Formative research for developing an eye health strategic planning and evaluation framework and checklist for health systems

© 2016 Dr. Gail Melva OrmsbyThis doctoral study creates and tests an Eye Health Strategic Planning and Evaluation Framework and a Checklist to assist the planning and evaluation of eye health programs within the health systems of low resource settings. The integration of eye health care into the health system is a high priority in communities where effective health services are severely stretched or unavailable, since avoidable blindness remains a public health challenge. Evidence is offered for a people-centred approach to health care systems. Using this approach ensures that more stakeholders are likely to be involved in the delivery of quality eye health care, and hence, that the promotion, prevention, diagnosis, treatment and rehabilitation components of eye health are properly addressed. The Framework and the Checklist were developed through a multi-phased, multiple research methods process. The key domains of the Framework were informed by a literature review and a Cambodian field-based project that was part of the Avoidable Blindness Initiative funded by the Australian Government. These key domains included: ‘situation analysis’, ‘determinants of accessibility’, ‘service delivery systems’, ‘eye unit operation systems’, ‘networks and linkages’, ‘outcomes’ and ‘impact’, along with 44 components. Two international expert review groups (n=19) experienced in ophthalmology, optometry, strategy formation, program implementation and eye health research, provided feedback on the concurrent validity and the usefulness of the Framework and the Checklist. To assess the validity and suitability of the Framework in another health care system, the LV Prasad Eye Institute, a not-for-profit network in India, was selected as a ‘gold standard benchmark’. Eleven experienced professional program managers endorsed the Framework’s structure, content and usefulness. The Framework’s support Checklist was then developed through the review of documents and literature, as well as a case study including key informant interviews (n=11), field-based site observation of the operational procedures in vision centres (n=4) and secondary eye care hospitals (n=2), resulting in 239 identified indicators. The relevance and face validity of the Framework and the Checklist were evaluated by Cambodian Government eye health professionals from the National Eye Health Program across three Provinces (Prey Veng, Siem Reap and Battambang), as well as three NGOs involved in the delivery of eye health programs. In-depth interviews among eye health workers provided qualitative insights about the challenges of planning and evaluating eye health strategies. In-depth interviews (n=77) among community leaders (e.g. teachers, commune leaders, health centre staff and monks) considered their perspectives of eye health care as a means to test the use of the Checklist indicators. A total of 62 patients were interviewed about the eye health care services from their perspective, and their satisfaction with acquiring spectacles. Additionally, the Framework and the Checklist were trialled as a structured tool to guide an end-of-project evaluation of the Avoidable Blindness Initiative program in Takeo Province. In summary, the Eye Health Strategic Planning and Evaluation Framework was reviewed by a total of 47 eye health professional/experts from several countries. The final Framework consists of 7 domains and 47 components. The accompanying Checklist was refined and reduced to include a total of 206 indicators. The Framework and the Checklist have been endorsed as relevant tools to assist with planning and evaluation of eye health program strategies. Additionally, the Framework and the Checklist support the integration of eye health care programs into the health system, particularly in low resource settings. The Framework and the Checklist inform a foundational structure to guide the development of a monitoring and evaluation framework for eye health programs