Integrating primary eye care into child health policies and programmes: A case study from Tanzania

The lack of primary eye care services in low resource settings leads to children presenting late to health services, ultimately leading to avoidable sight loss. Integration of eye care into child health programmes and policies would be a sustainable solution to the delivery of primary eye care for children. This thesis aimed to present a model of how eye health could be integrated into child health programmes and policies, using Tanzania as a case study. The first paper is a systematic review of the evidence on whether universal screening of the eye within eight weeks of birth improves vision and health outcomes. The review found that screening shortly after birth increases early identification, referral, and surgery for congenital cataracts. The second paper is an evaluation of training primary healthcare workers using an additional module on eye care as part of the curriculum of the WHO/UNICEF Integrated Management of Newborn and Childhood Illness (IMNCI) training programme in Tanzania. The knowledge and skills of primary healthcare workers in childhood eye diseases improved after routine IMNCI training included the new eye care module. The final paper is a qualitative health policy analysis exploring key factors which led to the policy change in Tanzania to include eye health in the national IMNCI strategy. Leveraging existing policy communities and networks, clear consensus on the framing of ideas, generating local evidence and a critical IMNCI policy window in Tanzania, together with the expansion of global child health policy all influenced the policy change. The case study of Tanzania used in this thesis proposes a model of how eye health can be included in the child health strategy IMNCI at programme and policy levels. The lessons learned can be used in other countries to include eye health in IMNCI or other child health policies and programmes.