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Researches Medical sociology and HIV/AIDS
Impacts of resources and socioeconomic factors on eyecare and blindness prevention and control

Impacts of resources and socioeconomic factors o­n eyecare and blindness prevention and control

 

Vu Thi Minh Hanh and colleagues

 

 

Objectives

(1) To examine resource investments and capacity of service providers (both public and private) atgrassroots level ineyecare and blindness prevention and control (YCBPC); (2) To examine usage of, accessibility to, and demand for services in YCBPC; (3) To analyze impacts of soci-economic factors o­n YCBPC; (4) To provide recommendations for improving YCBPC activities and developing the national plan o­n blindness prevention and control.

 

Study subjects

Those directly involved in implementing YCBPC program at all levels, including 3 main groups: leaders and managers, service providers, and beneficiaries.

 

Study locations

For quantitative data o­n resources and service usage at provincial level, this study included 64 provinces and municipalities. For detailed information, the survey sample included 16 provinces and municipalities representing the 8 ecological regions in Vietnam, includingHồ Chí Minh city, Vũng Tàu, Tiền Giang, Bình Phước, Cần Thơ, Ninh Thuận, Bình Định, Gia Lai, Thua Thien Huế, Nghệ An, Thái Nguyên, Hải Phòng, Bắc Ninh, Hà Tây, Phú Thọ, and Lào Cai provinces.

 

Methods

Document collection, review, and analysis; data collection by fill-out forms from 64 provinces/municipalities; surveys conducted in 16 selected provinces/municipalities including 230 in-depth interviews with leaders in health and education sectors, the Population Committee; 128 focus group discussion with representatives from concerned local organizations and agencies, patients of cataract surgery or their family members, people in community; and self administered questionnaires filled out by 480 eyecare health workers at all levels.

 

Results

-The network ofYCBPC was established from central to provincial, district, and commune level. Its model and structure were diverse with the participation from a large number of members. The network, however, did not cover the whole country and its distribution was not adequate. Because the organizational structure was not unified across localities, no synergy effectswere observed.

-There was shortage of human resource at all levels, especially at the grassroots. Distribution of human resource was disproportional and there was a lack of specialization. The demand for YCBPC was therefore not met, given an increasing prevalence of disorders of refraction andeye-bottom disease.

-The whole network of medical facilities that provided eyecare servicesat provincial and district levels had about 2,000 beds, making an average of about 30 beds per province/municipality. Physical infrastructue was inadequate in meeting an increasing demand for eye disease examination and treatment.

-Facilities were poorly equipped, especially those in mountainous and remote areas and at grassroots level. The investment in equipment at some localities was not appropriate.

-Compared to that of 2006, 2007’s investment in eyecare activity at localities did not increase. Budget for eyecare was limited, and government budget accounted for o­nly 10% while hospital fees accounted for 70%. These proportions were significantly different from the corresponding numbers in general healthcare expenditure: 30% from government; 60% from hospital fees, and 10% from other sources.

-There were many problems related to the capacity of service provision,especially at district and communal levels. Cataract surgery did not meet the demand. Due attention was not paid to post-cataract surgery care. Screening to identify disorder of refraction and glasses adjustment was not implemented at many localities. There was a risk that the private sector had greater influences, especially in high-tech services in urban areas.

-The majority of people in community selected commune health stations and district general hospitals for their eyecare because the services were less expensive and the facilities were located near their house. However,the quality and range of services at these facilities were rather preliminary, limiting their benefits to patients.

-A high proportion of people heard and understood of eye diseasesin general but little was known about certain eye diseases. Knowledge o­n eye protection and care was not sufficient.

-The majority of respondents went to health facilities when their eyes had a problem. However, self-treatment (using tradition therapy or buying medication without prescription) and no treatment were still common.

 

Recommendations

(1).Eyecare facilities at all levels should urgently join hand in developing a national strategy and actionplan for YCBPC. They should advise the health sector, central government, and provincial people’s Committees in the process of approving such a plan and mobilising resources for care network development.

(2).The eyecare network needs to be strengthened and becomes an independent specialty unit from central to local level.

(3).Training activity should be further facilitated, includingformal training, in-service and advanced training as well as training courses o­n eye disease prevention, examination and treatment for health workers at all levels.

(4).Eyecare facilities, especially those at commune/ward level should be supplied with better equipment and physical conditions.

(5).Budget for YCBPC program, especially from government budget, should be increased.

(6).Information, education, and communication (IEC) o­n eyecare should be enhanced, especially o­n child eyecare through diversification of IEC channels, target groups and methods.

(7).Inter-sectoral cooperation in IEC and maintenance of eyecare practice should be strengthened.

(8).Attention should be paid to improving the capacity of cataract surgery services.

 

20/03/2009
 
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