VISION 2020 LINKS
Figure 1. Ben Parkin and Dr Wani Mena in the Juba Ophthalmology Unit. (Credit Ben Parkin)
Figure 2. The LINKS teams together at Wad Medani. (Credit Nick Astbury)
The VISION 2020 LINKS Programme originated as part of the ‘VISION 2020 - The Right to Sight’ initiative established in 1999 by the World Health Organization and the International Agency for Prevention of Blindness to eliminate avoidable blindness worldwide. The Programme was first implemented by the International Centre for Eye Health (ICEH) at the London School of Hygiene and Tropical Medicine in 2004.
To date there are 28 VISION 2020 links between institutions in the UK and in low-income countries, mostly in Africa (also in Indonesia, Fiji and Jamaica)). In addition, a number of organisational and clinical linkages have been established including a link between the College of Ophthalmology of Eastern, Central and Southern Africa (COECSA) and the Royal College of Ophthalmologists.
The initiative aims to give teaching eye institutions in low-income countries the skills and resources to develop high quality programmes and training for all eye care professionals. Their main needs and priorities are identified by a formal needs assessment process which helps to establish a foundation for sustainable partnerships between teaching institutions in developing countries and partner eye hospitals in the UK.
The International Centre for Eye Health (ICEH) promotes the development of links by acting as a resource and networking centre for existing Links and facilitates the development of new ophthalmic links between partner institutions in Africa and the UK.
Nick Astbury and colleagues in Norwich ran a successful link with the University of Gezira in Sudan from 2005-2011 before the Republic of South Sudan gained independence in July 2011.
From 2005 and 2011, 21 exchange visits took place, 12 out to Sudan and 9 back to UK, involving 23 members of staff from Norwich and 32 from Wad Medani. This was an institutional link that involved several departments at the Norfolk and Norwich as well as the University of East Anglia. The initial 3-year activity plan covered nursing, community epidemiology and research, physiotherapy, neurology and ophthalmology (VISION 2020 LINKS Programme). After six years an exit strategy was agreed and plans were made to start a link in South Sudan.
Achievements of the Gezira (Wad Medani) link included:
- Development of a new nursing curriculum.
- Development and implementation of a paediatric nurse led diabetes service.
- Setting up an infection control structure covering all 7 hospitals in Gezira.
- Introduction of a major maternal and child health programme.
- Development of a community research programme and successful bid for funds to the Welcome Trust.
- New specialist glaucoma service introduced.
- Introduction of ophthalmic nursing protocols and guidelines.
In 2011 Nick Astbury and Carol Edwards led a team from Norwich to undertake a formal needs assessment chiefly related to nursing and ophthalmology training in Juba. Dr Wani Mena highlighted the priorities which particularly centred around human resource development and sub-specialty training. There is an ongoing fundamental shortage of teachers and trainers which is impacting efforts to increase both the number and skills of Eye Care professionals of all cadres.
Ben Parkin visited South Sudan in 2012 and 2013 with the Africa-Poole Link which is supporting all specialist services in Wau Teaching Hospital – see Figure 1. He spent time teaching and working in the Eye Units of both Wau and Juba Teaching Hospitals as well as giving lectures in two Nursing Colleges in Wau. He subsequently joined the Juba VISION 2020 LINK and registered the link with ICEH in 2015. The new Memorandum of Understanding has been agreed by parties in Juba and the UK. Figure 2.
Already the link has raised funds to purchase an operating microscope with teaching and other supplies for Juba Teaching Hospital Eye Unit with the aim of improving surgical teaching and clinical care. An Institute of Ophthalmology has been established by the Ministry of Health to continue middle cadre training including ophthalmic nurses, cataract surgeons and refractionists.
The next activity of the link will be a visit by two consultant ophthalmologists from Juba to the UK. The programme includes observation of ophthalmic practice in four different hospitals, with opportunities for clinical teaching in all sub-specialty areas. Continuing Professional Development needs will be addressed at two annual meetings, the Royal College of Ophthalmologists Annual Congress and the British Oculoplastic Surgery Society Scientific Meeting. A large number of specialist courses and meetings are available at these events. Finally the South Sudanese ophthalmologists have been registered on the East Anglian Sinus, Skull Base and Ophthalmic Surgery Course, a 3-day practical specialist surgical course using cadaver heads.
Another planned activity is to partner with the University of Nairobi in running a sub-specialist course, firstly in oculoplastics in 2017. A faculty of experts will give talks, show surgical videos and demonstrate techniques on patients to a limited number of local trainees as well as invited consultants from Juba and elsewhere.
Figure 3. Fiona Grady teaching orthoptics (credit Nick Astbury)
Figure 4. Carol Edwards discussing nursing issues with her colleagues (credit Nick Astbury)
Links provide innovative, sustainable and cost effective benefits to health care delivery in Africa by encouraging local health workers to develop their skills and thus enhance service delivery, staff confidence and morale. They allow for in-service training in which skills shared can be clinical, technical, community-based, organisational or managerial and are based specifically on identified local needs and priorities.