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Poore S, Foster A, Zondervan M, et al. Planning and developing services for diabetic retinopathy in Sub-Saharan Africa. Int J Health Policy Manag. 2014;4(1):19-28doi: 10.15171/ijhpm.2015.04.
Poore, S., Foster, A., Zondervan, M., & Blanchet, K. (2015). Planning and developing services for diabetic retinopathy in Sub-Saharan Africa. International journal of health policy and management, 4(1), 19-28. https://doi.org/10.15171/ijhpm.2015.04
Poore, Sophie, et al. "Planning and developing services for diabetic retinopathy in Sub-Saharan Africa." International journal of health policy and management vol. 4,1 (2015): 19-28. doi: https://doi.org/10.15171/ijhpm.2015.04
Poore S, Foster A, Zondervan M, Blanchet K. Planning and developing services for diabetic retinopathy in Sub-Saharan Africa. Int J Health Policy Manag. 2014 Dec 16;4(1):19-28. doi: 10.15171/ijhpm.2015.04. eCollection 2015 Jan. PMID: 25584349; PMCID: PMC4289033.
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Int J Health Policy Manag. 2014 Dec 16;4(1):19-28. doi: 10.15171/ijhpm.2015.04. eCollection 2015 Jan.

Planning and developing services for diabetic retinopathy in Sub-Saharan Africa.

International journal of health policy and management

Sophie Poore, Allen Foster, Marcia Zondervan, Karl Blanchet

Affiliations

  1. Royal Sussex County Hospital, Brighton, UK.
  2. International Centre for Eye Health, International Centre for Evidence in Disability (ICED), London School of Hygiene and Tropical Medicine, London, UK.
  3. VISION 2020 LINKS Programme, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK.

PMID: 25584349 PMCID: PMC4289033 DOI: 10.15171/ijhpm.2015.04

Abstract

BACKGROUND: Over the past few decades diabetes has emerged as an important non-communicable disease in Sub-Saharan Africa (SSA). Sight loss from Diabetic Retinopathy (DR) can be prevented with screening and early treatment. The objective of this paper is to outline the required actions and considerations in the planning and development of DR screening services.

METHODS: A multiple-case study approach was used to analyse five DR screening services in Botswana, Ghana, Tanzania and Zambia. Cases included: two regional screening programmes, two hospital-based screening services and one nationwide screening service. Data was collected using qualitative methodologies including: document analysis, in-depth interviews and observation. The World Health Organization (WHO) Health Systems Framework was adopted as the conceptual framework for analysis.

RESULTS: Planning for a sustainable and integrated DR screening programme demanded a health systems approach. Collaboration with representatives from a variety of ministerial departments and professional bodies was required. Evolution of DR screening services may occur in a variety of ways including: increasing geographical coverage, integration into the general healthcare system, and stepwise progression from a passive, opportunistic service to one that systematically and proactively seeks to prevent DR. Lessons learned from the implementation of cervical cancer prevention programmes in resource-poor settings may assist the development of DR programmes in similar settings.

CONCLUSION: To promote good planning of DR screening services and ensure limited resources are used effectively, there is a need to learn from screening programmes in other medical specialities and a need to share experiences between newly-developing DR programmes in resource-poor countries. The WHO Health Systems Framework presents an invaluable tool to ensure a systematic approach to planning DR screening services.

Keywords: Diabetic Retinopathy (DR); Health Systems; Screening Programme; Service Planning; Sub-Saharan Africa (SSA)

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