Thursday, December 15, 2005

KCCO: In The Eye Of The Storm

There is a lot that needs to be done in improving the delivery of eye care services in Africa, and the Kilimanjaro Centre for Community Ophthalmology (KCCO) is in the thick of it.

While partnering with numerous organizations and initiatives the KCCO is on the scene delivering health care where it is needed.

Because the United Nations set a series of goal in its Vision 2020 plan, there is a raised level of awareness about eye care and health, particularly for people living in developing countries.

In Africa a shortage of trained personnel and the absence of an effective and efficient system to deliver eye care services, particularly for cataract surgery has caught the attention of several concerned groups.

According to the web site of The British Columbia Centre for Epidemiologic & International Ophthalmology a "report prepared by an international consultation group (April 2000) recommended the creation of the East African College of Ophthalmology to improve the infrastructure and to standardize training among the four universities currently training ophthalmologists in Tanzania, Kenya, and Uganda. The report also emphasized the need for personnel trained in community based approaches to eye care delivery." At the time there were no strong programmes in community ophthalmology in East Africa. Among the four universities training ophthalmologists in Tanzania, Kenya, and Uganda was Kilimanjaro Christian Medical College (KCMC). And due to its location in a non-urban setting it was thought to be particularly well-placed to initiate such a programme. In addition to its non-urban location, the presence of a pre-existing community-based rehabilitation project and a history of interest in outreach and training, and ongoing community-based eye work made it attractive as well.

As a consequence the Kilimanjaro Centre for Community Ophthalmology was enlisted in this effort with the goals of

1 building the capacity of KCMC/Tumaini University to become a recognised centre for community ophthalmology and prevention of blindness; and

2 building the capacity of eye care professionals and others to implement prevention of blindness activities throughout the entire eastern Africa (Egypt to South Africa) region.

Tanzanian staff were hired and trained at all technical levels to become experienced in community ophthalmology and take on increasing responsibilities, "thus strengthening the infrastructure to sustain a high-quality, internationally recognized centre devoted to community ophthalmology."

KCCO has been so successful that in 2005 it was the subject of a case study in the British Journal of Ophthalmology (BJO-Online) where it was reported that the KCCO had performed 1165 cataract surgeries in the Kilimanjaro Region of Tanzania. The KCCO attributed its success to the following:

(1) The programmes in the community and at the hospital are closely linked so that they increase capacity together;

(2) KCCO conducts patient friendly programmes in a one-stop service context;

(3) The team of professionals performing the examinations includes eye workers with a sufficient level of skill to provide treatment and decide who can reasonably benefit from an operation so that patients are not needlessly put through the process of being transported and referred;

(4) Population distribution determines the sites for visits to a community and the visits ae conducted according to a regular schedule.

KCCO also partners with the The International Resource Centre for the Prevention of Blindness. This organization, among other things, operates to provide information and educational resources for eye health workers worldwide. And it is said that they are "Improving access to reliable information for health workers in resource-poor countries is potentially the single most cost-effective and achievable strategy for sustainable improvement in health care." They publish the Community Eye Health Journal, which they distribute free of charge to more than 15,000 eye health workers around the world. They develop teaching and education materials on blinding eye disease and related topics and distribute key texts, videos, slide sets and manuals for prevention of blindness.

There is a lot more I could say about The International Resource Centre for the Prevention of Blindness, but this article is about KCCO, and I must move on. However, I would like to note that they are "a division of the International Centre for Eye Health (ICEH), which is a research, training and information centre supporting Vision 2020. ICEH is a World Health Organization Collaborating Centre for the Prevention of Blindness based at the London School of Hygiene and Tropical Medicine."

Another partner of KCCO is Helen Keller International. Helen Keller International - Tanzania was established in 1984, and it was HKI's first office in Africa.

HKI-Tanzania was set up to provide primary eye care services in central Tanzania. And the HKI-Tanzania web site states that: "Pioneering efforts were made in the field of trachoma, and the Kongwa field office was the cradle for the WHO-endorsed S.A.F.E. strategy for trachoma."

HKI states that it is working with the Kilimanjaro Centre of Community Ophthalmology, in two regions in northern and central Tanzania to develop VISION 2020 programs for their region. "Regional Task Forces have been set up in both regions consisting of all eye care partners in the region. In both regions, HKI is working with partners to increase cataract surgery rates. The blindness rate due to cataract is 50% in Tanzania. The eye care program in the country is characterized by a large backlog of cataract cases, unequal distribution of ophthalmologists and cataract surgeons between urban and rural areas, inadequate performance of surgeons, poor coordination among prevention of blindness organizations (governmental and nongovernmental), inadequate program management, and an inability to reach out and mobilize communities where eye care services are most needed. Both the northern and central regions are investigating how to reach out to the communities through the creation of a region-wide direct referral site program and how to develop a sustainability plan with the regional hospital, including financial and organizational sustainability to institutionalize eye care services."

HKI is doing a lot more than I have talked about here, and HKI-Tanzania is doing a lot more in Tanzania than I have talked about here, but you do not want me to try to post a book at this log site, so I have to move on.

Another partner of KCCO is Seva, whose founder won the 2006 TED Prize. Seva says that the activities of the KCCO include:

"Development of community-based programmes and hospital based programmes to improve cataract recognition and referral by existing primary care and community based rehabilitation workers

"Creation of strategies to improve uptake of cataract surgery by women

"Investigation of innovative methods which have been used elsewhere to improve uptake (such as collaboration with traditional healers and training school children).

"Recognition and referral of children with vision loss through training of teachers and others

"School screening for refraction through collaboration with ophthalmic medical assistants

"Expansion of trachoma programmes (SAFE strategy) in collaboration with the

"International Trachoma Initiative (ITI)

"Expansion or implementation of vitamin A programmes

"Development of a programme to improve the efficiency and management of current outpatient and outreach activities
"Training in community ophthalmology to ophthalmologists and ophthalmology residents, particularly those from the East Africa region.

'Training courses for allied eye health personnel in community ophthalmology and eye health."

If eye care is of interest to you, KCCO provides a very inspirational story. And you can read more about them and the other organizations that I mentioned in the article at the cites below.


The British Columbia Centre for Epidemiologic & International Ophthalmology

The International Resource Centre for the Prevention of Blindness

HKI - Tanzania



1 comment:

Anonymous said...

Thanks for the write up about the KCCO. Our website is

Paul Courtright, DrPH
Kilimanjaro Centre for Community Ophthalmology
Tumaini University
PO Box 2254
Moshi, Tanzania