Health system dynamics analysis of eyecare services in Trinidad and Tobago and progress towards Vision 2020 Goals

Braithwaite, Tasanee and Winford, Blaine and Bailey, Henry and Bridgemohan, Petra and Bartholomew, Debra and Singh, Deo and Sharma, Subash and Sharma, Rishi and Silva, Juan Carlos and Gray, Alastair and Ramsewak, Samuel S. and Bourne, Rupert R. A. (2018) Health system dynamics analysis of eyecare services in Trinidad and Tobago and progress towards Vision 2020 Goals. Health Policy and Planning, 33 (1). pp. 70-84. ISSN 1460-2237

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Official URL: https://doi.org/10.1093/heapol/czx143

Abstract

Avoidable blindness is an important global public health concern. This study aimed to assess Trinidad and Tobago’s progress towards achieving the Pan American Health Organization, ‘Strategic Framework for Vision 2020: The Right to Sight—Caribbean Region,’ indicators through comprehensive review of the eyecare system, in order to facilitate health system priority setting. We administered structured surveys to six stakeholder groups, including eyecare providers, patients and older adult participants in the National Eye Survey of Trinidad and Tobago. We reviewed reports, registers and policy documents, and used a health system dynamics framework to synthesize data. In 2014, the population of 1.3 million were served by a pluralistic eyecare system, which had achieved 14 out of 27 Strategic Framework indicators. The Government provided free primary, secondary and emergency eyecare services, through 108 health centres and 5 hospitals (0.26 ophthalmologists and 1.32 ophthalmologists-in-training per 50 000 population). Private sector optometrists (4.37 per 50 000 population), and ophthalmologists (0.93 per 50 000 population) provided 80% of all eyecare. Only 19.3% of the adult population had private health insurance, revealing significant out-of-pocket expenditure. We identified potential weaknesses in the eyecare system where investment might reduce avoidable blindness. These included a need for more ophthalmic equipment and maintenance in the public sector, national screening programmes for diabetic retinopathy, retinopathy of prematurity and neonatal eye defects, and pathways to ensure timely and equitable access to subspecialized surgery. Eyecare for older adults was responsible for an estimated 9.5% (US$22.6 million) of annual health expenditure. This study used the health system dynamics framework and new data to identify priorities for eyecare system strengthening. We recommend this approach for exploring potential health system barriers to addressing avoidable blindness, and other important public health problems.

Item Type: Journal Article
Keywords: World Health Organization, health systems, health professionals, primary care, population, public health, health care utilization, costs, ophthalmology, survey
Faculty: ARCHIVED Faculty of Medical Science (until September 2018)
Depositing User: Ian Walker
Date Deposited: 17 Nov 2017 16:06
Last Modified: 14 Nov 2019 16:10
URI: http://arro.anglia.ac.uk/id/eprint/702446

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