title: Primary eye care skills scores for health workers in routine and enhanced supervision settings.
abstract: BACKGROUND
  Primary health care in Tanzania is provided at two types of health units, the dispensary and the health centre. Theoretically, primary health workers (with knowledge of primary eye care [PEC]) are ideally placed to identify people in need of eye care services. In Tanzania, they are expected to be able to identify, treat, or correctly refer a number of eye conditions including cataract, trauma, presbyopia, and the 'red eye'. They are also expected to be able to measure visual acuity correctly and to educate the community about prevention.
  
  
  OBJECTIVE
  The objective was to determine the effect of enhanced supervision of health workers on PEC knowledge and skills in Kilimanjaro Region, Tanzania.
  
  
  METHODS
  This was a quasi-experimental, cluster randomized intervention study of an enhanced supervisory method compared to a routine supervisory method; 36 dispensaries were randomly allocated into the two groups.
  
  
  METHODS
  Health workers based at government dispensaries in Mwanga District.
  
  
  METHODS
  Participants were interviewed pre and post intervention and the information was recorded using a standardized pretested questionnaire.
  
  
  RESULTS
  Mean scores of knowledge in healthcare workers was higher in the intervention group (score = 6.43, 80.4% improvement) compared to the non-intervention group (score = 4.71, 58.9% improvement). The ability to describe and demonstrate vision testing was better (score = 1.8) in the enhanced supervision group compared to the routine supervision group (score = 0.88, P = 0.03). There was a high level of attrition (24%) within one year from the time of baseline survey, especially amongst clinical officers (44%).
  
  
  CONCLUSIONS
  During the pilot study, enhanced supervision improved PEC knowledge and skills of health workers compared to health workers with routine supervision.
  
  
  CONCLUSIONS
  Training in PEC needs revision to become more practicum-based. There is need to revise supervision guidelines (to be skills-based) and the supervision skills of district eye coordinators (DECs) need to be enhanced. There is a huge need to improve governance (accountability and rule of law) of health staff.
authors.affiliation: Department of Ophthalmology, KCM College, Tumaini University, Moshi, Tanzania.
authors.forename: M
authors.initials: M
authors.lastname: Okwen
authors.affiliation: Kilimanjaro Centre for Community Ophthalmology, PO Box 2254, Moshi, Tanzania.
authors.forename: S
authors.initials: S
authors.lastname: Lewallen
authors.affiliation: Kilimanjaro Centre for Community Ophthalmology, PO Box 2254, Moshi, Tanzania. Electronic address: pcourtright@kcco.net.
authors.forename: P
authors.initials: P
authors.lastname: Courtright
mesh_terms: D002983:Clinical Competence / Q000706:statistics & numerical data*; D005128:Eye Diseases / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006282:Health Personnel / Q000592:standards*; D006801:Humans; D008297:Male; D010865:Pilot Projects; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards*; D011795:Surveys and Questionnaires; D013636:Tanzania
keywords: Health workers; Primary eye care; Supervision; Tanzania; Task shifting