Background:
Over the past few decades diabetes has emerged as an important non-communicable disease in Sub-
Saharan Africa (SSA). Sight loss from Diabetic Retinopathy (DR) can be prevented with screening and early treatment.
The objective of this paper is to outline the required actions and considerations in the planning and development of DR
screening services.
Methods:
A multiple-case study approach was used to analyse five DR screening services in Botswana, Ghana, Tanzania
and Zambia. Cases included: two regional screening programmes, two hospital-based screening services and one
nationwide screening service. Data was collected using qualitative methodologies including: document analysis, in-
depth interviews and observation. The World Health Organization (WHO) Health Systems Framework was adopted as
the conceptual framework for analysis.
Results:
Planning for a sustainable and integrated DR screening programme demanded a health systems approach.
Collaboration with representatives from a variety of ministerial departments and professional bodies was required.
Evolution of DR screening services may occur in a variety of ways including: increasing geographical coverage,
integration into the general healthcare system, and stepwise progression from a passive, opportunistic service to one
that systematically and proactively seeks to prevent DR. Lessons learned from the implementation of cervical cancer
prevention programmes in resource-poor settings may assist the development of DR programmes in similar settings.
Conclusion:
To promote good planning of DR screening services and ensure limited resources are used effectively, there
is a need to learn from screening programmes in other medical specialities and a need to share experiences between
newly-developing DR programmes in resource-poor countries. The WHO Health Systems Framework presents an
invaluable tool to ensure a systematic approach to planning DR screening service