Narrowing the gap between eye care needs and service provision: the service-training nexus

<p>Abstract</p> <p>Background</p> <p>The provision of eye care in the developing world has been constrained by the limited number of trained personnel and by professional cultures. The use of personnel with specific but limited training as members of multidisciplinary teams has become increasingly important as health systems seek to extract better value from their investments in personnel. Greater positive action is required to secure more efficient allocation of roles and resources. The supply of professional health workers is a factor of the training system, so it stands to reason that more cost-effective, flexible and available education methods are needed. This paper presents a highly flexible competencies-based multiple entry and exit training system that matches and adapts training to the prevailing population and service needs and demands, while lifting overall standards over time and highlighting the areas of potential benefit.</p> <p>Methods</p> <p>Literature surveys and interviews in five continents were carried out. Based on this and the author's own experience, a encies-based multiple entry and exit scheme for eye care in a developing country was derived, modeled and critically reviewed by interested parties in one country.</p> <p>Results</p> <p>The scheme was shown to be highly cost-effective and readily adaptable to the anticipated eye care needs of the population. Eye care players in one selected country have commented favourably on the scheme.</p> <p>Conclusion</p> <p>The underlying principles used to derive this model can be applied to many eye care systems in many developing countries. The model can be used in other disciplines with similar constructs to eye care.</p

Clearer vision: a competencies-based multiple entry and exit approach to the remodelling of eye care services in Thailand

Half the people in the world require a refractive eyesight correction and sixty million are blind. Over eighty percent of eye problems occur in the rapidly increasing older population, magnifying the demands for eye care as an increasing priority for health systems. The global value of the direct imposts of visual impairment and losses of quality of life together are many hundreds of billions of dollars. Sadly, over seventy-five percent of impairment could be successfully treated with cost effective, readily available techniques and better service delivery systems. This thesis examines the eye care system in a middle income country, Thailand, to determine what could be an appropriate training and service delivery model. The contention is that the key to improving the existing system is the provision of sufficient eye personnel with carefully defined but limited training who can produce satisfactory outcomes and who have targeted roles within the general health system. The search for a remodelled system was through the examination of four propositions: 1. That the present pattern of eye care service provision is an inappropriate model for Thailand 2. That a competencies-based multi entry/multi exit training scheme can provide an appropriate eye care workforce in Thailand 3. That the structuring of national health and eye care services to employ the output from a multi entry/multi exit training system would result in a widely available, equitable and cost effective utilisation of resources 4. That the structuring human resources within eye care services in Thailand along the lines suggested in Proposition 3 is acceptable to the major stakeholders The first finding of the thesis was that present government policies, staffing levels, training and deployment systems were inadequate to cover Thailand's predicted needs; that within fifteen years the number of required eye services would be at least double the present planned capacity for refractions and quadruple for cataract removal, these being the two main vision impairment causes. Secondly, it was found that a multiple entry and exit training system which uses a common set of competencies for the educational curricula for all eye care personnel and is co-ordinated with the general health system could produce an adequate range of eye care workers of sufficient quality. The final conclusion from this research was that the suggested models of training and service delivery and their associated implementation strategy were both acceptable to the major stakeholders, and would provide an appropriate eye care system for Thailand

Discrete choice, agent based and system dynamics simulation of health profession career paths

Modelling real workforce choices accurately via Agent Based Models and System Dynamics requires input data on the actual preferences of individual agents. Often lack of data means that analysts can have an understanding of how agents move through the system, but not why, and when. Hybrid models incorporating discrete choice experiments (DCE) solve this. Unlike simplistic neoclassical economic models, DCEs build on 50 years of well-tested consumer theory that decomposes the utility (benefit) derived from the agent's preferred choice into that associated with its constituent parts, but also allows agents different degrees of certainty in their discrete choices (heteroscedasticity on the latent scale). We use DCE data in populating a System Dynamics/Agent Based Model - one of choices of optometrists and their employers. It shows that low overall predictive power conceals heterogeneity in agents' preferences. Incorporating such preferences in our hybrid approach improves the model's explanatory power and accuracy