Public sector refraction and spectacle dispensing in low-resource countries of the Western Pacific.
BACKGROUND
Given that uncorrected refractive error is a frequent cause of vision impairment, and that there is a high unmet need for spectacles, an appraisal of public sector arrangements for the correction of refractive error was conducted in eight Pacific Island countries.


METHODS
Mixed methods (questionnaire and semi-structured interviews) were used to collect information from eye care personnel (from Fiji, Papua New Guinea, Solomon Islands, Vanuatu, Cook Islands, Samoa, Tonga and Tuvalu) attending a regional eye health workshop in 2005.


RESULTS
Fiji, Tonga and Vanuatu had Vision 2020 eye care plans that included refraction services, but not spectacle provision. There was wide variation in public sector spectacle dispensing services, but, except in Samoa, ready-made spectacles and a full cost recovery pricing strategy were the mainstay. There were no systems for the registration of personnel, nor guidelines for clinical or systems management. The refraction staff to population ratio varied considerably. Solomon Islands, Tuvalu and Vanuatu had the best coverage by services, either fixed or outreach. Most services had little promotional activity or community engagement.


CONCLUSIONS
To be successful, it would seem that public sector refraction services should answer a real and perceived need, fit within prevailing policy and legislation, value, train, retain and equip employees, be well managed, be accessible and affordable, be responsive to consumers, and provide ongoing good quality outcomes. To this end, a checklist to aid the initiation and maintenance of refraction and spectacle systems in low-resource countries has been constructed.
Ramke
Jacqueline
J
The Fred Hollows Foundation New Zealand, Auckland, New Zealand. jramke@gmail.com
du Toit
Rènée
R
Palagyi
Anna
A
Williams
Carmel
C
Brian
Garry
G
D005139:Eyeglasses / Q000706:statistics & numerical data*; D006291:Health Policy; D006295:Health Resources; D006296:Health Services; D006280:Health Workforce; D006801:Humans; D010139:Pacific Islands / Q000453:epidemiology; D017150:Public Sector; D012030:Refractive Errors / Q000534:rehabilitation*