Equipment for eye care

Community EyE HEaltH Journal | Vol 23 iSSuE 73 | SEPtEmBEr 2010 In many lowand middle-income countries, it is often the people who are poor or with a disability – or both – who find it most challenging to access and pay for health care. When people do come to us for eye care, it is therefore vital that we provide quality services efficiently and effectively. To achieve this goal, we must ensure that our equipment is well maintained and that we have enough spare parts and consumables for it to function with minimum interruptions. To cope with the sometimes inevitable breakdowns, we also need systems that will respond quickly to carry out repairs and replace broken or worn-out parts. Unfortunately, the survey commissioned by this journal (page 23) has shown that many eye units in lowand middleincome countries have vital equipment that is not working, often for long periods of time, and that this has affected the services offered to patients. Equipment needs to form part of our planning for eye care. This must start when eye care programmes are being designed and should include those who will be using the equipment. Without careful planning, it is likely that our equipment will not perform optimally and might even fail completely. And without working and effective equipment, our eye care programmes will not achieve their potential. Making the best out of an investment in equipment We should critically assess whether investment in a new piece of equipment will add value to the services we offer. Does it allow the eye care team to provide a better quality service? Does it allow the team to help more patients per day? Does it help the clinician to work more comfortably (and therefore more quickly)? The desire for sophisticated equipment should be balanced against the need for basic public health equipment such as ophthalmoscopes (as mentioned on page 32). Ultimately, the deciding factor must be our patients. What equipment will allow the eye unit to help the largest number of patients and provide them with the best possible care? When facing difficult decisions on a limited budget, it may be helpful to look at patient flow within the eye unit or eye care programme. Where are the longest queues, the longest delays, or the longest waiting times? These are the areas where additional investment in equipment may be of most benefit, provided everything else, including staff, is in place to support the equipment. For example, in some eye clinics there may be a queue of patients waiting to be examined at the slit lamp. One extra slit lamp may then allow the clinical staff to see many more patients per day, whereas one extra laser will not make much difference. Or in a clinic where ophthalmoscopes are shared between clinicians, a few extra ophthalmoscopes will have a similarly positive effect on patient flow. Equipment for eye care Community Eye Health Journal