Training and using mid-level eye care workers: early lessons from Timor-Leste

Abstract

A 12-month Diploma of Eye Care course for mid-level eye care workers was initiated in 2007 as part of Timor-Leste's National Eye Health Strategy. This paper reports the development and implementation of this course, examines its initial results and makes suggestions for improvements to the training and deployment of these workers. Course curriculum development and delivery, trainee selection and candidate assessment were examined. Graduate clinical knowledge retention at 6 months after course completion was investigated using clinical vignettes to determine diagnosis, management and patient counselling knowledge for common primary eye health conditions. Graduate workplace environments and activities were appraised. Development of the course curriculum and its delivery were in response to local circumstance, and according to education best practice teaching and learning strategies. Four rural nurses successfully completed the inaugural course. Although all remained in rural eye care services at 6 months after graduation, there was considerable variation in activity. Substantial depletion of clinical competency was revealed across the cohort. Adherence to current best practice in the design and delivery of the curriculum and course was insufficient to ensure productive graduates of ongoing clinical competency, positioned to make an impact on eye health. Attention needs to be directed to postgraduation integration into the workplace, and continuing support once there. The efficacy of this mid-level cadre and its impact on eye health requires further evaluation.