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Right to Sight is currently in an 18 month start-up phase,
launching an initial 20 projects in 8 African countries and one
Indian province.
These 20 projects have been identified for Right to Sight to
perfect ‘best practice methods’ for different challenges in eye
care provision. The end result should be a ‘product’ which can
be scaled up rapidly across the world. Right to Sight will
showcase these projects as models on which to base future
projects.
Right to Sight is working closely with Aravind (LAICO) and LV
Prasad consultancies to adapt eye care solutions developed in
the Indian model to the African context.
Right to Sight will focus on:
• Research
•
Training
• Sustainability
•
Partnership
• Awareness
Right to Sight experts, in particular based on the
outstanding successes of LV Prasad and Aravind Eye Care in
India, have identified a culture of research and enquiry as
being essential to successful sustainable solutions.
• Research encourages
solution-driven and goal-orientated thinking.
• Research helps avoid a culture of
complacency and supports leadership thinking.
• Research is necessary to answer
both clinical and operational questions in developing countries
Right to Sight is designing a ‘product’, a scaleable eye
care provision system, to partner organizations and governments
to eliminate avoidable blindness in developing countries.
The neediest countries, for example certain African countries
impoverished by war, are by nature unpredictable environments in
which to maintain a sustainable eye care service. The Right
to Sight ‘product’ must encourage and support a team with
flexibility, questioning and adaptation.
The training system within a Right to Sight unit will
provide qualified eye care workers and hospital managers who
must be encouraged to develop a questioning, analytical and
problem solving approach. They must feel supported and assisted
in dealing with daily obstacles to service delivery, obstacles
as simple as shut down of energy supply, delay in medications
delivery, even failure of patient transport systems.
Right to Sight will fund both operational and clinical
research in the context of it’s product. A percentage of the
budget for a Right to Sight unit will be allocated specifically
for research. Right to Sight will also offer a research
scholarship fund which will be open to applicants in early 2009.
This fund will initially focus on research in African eye care.
Research: Operational and Clinical:
Operational Research
• Tailored cost recovery models and
policies - “it starts to pay for itself”
• Sustainable systems and process
for consistent service - “proper organisation to avoid
chaos”
• New motivational methods to
ensure long term success - “Why do staff want to move
to more
appealing locations? “
• Logistics - “how do we get
patients to the clinics and home again?”
Clinical Research
Right to Sight clinical research will initially focus on
new causes of preventable blindness in Africa, in particular in
partnership with HIV screening programmes. Right to Sight
will also support research in Glaucoma in Africa.
• Meta-analysis of CMV retinitis
• HIV related ocular neoplasm
• Glaucoma prevalence
• New clinical training models
Right to Sight is different from other eye care
NGOs and is specifically focussed as a training and management
consultancy, designed to work in partnership with NGOs and
government bodies.
Right to Sight believes that sustainable
elimination of preventable blindness in a scaleable fashion is
possible through knowledge and skill transfer, in a culture that
perpetuates and reveres training and education.
Training Needs: 1) Eye Care and 2) Hospital Management.
Eye care training in the developed world is traditionally by
apprenticeship for skill transfer (a surgeon trains a surgeon, a
refractionist trains a refractionist..), by experience and by
pursuit of academic knowledge.
Eye Care Training:
In the developing world, eye care has generally been offered in
a service only facility, with absence of compulsory
apprenticeships beside cataract surgeons and optometrists. The
severe shortage of cataract surgeons and eye care workers
coupled with the thousands of blind cataract patients has
resulted in ‘crisis approach’ paid-for surgical camps, ‘buying
cataracts’, with no programme of skill transfer. The target
countries remain without surgeons and eye care workers.
Operational Training:
In the developed world, eye care workers and cataract surgeons
work with the support of clinic/hospital managers. Patients can
‘be processed’ and can access services. In Africa, the surgeons
and eye care workers are frequently unsupported. They need to
spend their valuable time on management and administration. The
average cataract surgeon in East Africa does 3 cataract
operations a week! Often the cause of low numbers is simply the
lack of transport systems for the thousands of blind, dispersed
patients.
Right to Sight expert advisors have proved the
exception to rule in India (the average cataract surgeon in
Aravind does 3 cataract operations an hour!) and The Gambia and
are involved with development of surgical training programmes in
other parts of Africa. The IAPB has identified and supported
training as the means to achieve V2020-the Right to Sight (WHO)
targets and WHO has funded trans-continental V2020 workshops.
Right to Sight projects are currently examining
different methods of training in order to decide on best
practice. Right to Sight supported units will be provided
with mandatory training systems. Right to Sight
aims to bridge partnerships at every level in order leave a
legacy of skill transfer and modular training, preventing a
repeat of this crisis of avoidable blindness.
Areas of Training:
Operational
• Sustainability methods
• Clinic layout
• IT Systems
• Patient communication
• Hospital management
• Outreach programs
• Optometry retailing
• Retail skills (for more
sustainability)
Clinical
• Rapid cataract surgical training
system
• Rapid refractive training systems
• Modular training block
• Apprenticeship training (on the
ground, performing functions while training)
Sustainability
Right to sight aims to provide consultancy and training services
to adapt proven solutions for sustainability of eye care
provision, learned from Indian eye care models and the corporate
sector, to other developing countries (south to south
collaboration). The focus of training will be:
Organisational Sustainability:
• Leadership
• Surgeon and staff retention
through:
• Continuous medical education
• Peer involvement
• Family education
• Cost effective outreach programs
• Equipment maintenance programs
Financial Sustainability:
• Cross Subsidy for cost recovery
• Staff pensions
• Investment advice
• Autonomous status to eye care
within the broader system
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