Table 3 Enabling factors and challenges for sustainable Primary Eye Care programme implementation in Rwanda
From: Process evaluation of a National Primary Eye Care Programme in Rwanda
Health system domain | Enabling Factors | Challenges |
|---|---|---|
Leadership and Governance | Commitment and support to PEC programme by Ministry of Health, with memorandum of understanding in place for delivery of PEC Good engagement between VFAN and RMoH, and other eye sector stakeholders | The eye health technical working group can be strengthened |
Healthcare Financing | PEC examination included in community health insurance coverage External funding raised to support PEC and outreach activities | Cost of glasses can remain prohibitive for the poorest Payments received for glasses are held centrally rather than in health centres with no clear communication of plans for allocation |
Health workforce | Integration of PEC curriculum into nursing schools | Turnover of PEC trained health centre nurses leaving gaps in provision of PEC clinics. Supervision can be strengthened, with reports of inconsistency in frequency and purpose. Competing priorities at health centres limits availability of nurses to provide PEC |
Medical products and technologies | Inclusion of eye drops on essential medications list Secured supply chain for non-prescription reading glasses and adjustable glasses. | Variable availability of eye drops and glasses can limit management options |
Information and research | Integration of PEC indicators on health management information systems data, co-ordinated by RMoH. | Data is held centrally and access can be difficult. Primary care data not routinely linked to secondary or tertiary care data, but collected locally by VFAN. |
Service Delivery | Successful integration of PEC delivery into health centres | Interface between different levels of care could be strengthened – increase communication and feedback between primary and other levels of care. |