Preventing childhood blindness through integration of eye health into child health policies and systems

Our consortium will refine and evaluate an integrated child eye health systems model (hereafter called "the model”), as a sustainable and scalable approach to reduce avoidable blindness in young children by increasing access to primary eye care in Tanzania and Nepal. Background

Over 1.4 million children are blind globally. Most live in low-income countries and most become blind by 5-years of age. Half of these children are blind from causes which are preventable or treatable.

Children can become or remain blind because they do not have access to eye care at their first contact with the health system, i.e., at primary level as eye care is not routinely included in child health care programs. However, the World Health Organization (WHO) recently recommended that routine newborn examination include eye screening.

A series of studies have been undertaken in partnership between stakeholders in Tanzania and LSHTM. Following an initial pilot study, formative research based on a Theory of Change assessed causal pathways, barriers, assumptions and possible outcomes of primary level interventions to reduce blindness in children. This study also identified health system gaps which need to be addressed.

Further studies showed that it is feasible to include eye care in WHO/UNICEF’s global primary level child health programme: the Integrated Management of Newborn and Children Illness (IMNCI), and that primary health workers (PHWs) can effectively screen children’s eyes using a low-cost device. Following these studies, the Ministry of Health (MOH) included the Eye Module in their IMNCI policy for in-service training and have since trained over 3000 PHWs. A recent study explored health policy factors which influenced the decision made by the MOH.

Using these findings, an integrated child eye health systems model has been developed which has five health system interventions for delivery at primary level. The model will be evaluated in Tanzania, and to increase generalisability, in Nepal, a very different context. Before the evaluation, the model will be refined and finalized in both countries by local stakeholders and communities in Work Package (WP) 1.

We will work with communities in both countries at all stages, and key stakeholders: MOH, WHO, UNICEF, non-government organizations and eye health care professionals. The consortium will strengthen research capacity by training and supporting research teams, supervising PhD students and mentoring supervisors.

This consortium of equitable partners, in collaboration with communities, governments and multi-lateral organizations, aims to provide evidence of the effectiveness, cost effectiveness and scalability of this sustainable health system model of delivering eye care for children at primary level. The findings will be used to advocate for policy change to reduce avoidable blindness at national, regional and global levels.

Methods Our consortium will undertake five work packages (WP) in both countries. WP1 Health system readiness at the primary level to deliver child eye health WP2 Cluster randomized trial to assess the effectiveness of the model WP3 Process evaluation of factors which influence effectiveness WP4 Cost and cost effectiveness of the model

WP5 Policy analyses to understand factors enabling and hindering sustainable scale-up of the model.