyes and prevent eye diseases in children (> 60%). The information sources most of the population relies on are health agencies (> 95%) and schools (> 55%). More than 79% of the respondents prefer receipt of information via television, through such channels as VTV3 (> 79%), VTV1 (> 64%), provincial TV (> 63%). Nearly 50% of the people prefer getting the information through the commune/ward PA system. The most watched TV programs are the news (88.2%) and entertaining shows (> 50%). Access to TV information often takes place between 19 PM and 22 PM (> 82%), and 5 PM and 5 PM for radio (> 42%).
Pressing ahead behavior change communication on eye care, particularly community-based child eye care through targeting right groups; renewing contents and messages; diversifying communication channels and modes;
Target groups: parents and school children, child caretaking women, especially those with under-2 children, premarital young women, leaders and senior officials of various levels, line agencies and civil society, especially in the education sector, Women's Union, Youth Union, primary eye care staff at communes/wards and villages, teachers, religious dignitaries and so on.
Target sites: emphasizing communication in rural areas of all the districts in the province. Expanding communication on child eye care to adjacent provinces.
Communication contents: providing full information on how to take care of the child’s eyes; detailed information on the symptoms, consequences, how to prevent and manage, where to seek check-ups and treatment of common eye diseases, particularly child eye disorders, including preterm infant retinal separation. Educating on the need for regular eye check-ups. Providing detailed information on addresses and eye care service provision capacity of local medical practices, especially province and district level facilities. Providing information on procedures to complete for access to local eye care.
Presentation: messages should be concise, detailed, easy to understand, easy to remember and easy to adopt. The messages should employ a mix of written/verbal language and pictures, and cover the full range of information required, from symptoms, how to avoid and prevent, how to treat, where to go for medical care.
Selection of communication channels: Local television broadcast immediately before or after such programs as the news and entertaining shows between 19-22 PM. Face-to-face communication: through health providers at the population level, religious dignitaries, teachers, civil society workers etc.; in gatherings, meetings and so on in the neighborhood. Video-based communication at hospitals, schools, public places, among others. Communication via short plays, art performances. Communication with leaflets, booklet and other materials. Communication through printed pictures on school children’s timetables and logbooks. Communication through eye care counseling rooms, particularly child eye care at medical practices, including the private sector. Communication in premarital club sessions. Commune/ward PA broadcasts between 5-8 PM.
Increased interagency coordination in communication: Engaging teachers in eye care communication, especially child eye care for school children and parents, screenings for early detection of child eye diseases. Involving the Women’s Union in educating child caretaking women, especially those with under-2 children. Promoting the participation of the Youth Union in educating young men and women via premarital clubs. The health sector to play a more active coordinating role in the Child eye care program.
Improving the quality, availability, access and ???affordability of eye care services to support behavioral change among the people. 

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