Planning and developing services for diabetic retinopathy in Sub-Saharan Africa
Planning and developing services for diabetic retinopathy in Sub-Saharan Africa
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DOI：
10.15171/ijhpm.2015.04
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发表时间：
2015-01-01
期刊：
影响因子：
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通讯作者：
Blanchet, Karl
中科院分区：
文献类型：
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作者：
Poore, Sophie;Foster, Allen;Blanchet, Karl
背景：在过去的几十年中，糖尿病已成为撒哈拉以南非洲（SSA）的一种重要的非传染性疾病。糖尿病视网膜病变（DR）的视力丧失可以通过筛查和早期治疗来预防。本文的目的是概述DR筛查service.Methods的规划和发展所需的行动和考虑因素：一个多案例研究的方法被用来分析五个DR筛查服务在博茨瓦纳，加纳，坦桑尼亚和赞比亚。案例包括：两个区域筛查方案、两个医院筛查服务和一个全国性筛查服务。数据收集采用定性方法，包括：文件分析，深入访谈和观察。世界卫生组织（WHO）的卫生系统框架被采纳为概念框架analysis.Results：规划一个可持续的和综合的DR筛查计划需要一个卫生系统的方法。需要与各部委和专业机构的代表合作。DR筛查服务的发展可能以多种方式发生，包括：增加地理覆盖范围，融入一般医疗保健系统，以及从被动的机会主义服务逐步发展为系统和主动寻求预防DR的服务。在资源匮乏的环境中实施宫颈癌预防计划的经验教训可能有助于在类似环境中制定DR计划。为了促进DR筛查服务的良好规划，并确保有限的资源得到有效利用，有必要从其他医学专业的筛查计划中学习，并需要在资源匮乏的国家新开发的DR计划之间分享经验。世卫组织卫生系统框架提供了一个宝贵的工具，可确保采用系统方法规划DR筛查服务。
Background: 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.Methods: 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.Results: 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.Conclusion: 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.