WORLD CONGRESS on REFRACTIVE ERROR and SERVICE DEVELOPMENT

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WORLD CONGRESS on REFRACTIVE ERROR and
SERVICE DEVELOPMENT

• DURBAN
• MARCH 2007

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Mid level Personnel Training programmes

• Hannah Faal
• West Africa

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Summary

• What, why and how
• Current status
• Team concept
• Guiding Principles
• Designs and strategies
• Numbers
• Case studies
• Changes
• Road map

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Definition

• Mid level ophthalmic personnel
• All categories of professionals who work full
  time in health care except qualified doctors.
• Location of staffsecondary level
• ? Non professionals, ?other levels
• PROVIDER RELATED
• PROFESSIONS RELATED
• EXCLUSION PROCESS

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Professions

• Are expected to
• Have long periods of formalised training
  programmes, increasingly in higher educational
  institutions and universities,
• to master a discrete body of knowledge and
  skills over which its members have exclusive
  control
• Use practical knowledge to solve problems
• Have professional bodies which serve as ultimate
  authorities in certification
• Have an established sub culture with codes and
  conduct of ethical practice and with exclusive
  rights and duties to discipline unprofessional
  conduct
• Are held to higher standards of behaviour
• Have the right to charge fees for services
  rendered to their clients, and value performance
  above reward
• Work independently

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Global change

• High income countries
• Service function which concentrated on surgery
  cataract surgery and refractive error correction
• Increased research in ophthalmic sciences, mainly
  diagnostics and therapeutics
• Development of subspecialties
• Flourishing of private eye care
• Increasing role of industry and technology
• Increasingly aware consumers and demand for
  quality care
• More professions and occupations with
  specialised skills were required by the eye care
  service
• Global change in the eye care environment
• Because of the long duration of training, the
  financial compensation required, there was an
  inevitable concentration of the few professionals
  in urban centres
• The rural and poor population were deprived
• Alternative human resources became necessary

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Response

• High level income countries
• Allied health (paramedical) personnel to
  accommodate the amplification of the tasks
• Low income countries
• Mid-level personnel to
• take on the load and shift increasing
  complexities of care to the professionals
• address the increasing need for population and
  geographical coverage and economic fit
• Fit into the health system structure of primary,
  secondary and tertiary.

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Process

• Controlled and tailored eg the Joint commission
  for allied health personnel in ophthalmology
  (JCAHPO)
• NGOs and others including the private sector
  initiated training and deployed personnel
• The result? proliferation of training
  programmes, a wide variety and differing
  categories of personnel, decrease in quality
• Re- enforcement of exclusion by the established
  professions
• no support from the established professions
• no guidance to governments on approval
  processes.

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Shift in focus professions to people

• Every person, in every village, everywhere has
  access to a motivated, skilled and supported
  health worker
• We have to work together to ensure
• Dr LEE Jong-wook
• Late Director General,
• WHO
• World Health Report, 2006

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Fresh lookhealth work force

• Health worker
• Are all people engaged in actions with the
  primary intent of enhancing health, including
  family caregivers, patients - provider partners,
  part time workers, volunteers and community
  workers
• Health service provider
• Health management and support workers
• To get workers with the right skills to the right
  place at the right time and improve social
  compatibility between workers and clients

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Team concept

• A shared vision
• A thorough job and task analysis with clear
  definitions of roles and responsibilities
• A well balanced mix and match of personnel, sub
  teams within a main team
• A culture of referral, feedback and supportive
  supervision
• An enabling environment
• A leadership committed to the people to be served
  and to the people serving
• Experts who should also be managers, leaders.

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Categories of teams

• Facility based only
• Facility based plus outreach
• Field teams who work independently and thus carry
  more responsibility but with supportive
  supervision
• Integrated into the health system

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Training programmes

• Existing staff
• increase in productivity
• bridging strategies which would bring the wide
  variety and low quality into the mainstream
• New innovative courses responsive to identified
  needs
• Based on evidence and a close study of the
  dynamics of change in health needs, behaviour and
  the external environment

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Guiding Principles

• Acceptance of responsibility and approval by
  existing professions as technical advisers to
  government
• Government approval translated into policies
• Statutory and regulatory bodies
• A fit into the educational structure and training
  norms
• A fit into the personnel management and career
  patterns
• A social compatibility with the population being
  served

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Designs and strategies

• For quick population and geographical coverage
• Multi entry- multi exit design
• Multi location centres
• Use of the private sector and the voluntary
  centres
• Distance education
• Telecommunication revolution- maximum use of
• Match of population/geographical coverage to team
  composition (mix and match)
• Selection from service area
• Close alignment of job/tasks and training
• Post training support and nurture
• Training of teams not individuals
• Continuing professional education, peer review
  and re-certification
• Culture of seeking and using evidence

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Choices- pros and cons

• To add on new skills to existing cadres
• New skills to eye care staff, eg refraction
  skills to ophthalmic nurses
• Eye care skills to other staff,
• To create new cadres, eg
• Refractionists, vision technicians

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Numbers

• Calculations-
• population based , 1 optometrist per 500,000
• Facility based, 1 optometrist at each secondary
  eye unit
• Personnel based, 4 refractionists per
  optometrist
• Calculations need to be comprehensive
• Based on the team concept to match the service
  volume and complexity

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Case study- South east Asia region and mid level
personnel, pre 2006

• Process
• Situational analysis
• A meeting on Mid level ophthalmic personnel
• A task force of experts to recommend generic
  nomenclature, define roles and job descriptions
  for all mid level ophthalmic personnel (MLOPs).
• Advocacy to highlight importance of MLOP to
  health ministries
• Bridging strategies for existing MLOPs
• Agreed generic training programmes
• Agreed formulae for calculations of needs
• HRD plans integrated into general health plans to
  implement policy decisions

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New cadre-Case study- Ghana

• A consultative process for a new cadre- the
  Optical technician course-
• Stakeholders
• Eye care services, national management
• Human resource division of the Ministry of Health
• Ghana Education service
• Tertiary training institution
• Professional body-optometrist association
• Eye care team leaders- ophthalmologists
• Ministry of health, regional management and
  hospital services
• Private sector
• Blind persons organisations
• NGDOs

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Team concept by service level - case study The
Gambia

• Eye care team
• Sub team for optical services
• Optometrist
• Refractionists
• Low vision worker
• Counsellor
• Optical workshop staff
• Store keeper
• Cashier
• Display and customer relations staff

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Shop and management
technology
Patients Public
Teams
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Anticipating change and planning for it

• Patients/public
• Coverage
• Satisfaction
• Demography
• Disease patterns

• Teams
• Demography
• Numbers attrition, migration
• Gender make up
• Progression

• Technology
• Age
• Quantity
• Complexity

REMAINING FOCUSED ON PEOPLE
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technology
Shop and management
Patients Public
Teams
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Road map

• A task force which would address human resources
  for eye health within the new global focus on
  people and recommended framework
• An advocacy plan spearheaded by the professions
  to prioritise eye care to governments and from
  that achieve the framework of policies, statutory
  and regulatory bodies, educational system and
  career progression fit
• Integrated HRD plans which would address existing
  cadres, develop innovative responsive strategies
• A culture of continuing professional education
• Staying dynamic, responding to the changing
  health and development environment
• Constantly focused on PEOPLE

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• Mid level personnel
• What mid level personnel?
• Did you mean to say health teams?

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Shift in focus professions to people

• Every person, in every village, everywhere has
  access to a motivated, skilled and supported
  health worker
• We have to work together to ensure
• Dr LEE Jong-wook
• Late Director General,
• WHO
• World Health Report, 2006

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Thank you