A VISION CENTER MODEL FOR AFFORDABLE AND ACCESSIBLE

COMMUNITY LEVEL EYE CARE

A Case Study for Bayelsa State

Usiwo G. Obibi

MPH Candidate

Salus University

Course: PH5540: Independent Study

Spring Term, 2019

Course Advisor

Anthony F. Di Stefano, OD, MPH, Med

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Rationale

Primary eye care largely refers to a combination of activities encompassing

promotive, preventive, therapeutic and rehabilitation services delivered at
community levels to avert serious sequels resulting in blindness (1). One of the
greatest challenges in the fight to eliminate avoidable blindness in different parts of
the world is a lack of access to good quality and affordable eye care services,
especially in the slump and far flung rural areas. Thus, the Vision Center targets to
deliver affordable primary eye care services to the under-served population of
Swali and Azikoro communities of Yenagoa L.G.A, Bayelsa State, Nigeria
irrespective of the socio-economic status or ability of the indigenes.

Bayelsa State with a population of 1,704,515 according to the 2006 census has a
population density of 158 people per square kilometer. It accounts for 1.2% of
Nigeria's total population (2) and is located in the Niger Delta region of Nigeria. It
has more water mass than landmass making the transportation and movement
within the state probably one of the slowest and most difficult in Nigeria. This
brings the issue of general accessibility to bear. Access to Health care is thus
greatly hampered because of this difficult terrain.

Eye care services are mainly provided through few of the Government public
hospitals and a few private eye clinics located in the urban areas. There are 8 Local
Government Areas in Bayelsa State but even in Yenagoa LGA which is the capital
City; access to eye care services remains low. Thus, even when close to the urban
areas, issues of costs, bureaucracy, language acts as barriers to effective uptake and
utilization of these essential eye care services. A 2010 hospital-based study
estimated blindness due to refractive error to be 0.68% in Bayelsa State (3).

Swali is a community along the Epie River located in Yenagoa L.G.A. of Bayelsa
State. It houses the largest rural market in all of Bayelsa state and has a population
of 179, 000 people (4), excluding those who come in regularly to trade in the
market. They speak the Epie language and are mainly into subsistence farming and
fishing with no eye care facility and only one public primary health centre (5) that
is hardly equipped. In fact, less than 6% of the primary health care centres have a
general practitioner attached to them, leaving the citizens with no options but to
consult patent medicine dealers and traditional healers as their main care providers
(6). Having conducted several eye care awareness, screening and treatment
programs around several Epie speaking communities and noting the need for eye
care intervention was huge, we thought it wise to set up a more permanent access
to eye care to increase uptake of services. Swali community has a large population
among these clans, was central to several of these Epie clans like Azikoro, Agbura

2
and Ayanma and was also easier to access from the city centre where a tertiary eye
care facility is located thereby making referrals easier.

Background

What is a Vision Centre? The International Agency for the Prevention of Blindness
(IAPB) defines a Vision Centre as an eye care facility that provides a range of eye
care services, including:

- Eye examination

- Refraction

- Supply and dispensing of affordable spectacle

- Treatment of minor eye problems and provision of first aid within the skill
set of the Centre’s eye care staff.

- Appropriate and barrier-free referral/transfer of patients with more complex

eye conditions to higher levels of the health care system.

Depending on the size, staff capacity and activities of specific Vision Centers, they
may also assist with:

- Coordination of community screening programs

- Assistance with other community eye care activities (such as Vitamin A

campaigns and non- surgical aspects of patient care).

- Post-operative patient care

Vision Centers are most effective if there is coordination, cooperation and

integration of the Vision Center services with other level of service, including
outreach, rural and regional hospitals. Vision Centers are a way of extending eye
care into the communities. They could be located in a district hospital, a
community primary clinic or as a stand-alone entity, depending on local
requirements and norms. Vision Centers are conceptually a series of functions
normally carried out in a specific location (7)

In many parts of the developing world, quality eye care services are only available
at regional hospitals, creating barriers of distance, cost and accessibility. The

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provision of eye examination and spectacles within communities minimize these
barriers. Although Vision Centers can be located in district hospitals to deal with
refractive and primary eye care, they still have a focus on improving community
access to eye care. In general, however, they provide services in remote, rural and
under-served areas in a small one- or two-room facility (8).

According to World Health Organization (WHO) estimates, there are 39 million

blind and another 246 million visually impaired people in the world (9, 10).
Cataract and refractive errors constitute more than 80% of the blindness and are
largely avoidable (11). The goal of vision 2020, “the right to sight”, has been to
provide comprehensive eye care services, and this is made possible by
incorporating a variety of innovative strategies (12). Over the years, the report
from various models has led to an evidence-based improvement in eye care with
sustained and integrated development. But despite gains witnessed in global
blindness elimination efforts, the current figures reflect the need for sustained
effort to achieve the goal of elimination of avoidable blindness as envisioned by
Vision 2020. The right to sight by the year 2020.

Across the developing world, blindness affects 1% more of the population and
significantly impaired 2.5 to 5%. Refractive error, however, affects 50 to 80% of
the population. A Vision Center staffed by a one-year trained person can take care
of uncorrected refractive errors, meeting 70% or more of overall vision needs of
the community. With an appropriately trained optometrist, a Vision Center can
cover 90% of the vision care and eye health needs and appropriately refer the other
10%. In this way, the cost effectiveness and efficiency of National vision and Eye
Health programs can be improved as the load on hospitals is reduced (13).

Planning and Development of the Vision Center

To effectively achieve the goals of the Vision Centre in Swali community as a pilot
program. The plan included sourcing for the funding organisation, partners in
various areas, budget costs, and deliverables. We had to look at the impute and
resources and the stakeholders to achieve this goal.

Target Population

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The target population was lowincome families in rural or mostly urban slum areas
in Swali community and environs. The input/resources included:

1. Funding
2. Equipment
3. Building
4. Patients
5. Stationeries
6. Furniture

Major Stakeholders

1. Funders; Center for Gender Values and Culture (NGO)

2. Program Managers: Treasured Healthcare International foundation.
3. Referrals: Federal Medical Centre (Eye Clinic Department)
4. Office of the wife of the Governor and Health Commissioner
representative from Primary health department, Bayelsa State.

Treasured Healthcare Intl Foundation has been involved in Vision screening and
treatment across the state. From time to time we invite dignitaries to flag off some
of these eye camps. One of them who had shown keen interest was Her
Excellency, the wife of the Governor of Bayelsa state. After deciding on the idea
of a more permanent eye care facility, we wrote to her requesting the involvement
of her Office and their official participating NGO, Centre for Gender Values and
Culture. Our initial strategic meeting was fruitful, and the product was a wider
collaboration with the primary health department of the Ministry of health and the
office of the Yenagoa local Government Chairman for the land space to build the
Vision Centre. Writing to the Federal Medical Centre to partner in receiving
referred cases, informing them of the partners already on board. This was seen as
an acceptable public private partnership initiative.

The office of the wife of the Governor was saddled with the addition responsibility
of inviting the community chiefs, CDCs and the market association. They will help
in disseminating information about the Centre and mobilize members to seek care
at the centre. We thus had an expanded stakeholders committee for the launching
of the Vision Centre.

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 1. EXPANDED STAKEHOLDERS FOR THE PROGRAM (MAJOR AND
MINOR)

2. Treasured Healthcare Intl Foundation. Program Manager/ 4 Staff

3. 2 Representative of the Health commissioner on Primary health care.

4. Representative of Centre for Gender Values and Culture- Program Funders

5. Community development Committee members (CDC).

6. Representatives of Local Gov. chairman

7. 2 Chiefs from the Community

8. Chairman of Market association

9. Representative of Women Association.

Activities and Timelines

The Vision Centre had a list of activities and a time frame to start by September
2012 in preparation for its official flag- off on the occasion of the Celebration of
the World Sight Day. The building was to be completed in 3 months, Staff
recruitment and training, purchase of equipment, furniture and purchase of optical
frames and stock lenses were all properly allotted completion timelines. The
activities included:

1. Recruitment and Training of staff

2. Publicity
3. Patient testing
4. Frames and Lens purchase and selection

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Timelines
The time frame for Setting up of the Vision Centre is as outlined below.
YEAR
2012 2013 2014
Activities Year 1 Year2 Year3
Construction of 3-Room Structure and Finishing. >
Purchasing office Equipment/Furnishings > >
Purchasing IT Equipment >
Purchasing Medical/Optical Equipment > >
Start using the Centre >
Start conducting Eye Examinations /Tests >
Employ and train 1 Optometrist and 1 Optical receptionist. >
Monitoring > > > > > > > > > > >
Evaluation of Program > >

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Pictures of Vision Centre

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 The Vision Center is staffed by an appropriately trained optometrist and an Optical receptionist. CGVC had taken up the
payment of their salary for One year.
 A volunteer Dispensing Optician will visit from the Federal Medical Centre weekly.
 This is at no cost to the Vision Centre. Recruitment of Optometrist was internally handled by THI Foundation while the
receptionist was recommended from the community by the community chiefs after they were giving the criteria of minimum
qualification (Post-Secondary School) and age bracket (25-35yrs) and trained by the Foundation.

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Personnel and Functions

Optometrist:

The eye health and vision concerns of the patients form the primary responsibility of the
optometrist. He is saddled with the following duties:

1. Determine the vision problems of patients by engaging them in conversations

2. Take and record patients’ histories to have a better understanding of their vision concerns
or eye diseases.
3. Measure visual acuity and perception of patients.
4. Examine patients’ eyes and carry out diagnostic tests using eye testing instruments and
pharmaceutical agents.
5. Make accurate diagnosis of patient’s ocular conditions.
6. Develop and implement treatment plans.
7. Prescribe medications and treat eye diseases within his scope of practice and capacity of
the Vision Center.
8. Write lens prescriptions for patients with poor sight and\or photosensitivity after
determining the refractive state of the patients’ eyes.
9. Counsel patients on Visual hygiene and prescription lens care.
10. Implement other corrective procedures such as eye exercises and eye patch for patients
with amblyopia.
11. Make appropriate referrals of cases not within his scope of practice and capacity of the
Vision Center, to a secondary or tertiary health institution within the region for better
management.
Optician:

The optician fits and dispenses spectacle prescriptions and other aids written by the optometrist.
He helps in frame repairs and maintains some of the equipment.

Optical Receptionist:

The optical receptionist of the Vision Center is saddled with the following duties:

1. Receives the patients at check-in, register and schedule them for appropriate services and
also interface with patients and the optometrist.
2. Handles regular office duties such as billing and maintaining medical records.
3. Keeps the office, instruments and optometric equipment clean and ready to use.
4. Help patients to find frames that fit and look great and notify them when glasses are
ready.

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 5. Manage inventories of the Vision Center.
6. Liaise with the Community members and give feed back to the Optometrist.

Budget (Finance)

1 Medical/Optical eequipment N2,800,000

2 Computer and accessories N180,000
3 Stationeries. N150,000
4 Optical Frames. N 450,000
5 Stock Lenses. N 320,000
6 Furnitures N 280,000
7 Drugs. N 200,000
8 Recurrent expenditure. N 100,000
9 Building Construction N 3,800,000
10 Salary for 1 year N1,200,000
Total NGN 9,480,000

TOTAL: Nine Million Four Hundred and Eighty Thousand Naira Only.

Implementation and Sustainability

The operational sustainability of the Vision Center has largely depended on the quality of the
clinical staff, as well as administrative and efficient managerial skills of other non-clinical staff
members. Very well in pursuit of sustainability, the Vision Center has become self-sufficient in
their management of resources and finances, through a combination of the following strategies:

1. The Vision Center has engaged in local partnership with the following:
A. Office of the wife of Governor of Bayelsa State, which provided the Vision Center
with access to community leaders.
B. Center for Gender Values & Culture, which provided the Vision Center with funding
for one year as well as infrastructure and equipment.
2. The Vision Center is well integrated into an existing health care service in the region –
Treasured Healthcare Int’l Foundation which has played an invaluable role in the
management of the Vision Center.
3. The Vision Center engages in cost recovery through reduced fees for drugs and spectacles to
the needy, and by offering value-added services to wealthier patients, when appropriate.

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The Vision Center described here is in line with the guiding principles for a Vision 2020
Action plan, which can be summarized in the acronym “ISEE” (14)

A. Integrated: Into existing health care system

B. Sustainable: In terms of money and other resources
C. Equitable: Care and services available to all people in need regardless of circumstances.
D. Excellence: A high standard of care throughout

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Impact and Observation of the Vision Center in the Past 5.5 Years
2013:
TOTAL NO. OF PATIENTS SEEN: 639 DIAGNOSIS
MALE FEMALE TOTAL ADULT TOTAL CHILDREN REFRACTIVE ERROR: 400
281 290 571 68 CATARACT: 34
GLAUCOMA: 5
LOW VISION: 4
TRACHOMA: 2
ONCHOCERCIASIS: -
OTHER UNCOMPLICATED OCULAR DISEASES: 57
OTHER MORE COMPLEX CONDITIONS: 19
NUMBER OF REFERRALS: 49

TOTAL NO. OF PATIENTS SEEN: 639

600

500

400

300

200
2013

100

0
Other
Other More
Refractive Uncomplicated Number of
Diagnosis Cataract Glaucoma Low Vision Trachoma Onchocerciasis Complex
Error Ocular Referrals
Condition
Condition
Male 281 400 34 5 4 2 0 57 19 49
Female 290 400 34 5 4 2 0 57 19 49
Total Adult 571 400 34 5 4 2 0 57 19 49
Total Children 68 400 34 5 4 2 0 57 19 49

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2014:
TOTAL NO. OF PATIENTS SEEN: 555 DIAGNOSIS
MALE FEMALE TOTAL ADULT CHILDREN REFRACTIVE ERROR: 365
267 229 496 59 CATARACT: 27
GLAUCOMA:8
LOW VISION:2
TRACHOMA: 35
OTHER UNCOMPLICATED OCULAR CONDITIONS: 70
OTHER MORE COMPLEX CONDITIONS:12
NUMBER OF REFERRALS:36

TOTAL NO. OF PATIENTS SEEN: 555

600

500

400

300

200

100
2014

0
Other
Other More
Uncomplicated Number of
Diagnosis Refractive Error Cataract Glaucoma Low Vision Trachoma Complex
Ocular Referrals
Condition
Condition
Male 267 365 27 8 2 35 70 12 36
Female 229 365 27 8 2 35 70 12 36
Total Adult 496 365 27 8 2 35 70 12 36
Total Children 59 365 27 8 2 35 70 12 36

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2015:
TOTAL NO. OF PATIENTS SEEN: 445 DIAGNOSIS
MALE FEMALE TOTAL ADULT TOTAL CHILDREN REFRACTIVE ERROR:212
180 203 321 62 CATARACT:27
GLAUCOMA:5
LOW VISION:3
TRACHOMA:1
OTHER UNCOMPLICATED OCULAR CONDITIONS:120
OTHER MORE COMPLEX CONDITIONS:15
NUMBER OF REFERRALS:33

TOTAL NO. OF PATIENTS SEEN: 445

350

300

250

200

150
2015

100

50

0
Other Other More
Number of
Diagnosis Refractive Error Cataract Glaucoma Low Vision Trachoma Uncomplicated Complex
Referrals
Ocular Condition Condition
Male 180 212 27 5 3 1 120 15 33
Female 203 212 27 8 2 1 120 15 36
Total Adult 321 212 27 8 2 1 120 15 36
Total Children 62 212 27 8 2 1 120 15 36

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2016:
TOTAL NO. OF PATIENTS SEEN: 366 DIAGNOSIS
MALE FEMALE TOTAL ADULT TOTAL CHILDREN REFRACTIVE ERROR:187
159 163 280 44 CATARACT: 22
GLAUCOMA:5
LOW VISION:2
TRACHOMA: 0
OTHER UNCOMPLICATED OCULAR CONDITIONS:90
OTHER MORE COMPLEX CONDITIONS:16
NUMBER OF REFERRALS:36

TOTAL NO. OF PATIENTS SEEN: 366

200

180

160

140

120

100

80

60
2016

40

20

0
Other Other More
Number of
Diagnosis Refractive Error Cataract Glaucoma Low Vision Trachoma Uncomplicated Complex
Referrals
Ocular Condition Condition
Male 159 187 22 5 2 0 90 16 36
Female 159 187 22 5 2 0 90 16 36
Total Adult 159 187 22 5 2 0 90 16 36
Total Children 159 187 22 5 2 0 90 16 36

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2017:
TOTAL NO. OF PATIENTS SEEN: 253 DIAGNOSIS
MALE FEMALE ADULT CHILDREN REFRACTIVE ERROR:152
124 102 199 27 CATARACT: 18
GLAUCOMA: 3
LOW VISION: -
TRACHOMA: -
OTHER UNCOMPLICATED OCULAR CONDITIONS: 43
OTHER MORE COMPLEX CONDITIONS: 11
NUMBER OF REFERRALS: 27

TOTAL NO. OF PATIENTS SEEN: 253

250

200

150

100
2017

50

0
Other Other More
Number of
Diagnosis Refractive Error Cataract Glaucoma Low Vision Trachoma Uncomplicated Complex
Referrals
Ocular Condition Condition
Male 124 152 18 3 0 0 43 11 27
Female 102 152 18 3 0 0 43 11 27
Total Adult 199 152 18 3 0 0 43 11 27
Total Children 27 152 18 3 0 0 43 11 27

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2018 (JANUARY TO JUNE):
TOTAL NO. OF PATIENTS SEEN: 118 DIAGNOSIS
MALE FEMALE ADULT CHILDREN REFRACTIVE ERROR:59
39 52 64 27 CATARACT: 7
GLAUCOMA: 2
LOW VISION: 2
TRACHOMA: -
OTHER UNCOMPLICATED OCULAR CONDITIONS: 20
OTHER MORE COMPLEX CONDITIONS:4
NUMBER OF REFERRALS: 13

TOTAL NO. OF PATIENTS SEEN: 118

250

200

150

100
2018

50

0
Other Other More
Number of
Diagnosis Refractive Error Cataract Glaucoma Low Vision Trachoma Uncomplicated Complex
Referrals
Ocular Condition Condition
Male 124 59 7 2 2 0 20 4 13
Female 102 59 7 2 2 0 20 4 13
Total Adult 199 59 7 2 2 0 20 4 13
Total Children 27 59 7 2 2 0 20 4 13

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Serving the communities and bringing primary eye care to the under-served population of
patients in the rural communities of Swali and Azikoro during the past five and half years of
establishment of the Vision Center has been the primary motive of the vision center. The vision
center has provided comprehensive vision care to both children and adults. A total number of
2,089 patients have undergone comprehensive eye examination at the Vision Center over the
past five and half years and a remarkable achievement have been recorded in the reduction of
refractive error related blindness, by a proper measurement of the refractive error of patients
and dispensing of suitable pairs of spectacle lenses. Management of uncomplicated ocular
disease conditions and referral to secondary, tertiary and specialist health institutions for better
management of patients with more complex conditions.

Vision 2020’s major priorities are cataract, refractive error and low vision, trachoma,
onchocerciasis and childhood blindness (15). These have been selected not only because of the
burden of blindness that they present but, also, because of the feasibility and affordability of
interventions to prevent and treat these conditions. Uncorrected refractive error, has recently
achieved prominence as a major cause of functional blindness and significantly impaired vision,
as a result of landmark population based studies in adults, children and in post-cataract
patients(16,17).

The data collected above from a five-and-half year period of establishment of the Vision Center
suggests a high prevalence of refractive errors and cataract among the people of these
communities and thus, further confirms the WHO’s assessment of uncorrected refractive errors
and cataract as contributing over 75% - 80% of avoidable blindness. The words of hope
however, is that while refractive error is among the most common causes of avoidable blindness
and visual impairment, it is also the easiest to cure with an appropriate pair of prescription
glasses. The patients diagnosed with cataract, glaucoma, low vision and other complex ocular
conditions were referred to tertiary health institutions and specialty centers for better and more
effective treatment and management.

A progressive decline in patient flow has been witnessed over the years from first year of
establishment to date. This however, does not indicate a decline in clinical efficiency or
management of the Vision Center but rather suggests a high level of achievement and impact on
the indigenes of these communities as more awareness have been created on eye health and
vision care already, and patients generally have an improved knowledge, attitude and practice
towards visual hygiene and general health. Moving on, the establishment of the Vision Center
could also be said to have birthed the emergence and active participation of other private eye
care centers within these and other neighboring communities. Furthermore, a good referral
mechanism linking these communities with secondary and tertiary health institutions and
specialist eye care centers in the region and also the introduction of health insurance schemes
(NHIS and BHIS) which the Vision Center is not aligned to, and to a lesser extent, the unstable
nature of the nation’s economy have all played a contributory role in the progressive decline
witnessed over the years.

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Avoidable blindness has become a menace and wasteful global problem. Thus, the Vision
Centre has established itself as a crucial part of the global team that will eliminate this menace,
by delivering effective and sustainable care to the optical needs of the people of Swali and
Azikoro communities, thereby ensuring their fundamental right to sight. Since vision loss
comes with a substantial cost to quality of life, whether giving care to the poorest of poor or
attending to the elites in the community, bringing vision care to those in need is the heart of
what the Vision Centre does.

EVALUATION OF THE MODEL

Time Frame:
Time frame is 2 months. Field work and data collation will be done in the 1st 4 weeks while
analysis and result compilation the later 4 weeks.

1st Evaluation activity timeline- March 2014- April 2014

Evaluation activity 1st Week 2nd Week 3rd Week 4th Week

Evaluation Planning 

Our Evaluation Questions

1. Are those receiving services the intended target?
2. Are the proper testing, investigations and quality of refractive services being received?
3. Are the program activities being performed adequately?
4. Are the resources enough; is the facility adequate to provide the expected services?

Stage of program development

The program is currently in the Implementation stage having been in operation for over 5 years.

Human Resources
I lead the evaluation with 4 assistants for data collation and analysis.

Name Role Duty

Dr.U.Obibi Program Monitor all evaluations activities to ensure objectives are
evaluator carried out.
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Dr. Debby Ali Data Collector Analyze Data Accurately
Me. John Ese Data Analysis Coordinate the analysis of all data submitted
Mrs. Joyce Data Collection Collate Data
Tega
Mrs Mary Data Collection Collate Data
James

Activities
- Training of staff
- Publicity
- Patient testing
- Frames selection
- Fitting of lenses

Outputs
1. Number of patients tested.
2. Number that received glasses
3. Number treated for eye diseases
4. Number of patients referred

Outcome
1. Short term: immediate relief, can see better, can read better, no eye pains or infection
2. Midterm: Better image for vision center, attracts more patronage/funding
3. Long term: Patient live better quality of life, are more relevant to society, not a burden to
others and may return back to employment.

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USERS NEED/WHAT TO KNOW USE

CGVC (NGO) If the intervention is meeting set To know if they will continue
objectives funding

Program Manager How program may be enhanced to Necessary changes to increase

improve outcome effectiveness and efficiency

Ministry of Health Health outcomes for policy changes. Monitor Societal health in
improving quality of life.

Data Collection
Key Performance Indicators

1. Has there been adequate staff recruitment and appropriate training?

2. Has there been awareness created in the community of the benefit of the Vision Center.
3. Is this intervention reaching the target population at risk and those in need?
4. Are there alternatives like traditional eye treatment centers?

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 5. Are there cases of eye diseases among the target population not being reported or referred
to the vision center?

Source of Data
1. Interviews: with Direct Beneficiaries (patients seeking services), service providers, state
health officials, community members, market women.
2. Surveys: with questionnaires.
3. Secondary Data (Report and Documentations): Attendance record, eye examination
records book, Optical workshop records.

Conclusion/Recommendations

Due to increased awareness on eye health and vision care, lower cost and less
bureaucracy, the uptake of eyecare services has increased by over 2089 persons as can be
seen since the 5 years period from the establishment of the vision Center. Also, the
successes from the treatment and management of our patients and those referred has
created more confidence in the utilisation of affordable and quality eyecare from our
facility. More vision Centers need to be established in all the local government areas of the
state, wether stand alone or incorporated inside primary health centres. Funding for staff
salaries should be increased to a minimum of two years to enhance sustainability
especially for local goverment areas that are relatively distant and poverty levels are
higher. With continuous improvement in the activities of the Vision Center over a 5 years
duration, it is recommended that the Vision Center may be converted to a full fledged Eye
Clinic, or the project is wound up.
It is hoped that this model can be used for future education, policy decision or
collaboration to enhance access and provide quality yet affordable eyecare in rural
communities.

Reference(s)

1. Strategies for the Prevention of Blindness in National Programmes: A Primary Health

Care Approach. Geneva: WHO; 1997
2. Quick Facts | Bayelsa.gov.ng - Bayelsa State Government.
https://www.bayelsa.gov.ng>node

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3. Azonpbi I. R. Refractive error blindness in Yenagoa, Bayelsa State, Nigeria: a hospital
based study. Benin Journal of Postgraduate Medicine, 2010:12:1:37-42
4. Swali | Nigeria Facts nigeriafacts.net › swali
5. List of Clinics and Healthcare Centres in Yenagoa - Finelib.com
https://www.finelib.com › yenagoa › health
6. Health manpower development in Bayelsa State, Nigeria-NCBI-NIH
Kalada G McFubara, Elizabeth R Edoni, and Rose E Ezonbodo
- Akwagbe
https://www.ncbi.nlm.nih.gov ›articles

7. DandonaL, DandonaR.Shamanna BR, Naduvilath TJ, Rao GN. Developing a model to

reduce blindness in India. India J opthalmol1998:46:263-68
8. RaoGN. An infrastructural model for the implementation of Vision2020: The Right to
Sight. Community Eye Health J 2005; Vol18;issue54:s61-62
9. Pascolini D, Mariotti SP. Global estimates of visual impairment: 2010. Br J
ophthalmol.2012:96:614-8
10. Murthy GV, Gupta SK, Bachani D, Jose R, John N. current estimates of blindness in
India Br J Ophthalmol.2005:89:257-60
11. Rao GN. Vision 2020. The right to sight. Indian J ophthalmol.2000;48:3 Vision Center
Manual. Vision 2020: The right to sight India publication. [Last accessed on 2013 Dec
18]. Available from: http://www.vision2020India.Org/pdfs/vision-centermanual-2012.Pdf
12. Murthy G, Raman U. Perspectives on primary eye care. Community Eye Health.
2009;22:10-1
13. Strategies for the Prevention of Blindness in National Programmes: A Primary Health
Care Approach. Geneva:WHO;1997
14. Action plan for the prevention of avoidable blindness and visual imparment 2009-2013.
Geneva: World Health Organization;2020
15. Paul Courtright and Susan Lewallen, “Global Blindness 2010: What Do We Know?
Expert Review of Ophthalmology 6,no.3(2011):388-92

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16. Holden B, Resnikoff S. The role of optometry in vision 2020. Community Eye Health.
2002;15(43):33-36.
17. World Health Organization. Geneva: WHO; 2020. Elimination of avoidable visual
disability due to refractive errors. (WHO/PBL/00.79)

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