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

Sophie Poore,Karl Blanchet,Allen Foster,Marcia Zondervan

doi:10.15171/ijhpm.2015.04

Abstract

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. 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. 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. 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.

Highlights

Diabetes is an increasing cause of morbidity and premature mortality in Sub-Saharan Africa (SSA) [1]
It is possible that lessons learned from cervical cancer prevention programmes in resource-poor settings can assist the development of Diabetic Retinopathy (DR) programmes
DR screening programmes are proven to be cost-effective interventions in high-income settings, [13] this is yet to be determined in African settings [2]

Summary

Introduction

Diabetes is an increasing cause of morbidity and premature mortality in Sub-Saharan Africa (SSA) [1]. In order to provide well-coordinated and well-documented diabetic care, considerable strengthening and reorganisation of the health system is needed as the health system in SSA is more accustomed to treating episodic health events (such as infectious diseases or trauma) [2,4]. It is possible that lessons learned from cervical cancer prevention programmes in resource-poor settings can assist the development of DR programmes. Poor performance of cervical cancer prevention programs in developing countries is reported most frequently to be a consequence of inadequate planning and lack of systems for continuous monitoring and evaluation - irrespective of the screening test or treatment methods used [5]. This paper will report on the planning, implementation and development of five DR screening programmes in Botswana, Ghana, Tanzania and Zambia. The discussion will be framed using the World Health Organization (WHO) Health Systems Framework or ‘building-blocks’ (Figure 1)

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Conclusion