Building a Blueprint for Change

Our research has shown that the vision care system in rural China needs radical revision. We are currently partnering with local governments to develop a model for the provision and uptake of care.

The first Seeing is Learning project found that despite the high prevalence of uncorrected vision in rural China, access to vision services is limited. The data showed that China’s methods for screening and treating vision problems needs radical revision. The Chinese government needs a model for vision care screening and treatment to implement throughout the country.

The results of our work were first included in an official policy brief for China’s State Council, who approved the findings for policy discussions. We then entered into talks with the Gansu provincial government to devise a plan of action for the province’s untreated myopic children. They invited us to create a partnership with Tianshui prefecture to design and run a full-scale model of service provision in two counties (Qinan and Yongshou) so that they can observe and upscale the model.

In the meantime, the prefectural government drafted a circular for all schools and education bureaus in Gansu province emphasizing the importance of vision care. This represents the first time a government agency has specifically called on schools to emphasize vision care and explicitly states three key messages:

Vision care is important for students
Glasses are not harmful for children
Eye exercises are not enough to ensure proper vision among children

Building Model Vision Care Counties

Our partners in the provincial and prefectural education bureaus want Gansu and Shaanxi to be models for all of rural China. We believe we have learned enough from our previous vision care work to work with the government and our partners to operate successful models. That is the inspiration behind the current phase of the initiative, in which specially developed Vision Centers, based in Qinan and Yongshou county hospitals, will provide vision care to every child in grade 4 to grade 6 in each county’s rural schools.

We are employing each of the major lessons we have learned to execute and advocate for this model:

Uncorrected vision is pervasive and damaging for children, and warrants swift action
Eyeglasses are a safe and effective treatment for vision problems among children
Eye exercises are not enough to correct vision problems
Subsidized care is an important driver of uptake
Screening can be effectively executed by teachers locally

Vision care staff and centers

The Qin’an and Yongshou county hospitals each selected 4 employees to staff the Vision Center. These individuals flew to Guangzhou in September 2014 where they underwent training from Zhongshan Ophthalmic Center (ZOC) and returned in early November as certified refractionists and opticians. Two of the trainees, actually eye doctors by training, returned to Guangzhou in November to learn to properly treat amblyopia.

The county hospitals both agreed to provide space in their outpatient buildings to serve as the Vision Center. Beginning in November 2014 we worked to redesign these spaces for vision care, and then had all our equipment installed—including an autorefractor and lens edging machine, as well as five smaller devices.

Preparing for launch

The optometrists spent all of October and November 2014 month practicing and honing their skills under the supervision of ZOC staff. They screened and refracted hundreds of “practice” children from nearby schools, and are working to grind and mount lenses for dispensing next month. A consultant from Brien Holden Vision Institute also arrived during this time to train the staff on the “business” side of the Vision Center, i.e.: how to manage lens inventory, how to display frames in an appealing fashion, how to organize records, etc.

Launch!

At the request of the Gansu and Shaanxi governments, in late December we organized Vision Center launch events. This was an important opportunity for the government in each area to endorse the centers in a high profile fashion, as well as ensure the cooperation of local school administrators and teachers.

Though the ceremony was on December 25, work treating children has been been underway since December 1, 2014. Commonly doctors from other departments stop by the vision centers to check them out, the hospital administrations are supportive, the education bureaus are in touch with us regularly and very solicitous, and the optometrists are motivated and invested.

Since December we have trained about 80 teachers to screen, had them screen about 2000 primary schoolers. Of these, they have referred 800 students that did not pass the screening to the respective Vision Center. There our staff examined each child and for those that required correction made and dispensed about 700 pairs of glasses. The hospital staff are busy but in good spirits. The following is their typical work schedule:

Monday - train local teachers how to screen, making sure teachers know how to refer children that do not pass.
Tuesday and Wednesday – This is the staff “weekend.”
Thursday – screen preschoolers and make sure the teachers the optometrists trained on Monday have screened their respective students.
Friday – call schools/parents of children that failed screening to ensure they arrive at the vision center during following weekend.
Saturday and Sunday – examine, provide prescriptions, and dispense glasses

The amblyopia component

Amblyopia affects 2-3 percent of children but requires early treatment (before 6 years of age) if permanent vision loss in the affected eye is to be avoided. Currently, very few rural children in China seek or receive treatment for amblyopia and will face permanent vision problems without proper correction. Most educators are unaware of this problem or the simplicity of the solution. Most health care providers in rural areas do not provide modern or clinically proven treatments for the condition.

In addition to training primary school teachers to screen their students, our county hospital staff has learned to screen rural pre-schoolers for amblyopia. One staff member at each hospital –both doctors by training – has been specially prepared by ZOC to provide proper treatment for those children identified during the screening as being at risk for amblyopia. So far, about 500 pre-schoolers have been screened, and 40 have been referred to the county hospital. Of these, 30 children are undergoing treatment.

Regarding the amblyopia program, REAP will be measuring: