Quality services for the poor are achievable – The central success of this SI has been the establishment of durable quality specialist services that will be widely utilised. Quality facilities also attract qualified staff. This SI has shown that, with the right commitment and investment, an essential public health service can be established to serve the poor.
Change is possible – Luapula Province now ranks second in the country for eye care. A qualified ophthalmologist now serves the area, there has been significant investment in infrastructure and equipment, and funds have mobilised community sensitisation and training activities to ensure sufficient dissemination of prevention activities and behavioural change.
Improved productivity and overall wellbeing – Beneficiaries of the programme who have received cataract surgery after being partially or almost totally blind have reported not only positive health outcomes, but also an improved ability to be productive members of their community. As we begin to explore the concept of prosperity and its impact from local development initiatives, we can look to the experience of this and other SIs and assess the degree to which they impact not just wellness, but overall wellbeing.
Mainstreaming of blindness into public health priorities – The prevention of blindness, like disability, is still not generally mainstreamed into development planning; it tends to be in the province of the specialist agencies. This programme has demonstrated that the issue of blindness is a priority for poor communities, as it is an issue of immense hardship for families struggling with poverty.
Stakeholder analysis and engagement – Although implementers have worked closely with the respective local and provincial authorities in the health, education and water/sanitation sectors, this has not resulted in sufficient adoption of the programme at provincial and district levels to create intra government ‘sponsorship.’ It seems that eye care still remains a ‘donor-funded’ cause, even though it is a component of the government’s national strategic health plan and overseen by a government agency. More analysis of the interests of various stakeholders would potentially have prompted a more deliberate strategy of collaboration.
Expectation of diagnosis and treatment at the RHC and community levels – The goals of training were overly ambitious in terms of expecting staff to diagnose and even treat infections. The best that can be achieved at RHC primary level is awareness of the need and a robust system of routine and emergency referral.
Baseline and training outcomes – Because of funding constraints, a proper baseline study for the Initiative could not be carried out as intended. The ability to compare current incidence and prevalence rates with those at the inception of the Initiative is key to demonstrating the impact of this programme.
High rural health centre staffing attrition – High staff attrition was identified as a risk to the training investment.