Integrating Eye Health Care within the Public Health System: A Case Study of the Kiri Vong Referral Hospital Vision Centre, Takeo Province, Cambodia

Abstract

Purpose: Integrated community eye health services remain a challenge in low-income countries. We report outcomes of a new district level Vision Centre (VC) providing refraction and primary eye care. Design: A retrospective, non-randomised, multiple method case study. Materials and Methods: Data were derived from VC and eye hospital records for the commencement of the VC (2010 to 2012). The new Eye Health Strategic Program Planning and Evaluation Framework and the WHO Health Systems Six Pillars were used as the summative evaluation framework. Themes included: social determinants, service delivery, detection of vision impairment, customers, coverage and utilisation of services, quality, awareness raising, leadership and governance, workforce, accessibility, health information, cost recovery, networks and linkages, advocacy, health systems integration, outcomes and impact. A semi-structured questionnaire tool was used to interview staff, community leaders and patients. Results: Outreach screenings and eye health promotion influenced individuals to seek eye care. Of the 7,858 consultations (between May 2010 to October 2012) were conducted by two ophthalmic nurses at the VC, and 2,802 refractions were performed with an average of 90 refractions per month. Of those refracted, 73% (n = 2,037) required glasses and of whom, 54% (n = 1,090) were dispensed as ready-made glasses. The cost recovery mechanism of the VC contributed to the overall salaries of the district hospital and the purchase of new supplies. The district hospital administrators reported a 6-10% increase in the number of out-patients visiting the hospital. Conclusion: Collaborative planning, training, mentorship, improved private-public partnerships resulted in an integrated VC in a district hospital.