The ‘Mandeville Model’
HOW CCB-EYE CARE CARIBBEAN HELP GIVE SIGHT TO MORE THAN 4,000 JAMAICANS.
A Case Study of an innovative NGO-Government Partnership for Eye Care.
1. Summary Overview:
1.1 The Caribbean Council for the Blind and The Foundation For Eye Care In The Caribbean (CCB-Eye Care Caribbean) with support from Sightsavers, initiated a partnership with the Mandeville Regional Hospital, in Jamaica which represents a positive example of a partnership between a Government Hospital and an NGO. The two Partners have overlapping interests (V2020), but have different types of resources and technical expertise at their disposal. The partnership has significantly improved the eye care services available to patients at the Hospital and has the potential to continue to facilitate improvements in the future. The partnership is fully sustainable.
1.2 The long-term and flexible approach of CCB-Eye Care Caribbean, the decentralized nature of the Health System in Jamaica and the personal enthusiasm and commitment of the Staff of Eye Department at the Hospital, all contributed to the success of this initiative.
2. Background and problem analysis:
2.1 CCB-Eye Care Caribbean, is a constitutionally independent NGO, comprising 29 Member Agencies representing predominantly the Anglophone and Francophone Caribbean. The CCB was established in 1967 with support from the Royal Common-wealth Society for the Blind, now Sightsavers. The majority of the support provided to programmes in the Caribbean Region by Sightsavers is managed through CCB-Eye Care Caribbean.
The stated objective of the current partnership between Sightsavers and CCB-Eye Care Caribbean, is ‘to facilitate the development of comprehensive and sustainable systems to deliver V2020 and Inclusive Services for people who are blind in the Caribbean Region.’ The structure of the partnership and programme was deliberately developed to promote a flexible approach to development of activities and projects towards the overall programme objectives.
2.2 Jamaica is an emerging economy in the “Caribbean Basin”. While this puts the country in the “medium development” category, there are significant gaps in its surgical and post-diagnostic medical options. There are many people in the country who experience major difficulty in accessing some level of health care, including eye care. A study carried out in 1996 (by Help the World See) established that an average wage earner in Jamaica would need to work for 52 days to earn sufficient money to buy a pair of glasses. One of the main aims of the CCB/Eye Care Caribbean support in Jamaica is to ensure that quality eye care is not just available, but is also affordable to everyone who needs it.
2.3 Under the Health Sector Reform process, the Jamaican Health Service has been decentralized; whereby responsibility for management and delivery of services lies with the four Regional Health Authorities, while the Ministry of Health Head Office provides a policy-making, steering and regulatory role (Health System and Services Profile of Jamaica 2nd edition, December 2001, PAHO).
2.4 The Mandeville Regional Hospital, falls under the Southern Regional Health Authority and serves a population of approximately 512,000. The Eye Department currently has two Ophthalmologists and one dedicated Nurse. In common with most senior health staff in the Public Sector, both Ophthalmologists work part-time in a private capacity.
Prior to the involvement of CCB-Eye Care Caribbean, a Government Ophthalmologist had already been in post at Mandeville for 12 years. However, there was very little in the way of equipment, materials and personnel for that Ophthalmologist to perform his tasks. A Canadian NGO, CanSee, visited the Hospital on an annual basis and carried out an aver-age of 65 cataract surgeries on each visit.
2.5 With an estimated 1,500 cataract surgeries per year needed just to meet incidence level, the service available was clearly inadequate. In addition, the service was only able to meet a small percentage of the estimated need in terms of Glaucoma and Diabetic Retinopathy. Some patients could seek services in the Private Sector, or travel to Kingston, or overseas. However, the great majority of patients, especially the poorer ones, would be likely to remain unserved.
3. Negotiation and system development:
3.1 Initial contact was made by the Ophthalmologist at the Hospital, Dr Marlene Smith-Day, to the CCB-Eye Care Caribbean and they were invited to undertake a visit to the Eye Unit at the Hospital.
An initial visit, by the Executive Director of CCB-Eye Care Caribbean, Mr Arvel Grant, resulted in an offer of technical and material assistance to introduce a formal programme of cataract surgery at the Hospital, as a first step in the development of a full set of ophthalmic services at the Unit.
3.2 In negotiating the agreement, the CCB first contacted the then Minister of Health in Jamaica, Hon. John Junor, at a Commonwealth Health Ministers Conference in Barbados and gained his personal support in convincing the MOH to sup-port the intended intervention. Through this channel, the MOH put CCB-Eye Care Caribbean in direct contact with Ms Faye Petgrave, then Director of the Southern Regional Health Authority. Ms Petgrave initiated a meeting with members of the management team of the SRHA, Dr Smith-Day and Mr Arvel Grant.
The meeting agreed on a rough time-table for intervention, starting with a Diagnostic and Cataract Service, and moving on to development of services for Refractive Error, Diabetic Retinopathy and Glaucoma, in stages.
CCB offered to make investments in equipment, training and start-up supplies of consumables, but only on the basis that the MOH would commit to the provision of improved physical space and personnel to accommodate an expansion of the Eye Unit. As a result of this negotiation, it was agreed to find space for the Eye Unit in the newly expanded hospital building (which had not previously included an Eye Unit).
3.4 CCB/Eye Care Caribbean, initiated technical support to the Mandeville Hospital Eye Unit in 1999. Initially this support took the form of funding for equipment, training and low cost, high quality supplies for cataract surgery. From 2002, the support was brought under a Protocol Agreement which allowed for a sustainable system whereby the technical support and provision of sup-plies by CCB-Eye Care Caribbean, would be directly covered (either) by Government or through the fees charged to patients for their surgery or spectacles.
3.5 By 2006, the demand for eye care services outgrew the accommodation provided in the newly constructed hospital building. CCB-Eye Care Caribbean negotiated with the management of the Mandeville Regional Hospital (MRH) and the Southern Regional Health Authority (SRHA) for the then Nurses Hostel to be assigned as the dedicated Eye Unit.
3.6 With financial and technical support from Sightsavers and other Partners, CCB-Eye Care Caribbean, refurbished a section of the for-mer Nurses Hostel Building and equipped it to serve as the Out Patients Department (OPD) for eye health services at the Hospital.
Arrangements for the refurbishing of the remaining section of the Nurses Hostel are nearing completion. Once done, the area will be-come a suite of 2 Operating Theatres, dedicated to eye surgery; re-placing the current situation where the Ophthalmologists at the Mandeville Regional Hospital are limited to up to one surgical day each week.
3.7 The efforts, to date, have transformed output from 65 cataract surgeries each year (in 90s), to more than 600 eye surgeries during 2009. CCB-Eye Care Caribbean projects that the annual surgical out put will triple by 2012, to about 1,800 surgeries in that year.
3.8 The following is a summary of the numbers of: patients seen and In 2007 of the 9,381 patients who visited the Clinic, 295 had surgical procedures carried out. In 2008, the number of patients visiting the Clinic jumped to 11,138 and of that number 497 went into surgery. In 2009, the Ophthalmologists at the Clinic operated on 692 patients; with 15, 803 patients being seen overall during the year.
Prepared by Arvel Grant, Chief Executive Officer.
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{besps_c} 0 | mandeville-regional-hospital.JPG | | Mandeville Regional Hospital {/besps_c}
{besps_c} 0 | dr-gavin-henry-opthalmologist.jpg | | Dr Gavin Henry, Opthalmologist {/besps_c}
{besps_c}0 | minister-of-health-jamaica-John-junor.jpg | | Minister of Health, John Junor {/besps_c}
{besps_c} 0 | dr-marlene-smith-day.jpg | | Dr. Marlene Smith-Day {/besps_c}
{besps_c} 0 | dr-gavin-henry-with-patient.JPG | | Opthalmologist, Dr Gavin Henry with a patient {/besps_c}
{besps_c} 0 | entrance-to-mandeville-regional-hospital.JPG | | Entrance to Mandeville Regional Hospital {/besps_c}
{besps_c} 0 | patients-in-waiting-eye-clinic-mandeville-regional-hospital.JPG | | Patients in waiting at the Eye Clinic, Mandevilee Regional Hospital {/besps_c}