Classical Approach Essay

These clinics provide a figure of speech of primary wellness caveat services with shopping mall c be frequently beingness a neglected component. The personnel at this organize aim of the health c atomic number 18 musical arrangement argon expected to be multi-skilled with mall perplexity skills being one of their range of skills. The sum headache personnel be usually primary health c are nurses who have completed a course in heart treat. view screening and give-and-take of sanctioned acute mettle conditions such asconjunctivitis, is the main spot of eye cautiousness personnel at this level. In addition they should be adapted to lock in in health promotion activities by developing eye health education tools and communicating these messages to the residential area the clinic serves. District health clinic in the main responsible for(p) for primary health care services and serves or receives bear onral from a number of primary health care clinics. These c linics are generally rounded by primary health care nurses with medical doctors on a transplantless or part time basis depending on the number of populate in the catchment area or remoteness of the clinics. Furthermore ophthalmic nurses (ON), ophthalmic clinical officers (OCO) and/or ophthalmic medical assistants (OMA) are deployed in few countries to these clinics.THE regulate wellness SYSTEM (CONT.)District HospitalSecondary level of care is provided in these hospitals. These hospitals serve a number of health orders, which refer patients to them. Ocular complaint diagnosis and management, refraction and low good deal are usually provided at this level. The district hospitals can be staffed by ophthalmologists, optometrists, ON, OCO, OMA. regional HOSPITALSecondary and tertiary level of eye care is provided at these hospitals, which are often the referral site for a group of district hospitalsEyecare staff may include ON, OCO, OMA, optometrists and ophthalmologistsPROVINC IAL HOSPITALTertiary and quaternary care is provided at this level. Serves a few regional hospitals which refer causal agencys that cannot be managed at a regional levelEyecare staff may include ophthalmologists, optometrists and ONDEFINING THE position OF DIFFERENT CADRESIt is critical that on that point be a clear definition of roles within the health district. Duplication should be avoided and a clearly defined referral system should be developed as in a climate of limited resources and overworked staff, duplication is illogical and wasteful.There are various participants of the eye care teams. The following are the possible roles that the distinguishable personnel play within health districts. These roles can vary across districts and are often not consistent, in the sense that their job descriptions could change periodically depending on resources and challenges at the district level COMMUNITY HEALTH WORKERSThe key roles for community health workers are usually screening, case finding, health promotion and health education. Key tasks for eye care include case finding and/or screening for ocular disease and refractile errors. plot of land the primary health care nurse is well trained and high-minded for ocular health and vision, case finding and/or screening, outreach from clinics is usually rattling difficult ascribable to the plethora of tasks and patient numbers at this level. The community health workers therefore constitute an ideal cadre for community ground eye care activity. They can be circumstancely useful in health promotion activity. This is necessary in rural areas in particular due to the high usage of alternative approaches to managing eye diseases e.g. urine being used as a treatment for conjunctivitis resulting in patients presenting at clinics with gonococcal conjunctivitis (Naidoo K2006, pers. comm). PRIMARY HEALTH CARE NURSE (PHCN)The primary feather Health Care Nurse is based at the primary health care clinic. The primary health care nurse is primarily responsible for case finding and for the basic therapeutic management of a massive range of diseases. Eye care is simply one of the m any(prenominal) tasks that they engage in. In terms of eye care they usually screen for eye diseases and visual loss and refer to the nearest clinic. However, they could also be responsible for the prescribing of presbyopic glasses after having ruled out the presence of any potentially blinding disease.Given the lack of knowledge about eye care their tasks can also include liaising with local community structures to promote eye care activities and uptake of the clinical services. The PHCN should address community groups and schools regarding the promotive and limp approaches to eye care. An example is the alarming number of diabetic and hypertensive patients who are never informed about the impact of these systemic diseases on their eyes, usually due to the hectic schedule of clinicians who diagnose these patients. Th is leads to diabetic and hypertensive patients completely seeking eye care services when visual loss has occurred. much(prenominal) patients can benefit tremendously from preventive and promotive efforts.DEFINING THE ROLE OF DIFFERENT CADRES(CONT.)ophthalmic NURSE (ON) / OPHTHALMIC MEDICAL ASSISTANT (OMA) / OPHTHALMIC CLINICAL OFFICER (OCO)ONs / OMAs / OCOs are mainly allocated to the district hospital but can also be deployed at the district clinic. In galore(postnominal) health districts the ophthalmic nurses are the foundation of the eye care system as optometrists and ophthalmologists are un available. The ophthalmic nurses manage all ocular disease as well as conduct refractions in instances where they have beenprovided with the spare formulation. OPTOMETRISTSOptometrists at the district hospital level are a actually valuable resource in providing ocular disease management and refractive services. However the current limited number of posts as well as the unavailability o f optometrists for the public sector often prevents these appointments from occurring. Given the current wages scales for optometry and the lack of posts in many countries insufficient number of optometrists are mobilised to take on positions at district hospitals. The role of the optometrist at a district hospital level in such circumstances should therefore be one of a visiting clinician to provide support for the ophthalmic nurse in the form of training and mentoring and managing complex cases.The optometrists primary location in such circumstances will be at the regional hospital level handling referrals from different district hospitals. At this level the optometrist should provide refraction services, low vision services and ocular disease diagnosis and co-management/management.OPHTHALMOLOGISTOphthalmologists provide treatment and management of ocular disease, and functional care. The lack of ophthalmologists as well as the attractiveness of the private sector makes it diffi cult to deploy ophthalmologists to district hospitals. They are therefore usually located at regional hospitals or bragging(a) district hospitals. In order to significantly impact on the cataract surgical rates in the developing public it is necessary to increase the role of the ophthalmic nurses and optometrists in disease management and co-management of post surgical patients.DISTRICT HEALTH MANAGERThe district manager is an integral component of the humankind resource team of the district. A supportive manager can change enormous developments in terms of eye care, as the allocation of resources in the public sector is usually centrally controlled. The decentralisation of tasks to the district managers from the idyll government level creates an opportunity for greatersuccess with district level planning. THE TEAM APPROACHThe public health system is often under-utilized due to the lack of a team effort in the delivery of health care services. The different personnel work indep endently and are often engaging in a duplication of tasks. Territorial approaches by professionals are quite common with a my role mentality predominating rather than an us mentality (Croasdale A 2006, pers. comm).In order to effectively generate cooperation team training in the form of clinical and planning workshops are important. Further there is also a lack of integration among the eye care personnel and other departments. This hinders the effective management of patients e.g. diabetic patients should be co-managed between the physician and the eye care personnel.DEFINING THE ROLE OF DIFFERENT CADRES (CONT.) civilian SOCIETY INTERVENTIONSThe LV Prasad Eye Institute (LVPEI) in India has developed an progressive model for the delivery of eye care in the developing world (Fig. 2-1), which has been implemented very successfully (Rao, 2005). In this pyramid model, basic eye care screening is done by Vision Guardians at the settlement level, at a ratio of 15,000.Vision Technicians in Vision meanings at the community level provide primary eye care (150,000), while advanced tertiary care takes place at the Centre of Excellence level (150 million).Tasks are thus divided amongst the available workforce, so that the relatively few individuals capable of high-end tasks are freed to deliver those. local anaesthetic communities should always be involved in the establishment of eye care services, and educated about eye care since available facilities are not always accessed spontaneously.The WHO recommends that the minimum target for mid-level eye care personnel be 150,000 populations.