Kenya

Lead Agency
Sight Savers International

Name of Project
Kenya Ophthalmic Outreach Programme

Name of Partner/ Implementing Organisation
· Kenya Society for the Blind (KSB)
· Ministry of Health (MOH)

Location
Nakuru, Baringo, Koibatek, Keiyo Marakwet, Machakos, Makueni, Mwingi, Kitui and Kajiado districts. The programme is managed by KSB from Nairobi.

BRIEF DESCRIPTION

The Kenya Ophthalmic Outreach Programme (KOOP) is implemented in partnership with the MOH and KSB and has been supported by Sight Savers since the late 1950’s. The Sight Savers programme covers the training of different levels of eye care personnel, the provision of eye care consumables and equipment as well as support for curative and preventative eye services.

From 2001 onwards Sight Savers International’s (SSI) support has focused more on eye care, and in the period 2001 - 2003 a total of 370,000 patients were seen and treated, of whom 15,000 received sight restoring cataract operations. The training of eye care personnel at the University of Nairobi and at the Kenya Medical Training Centre has ensured the availability of skilled personnel at the secondary and tertiary levels.

Over the years a training programme has enabled the integration of primary eye care practices into the programme area. Through this training, mid-level eye care workers have gained the skills to implement and advocate eye care services at the community level.

OSSI has supported the provision of equipment and consumables to the ongoing eye care services to ensure that poor patients who cannot afford the cost of medical services can access eye care. Two vehicles are used for the screening and transport of patients to hospitals and for the dissemination of primary eye care services. A third vehicle supports the coordination of the eye care programme.

Planned activities from 2004 onwards include:

• The screening and treatment of patients in rural areas through both static and mobile facilities
• Cataract surgeries at University of Nairobi, Kenya Medical Training Centre and in Nakuru and Machakos districts
• The provision of tetracycline ointment to trachoma endemic areas
• Support to outreach services for underserved areas
• Provision of ophthalmic equipment to both primary and tertiary eye units

BACKGROUND

The Kenya Ophthalmic Programme (KOP) is a Kenyan Ministry of Health project, implemented in partnership with the Kenyan Society for the Blind (KSB), which has been supported by SSI since the late 1950’s. The programme covers various components such as training of different eye care workers, provision of eye care consumables and equipment, curative and preventive eye services. These are aimed at addressing the high incidence of blindness in programme areas, especially those cases that are avoidable. The project targets Nakuru, Koibatek, Baringo, Machakos, Makueni, Mwingi, Kajiado and Kitui districts, which have an estimated population of 5.1 million people. It is divided into two zones, Nakuru and Machakos.

SSI supports the provision of equipment and consumables to the on-going eye care services. This ensures that poor patients who cannot afford medical services can access eye care in the programme area. Two vehicles are used for the screening and ferrying of patients to hospitals as well as for the dissemination of primary eye care services in the two zones.

Primary Eye Care (PEC) activities are also undertaken to ensure the integration of primary eye care practices in the programme area. Through PEC, mid level eye care workers are given the skills to implement and advocate for eye care services at the community level. The PEC project ensures that primary eye care provision is considered by the District Health Management Boards within the programme area.

PROGRESS

The Kenya Ophthalmic Programme promotes and provides eye care services with the aim of reducing avoidable blindness in under-served communities. Its specific objectives and 2004 progress is:

• To support the provision of mobile services in two eye zones and through the ophthalomology department at the University of Nairobi.
   
• To restore sight through cataract operations. Cataract is the leading cause of blindness in the country.
   
• To support the training of human resources within the eye care programme, as follows:
   
  • Postgraduate students in ophthalmology: Three postgraduate doctors successfully completed their masters in ophthalmology last year. There are currently 20 postgraduate doctors doing masters in ophthalmology.
     
  • Cataract surgery course: The six ophthalmic clinical officers admitted in April 2003 completed their Cataract Surgeon course successfully.
     
  • Ophthalmic clinical officers/ cataract surgery course: Out of the 13 Registered clinical officer ophthalmic students, eight qualified and five were referred but have also qualified and have been posted.
     
  • New admissions:
    
    • Five Ophthalmic Clinical Officers’ students were admitted to KMTC in September for one year cataract surgery courses.
    
    • 10 General Clinical Officer students were admitted to KMTC in September for two year Ophthalmic clinical officers / cataract surgery courses.
    
    • 14 Registered Nursing Officer students were admitted to KMTC in September for a one year Ophthalmic nursing course, which they have already completed. A new class of 16 Registered Nurses has commenced.
    
    • To provide appropriate ophthalmic equipment to primary and tertiary eye units. The five ophthalmic clinical officers in Kajiado, Iten, Malindi, Kilifi and Kakamega were supplied with retinoscope, refraction set and a torch.
    
    • To provide technical support to the VISION2020 initiative at the community and district levels through co-ordination visits.

Under primary eye care work, the following were achieved:

KNOW (Kenya National Ophthalmic Workers) Workshop
The KNOW workshop, held annually, brings ophthalmic workers together to share knowledge and experiences, and share challenges faced in the provision of eye care services in order to come up with possible solutions. The 2004 workshop was attended by 60 eye care workers, drawn from all levels of eye care service delivery units. This forum has strengthened the working relationship among different cadres of ophthalmic workers and also partnerships among eye care providers (private institutions, NGOs and government institutions).

District Primary Eye Care (PEC) co-ordinators planning workshop
The aim of the workshop was to plan the primary eye care activities for the remainder of the year, with the PEC district co-ordinators. It was held in the second quarter and was attended by seven coordinators from SSI supported zones.

Trachoma Trichiasis Surgery Training

Five ophthalmic workers, drawn from Trachoma endemic districts and K.M.T.C; (three OCOS and two ONs) were trained, each performing at least nine operations whilst under supervision.

Nakuru eye unit, a training centre for both post graduate ophthalmology and cataract surgery students, was issued with a Trichiasis surgical kit, while every participant was supplied with a torch awaiting the supply of, at least, a Trichiasis surgical kit.

Refraction Training

A good percentage of patients treated in the health facilities under the programme suffer from visual impairment due to refractive errors. Refraction and correction with spectacles restores the patient’s sight. It is the responsibility of optometrists and opticians to offer this service, but this cadre of staff is almost non- existent in Kenya and the few that are there are stationed in urban centres such as Nairobi. To minimise this gap, the country’s clinicians, ophthalmologists and ophthalmic clinical officers (OCO), carry out refractive and corrective procedures alongside other ophthalmic activities.

The previous generation of OCOs did not have a refraction module in their training curriculum, forcing them to refer cases of simple refractive error from rural areas, to ophthalmologists in tertiary centres. An OCO was identified and trained in South Africa to come and start short courses of refraction for those not previously trained. The first course of this kind was held at Machakos Hospital eye clinic for two weeks and was attended by five OCOs.

The participants underwent a comprehensive two weeks theory and practical training in refraction; at the end of which they were tested and certified competent to offer the service. They were each issued with a refraction set, a retinoscope, a trial frame and a torch. With more refractionists trained, the programme anticipates making refractive services more accessible to the rural communities. Costs will reduce considerably since patients do not have to travel far to seek these services.

TIMESCALE

2004 - 2006

APPROXIMATE COST (Year 1, 2, 3 & Total)*

US$450,000 (see table below for breakdown)

ESTIMATED NUMBER OF TOTAL BENEFICIARIES

Number of beneficiaries receiving sight-restoring procedures: 7,725
Number of beneficiaries receiving other eye care services: 300,000

Information compiled on 20/6/05 by Peter Renew and Katy Dore at SSI, for publication on FundraiseOnline.

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