title: "Planning eye health services in Varamin district, Iran: a cross-sectional study".
abstract: BACKGROUND
  A recent survey of avoidable blindness in Varamin District, Iran, identified moderately high levels of visual impairment (10%) and blindness (1.5%) in people >50 years. This study aimed to define current provision, identify gaps and suggest practical solutions for improving eye health services in this area.
  
  
  METHODS
  The World Health Organization (WHO) framework for analyzing health systems has several key components: service delivery, health workforce, information system, medical products and technologies, financing, and governance. We used this structure to investigate the strengths and weaknesses of the eye health system in Varamin. All public and private eye care facilities and a random selection of primary health care (PHC) units were assessed using semi-structured researcher-administered questionnaires.
  
  
  RESULTS
  Varamin has 16 ophthalmic clinics, including two secondary hospitals that provide cataract surgery. There were ten ophthalmologists (1:68,000 population), two ophthalmic nurses and five optometrists working in Varamin district. There were no eye care social or community workers, ophthalmic counsellors, low vision rehabilitation staff. Although the Vision 2020 target for ophthalmologists has been met, numbers of other eye care staff were insufficient. The majority of patients travel to Tehran for surgery. The recent survey identified cataract as the leading cause of blindness, despite the availability of surgical services in the district and high health insurance coverage. Poor awareness is a major barrier. No units had a written blindness prevention plan, formal referral pathways or sufficient eye health promotion activities. Only one of the PHC units referred people with diabetes for retinal examination. There is partial integration between eye care services and the general health system particularly for prevention of childhood blindness: chemo-prophylaxis for ophthalmia neonatorum, school vision tests, measles immunization and Vitamin A supplementation.
  
  
  CONCLUSIONS
  This analysis demonstrated the need for better integration between eye care services and the general health system, local planning for prevention of blindness, an information system, a better staff mix and health education to increase community awareness and service uptake. There is the capacity to deliver far more surgery locally. All aspects of a health system need to be developed to deliver comprehensive and efficient eye care.
authors.affiliation: Ophthalmic Epidemiology Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran. mdkatibeh@yahoo.com.|International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK. mdkatibeh@yahoo.com.
authors.forename: Marzieh
authors.initials: M
authors.lastname: Katibeh
authors.affiliation: International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK. karl.blanchet@lshtm.ac.uk.
authors.forename: Karl
authors.initials: K
authors.lastname: Blanchet
authors.affiliation: Ophthalmic Epidemiology Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran. behshady@yahoo.com.
authors.forename: Shadi
authors.initials: S
authors.lastname: Akbarian
authors.affiliation: Ophthalmic Epidemiology Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran. dr.hosseini4@yahoo.com.|Ophthalmic Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran. dr.hosseini4@yahoo.com.
authors.forename: Sara
authors.initials: S
authors.lastname: Hosseini
authors.affiliation: Ophthalmic Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran. hahmadieh@hotmail.com.
authors.forename: Hamid
authors.initials: H
authors.lastname: Ahmadieh
authors.affiliation: International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK. matthew.burton@ishtm.ac.uk.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Burton
mesh_terms: D000368:Aged; D001766:Blindness; D002386:Cataract; D002387:Cataract Extraction / Q000191:economics; D003430:Cross-Sectional Studies; D005260:Female; D006282:Health Personnel; D006285:Health Planning; D006301:Health Services Needs and Demand; D006801:Humans; D007231:Infant, Newborn; D007492:Iran; D011320:Primary Health Care; D012017:Referral and Consultation; D011795:Surveys and Questionnaires