PROJECT EVALUATION: INCREASING EQUITABLE ACCESS TO EFFECTIVE CATARACT SERVICES IN WEST, SOUTH, AND SOUTH -WESTERN UGANDA

Closing date : 21 Nov 2023
Introduction
The Fred Hollows Foundation (The Foundation) is a secular non-profit public health organisation based in Australia, which was founded in 1992 by eminent eye surgeon Professor Fred Hollows. The Foundation focuses on strengthening eye health systems and the treatment and prevention of avoidable blindness caused by Cataract, Trachoma, Diabetic Retinopathy, and Refractive Error. It operates in more than 20 countries across Australia, The Pacific, South and South-East Asia, and Africa. The Foundation was named The Australian Charity of the Year 2013 at the inaugural Australian Charity Awards.

The project is being implemented with the partners being Ruharo Mission Hospital Eye Centre (REC) and Mbarara University Referral Hospital Eye Centre (MURHEC) located in Mbarara city and CBM as the main implementing partner. The project area includes sub regions of Southwest, West and South Uganda, targeting Regional Referral Hospitals, District Hospitals, and sub district Health Units. Two recent studies from Uganda on Cataract Surgical Rate (CSR) showed that this region had the lowest CSR of 174/million compared to the national average of 230/million. This is an extremely low CSR rate when compared to other African countries. Consequently, data from the Uganda National Health Information Management Systems (HMIS) showed that this region had the highest prevalence of operable cataract. In this report, the proportion of patients with operable cataract was 84.7% in Bunyoro and 64.6% in Tooro region. The gender dimension also presents varying statistics on how male and female access eye health services with access rates for female being relatively lower.

The project has two parts which have distinct focus areas and evaluation requirements.

Equitable Access to Effective Cataract Services (focusing on outcomes for the general population and improving service quality)
Achieving Equity Through Integration of Health Services for Women (focusing on improving outcomes for women)
Project background
The project is working in partnership with government and mission-based hospitals and health centers in West, and South-Western Uganda to increase quality and equitable access to eye care services and other health services, with parts particularly focused on reaching the disadvantaged sub-populations of older persons and women. A summary of each of the components of the project that is to be evaluated are provided below.

Part 1) Equitable Access to Effective Cataract Services:

To increase community engagement in eye health services, communities will be educated on eye health issues through primary health workers, and eye patients will be screened and mobilized through existing health facilities. Primary health workers will be trained in basic eye screening and referral, and PEEK technology will be introduced to improve the accuracy of screening and referral. This approach will be scaled up throughout the project implementation period to cover all districts in the project area.

Increased eye health services will be achieved through infrastructure development, resourcing, andequipping cataract service-delivery sites to deliver quality cataract and other eye health services, training of eye-health workers, and strengthening district health systems to plan, budget and monitor eye health services. The project will also strive to improve the productivity and quality of cataract surgery through the training of surgical teams in theatre management, training of optometrists and ophthalmic nurses on biometry, high volume cataract surgery, standardization of quality measurement, patient follow-up procedures, expansion of the medical consumables store, eye centre admission ward and the operating theatre at Ruharo Mission Hospital eye Centre and provision of essential equipment including (biometry machines) and consumables including a wide ranges of IOLs. ensuring refraction and provision of eyeglasses/ prescriptions of patients operated for cataract. The project will improve the referral system and achieve efficiency gains in the patient flow to strengthen the health system.

The community will benefit from improved awareness of eye health and treatment options and increased access to eye care services. A total of 300,000 people will be reached with community education/ sensitisation sessions on eye health of which 191,000 are expected to have their eyes screened. The project plans to conduct cataract surgery for 14,700 people, distribute spectacles to 7,346 people and provide other sight saving interventions to approximately 88,151 people.

As required under ANCP funding the project is required to meet the ‘Significant’ DAC Gender Mark and ‘Significant’ ANCP Disability Marker. Therefore, the project has a focus on activities that engaged marginalised people, women, people with disability, indigenous people and people living in remote hard to reach areas. The project will pay particular attention to reducing access barriers for marginalised people.

Outcomes and outputs

Outcome 1: Communities are aware of cataract and other eye health services and actively seek services.