Table 4B.
Consensus statements on technical capacity for facility case management, with analysis of Likert scales
| Category/criteria | Technical capacity needed (elements that need to be available) | Top quartile |
50th percentile | Median (IQR) | ||
| Likert 1 | Likert 2 | |||||
| N | % | N | % | |||
| 1. Intervention characteristics | ||||||
| Basic product design | ||||||
| Stability/ease of storage/ease of transport | Torches can be solar powered and are stable. | 6 | 66.7 | 9 | 100 | 1 (1–2) |
| Appropriate and secure storage for drugs and consumables. | 8 | 88.9 | 9 | 100 | 1 (1–1) | |
| Eye-drops that do not require cool storage should be stocked. | 5 | 55.6 | 8 | 88.9 | 1 (1–2) | |
| Tetanus toxoid, which requires cool storage. | 6 | 66.7 | 8 | 88.9 | 1 (1–2) | |
| Topical antibiotic ointment does not require cold storage. | 6 | 66.7 | 8 | 88.9 | 1 (1–2) | |
| Sterile saline solution for eye irrigation is stable. | 4 | 44.4 | 7 | 77.8 | 1 (1–2) | |
| High dose vitamin A is stable. | 5 | 55.6 | 9 | 100 | 2 (1–2) | |
| Injectable antibiotics, for ophthalmia neonatorum and other conditions, may require cool storage | 4 | 44.4 | 7 | 77.8 | 1 (1–2) | |
| Pre-existing PHC transport channels should be available to transport PEC consumables. | 7 | 77.8 | 9 | 100 | 1 (1–1) | |
| Standardisability | The WHO AFRO PEC package is standardised. | 6 | 66.7 | 9 | 100 | 1 (1–2) |
| Safety profile | Staff who are trained/can be trained to deliver the intervention correctly and not cause harm. | 8 | 88.9 | 9 | 100 | 1 (1–1) |
| Supplies | ||||||
| Need for regular supplies | Medication supply system to support regular supply of eye medications and consumables. | 8 | 88.9 | 9 | 100 | 1 (1–1) |
| Equipment | ||||||
| High-technology equipment and infrastructure needed | Diagnostic equipment: Snellen distance visual acuity chart; near visual acuity chart, torches and batteries. | 7 | 77.8 | 9 | 100 | 1 (1–1) |
| Adequate space to use appropriate, standardised visual acuity charts. | 6 | 66.7 | 8 | 88.9 | 1 (1–2) | |
| Adequate space for counselling patients. | 8 | 88.9 | 9 | 100 | 1 (1–1) | |
| Number of different types of equipment needed | One set of diagnostic equipment. | 6 | 66.7 | 8 | 88.9 | 1 (1–2) |
| Maintenance needed | System to maintain equipment in the facility. | 5 | 55.6 | 9 | 100 | 1 (1–2) |
| 2. Delivery characteristics | ||||||
| Facilities | ||||||
| First-level care | Eye care services to manage uncomplicated eye conditions. | 6 | 66.7 | 9 | 100 | 1 (1–2) |
| Hospital care | Referral hospital to manage complicated eye conditions. | 8 | 88.9 | 9 | 100 | 1 (1–1) |
| Human resources | ||||||
| Skill level required for service provision | Staff able to make a diagnosis (take a history; measuring visual acuity; basic eye examination). | 8 | 88.9 | 9 | 100 | 1 (1–1) |
| Staff able to manage some conditions, for example, eye irrigation; remove foreign bodies; give IM injections. | 8 | 88.9 | 9 | 100 | 1 (1–1) | |
| Staff able to identify which cases to refer and the level of urgency. | 8 | 88.9 | 9 | 100 | 1 (1–1) | |
| Skill level required for staff supervision. Degree of supervision required. | Primary healthcare supervisors knowledgeable about eye conditions and their management. | 6 | 66.7 | 9 | 100 | 1 (1–2) |
| Regular supervision of PHC activities and PEC activities. | 6 | 66.7 | 9 | 100 | 1 (1–2) | |
| Frequency or duration of services: for example, on schedule/periodic or continuous to accommodate emergencies | Staff trained in PEC always available to manage eye conditions and emergencies. | 8 | 88.9 | 9 | 100 | 1 (1–1) |
| Management and planning requirements. Need for managerial staff | Facility managers who supply consumables and plan purchasing. | 6 | 66.7 | 9 | 100 | 1 (1–2) |
| Facility managers establish and maintain referral and feedback between the PH centre and eye care facilities. | 5 | 55.6 | 7 | 77.8 | 1 (1–2) | |
| Managerial systems to coordinate staff rotations to ensure daily facility coverage by trained PEC staff. | 7 | 77.8 | 9 | 100 | 1 (1–1) | |
| Communication and transport | ||||||
| Depends on delivery of communication and transport infrastructure | Communication channels to maintain referral and feedback mechanisms between the PH centre and referral centre. | 6 | 66.7 | 9 | 100 | 1 (1–2) |
| Transportation between the PH facility and referral centre. | 3 | 33.3 | 7 | 77.8 | 1 (1–2) | |
| 3. Government capacity requirements | ||||||
| Regulation/legislation | ||||||
| Need for regulation | National Essential Drug List includes appropriate medication and equipment for eye care in PH facilities. | 6 | 66.7 | 8 | 88.9 | 1 (1–1) |
| Regulatory measures need to be enforced and regulated | System that regulates drug prescribing and dispensing by appropriate staff. | 7 | 77.8 | 9 | 100 | 1 (1–1) |
| Reporting systems for measles outbreaks. | 9 | 100 | 9 | 100 | 1 (1–1) | |
| Reporting system for ophthalmia neonatorum. | 7 | 77.8 | 9 | 100 | 1 (1–1) | |
| Management systems | ||||||
| Sophisticated management systems required | Managerial structures for PH care include eye care. | 7 | 77.8 | 9 | 100 | 1 (1–1) |
| Collaborative action | ||||||
| Intersectoral action needed within government, and partnership between government and civil society | Intersectoral action within government or partnerships between government and civil society. | 6 | 66.7 | 9 | 100 | 1 (1–2) |
| 4. Usage characteristics | ||||||
| Need for supervision | Staff who make supervisory home visits. | 5 | 55.6 | 7 | 77.8 | 1 (1–2) |
| Staff who supervise referrals to ensure compliance. | 4 | 44.4 | 8 | 88.9 | 1 (1–2) | |
| Pre-existing demand | ||||||
| Need for promotion | Staff who engage in eye health promotion to target audiences. | 4 | 44.4 | 8 | 88.9 | 1 (1–2) |
| Black market risk | ||||||
| Need to prevent resale/counterfeiting | Staff who engage and train traditional healers to identify and refer eye conditions, with a system to support training. | 6 | 66.7 | 8 | 88.9 | 1 (1–2) |
IM, intramuscular; PEC, primary eye care; PH, primary health; PHC, primary healthcare; WHO AFRO, WHO Africa Office.