 Hello, everybody. Really, really welcome to the Community I Health Journal webinar. I see we've got attendees arriving. We've got... Beloved, if you could put in the chat where you're from, welcome builder, Dorothy just said, Ruchi Mohammed, I'm seeing Ruchi Priya, Sandy Bhutan, Tulsi's here, hello Tulsi. Ruth, welcome everybody. Gosh, we're up to 29 attendees. Anag, welcome. Hi, Anita. Anita is a member of the journal team who's joining us. Benson and Gure, Bildad, Darman Diwalia. Welcome, everybody. Hello, Dorota. Wonderful. Oh, we are 32 attendees. So it's just a couple of minutes, three minutes past 11. We'll give you a few more minutes. Hi, Daksha. Daksha is also a team member here at ICH. So yeah, from the International Centre for Eye Health and the London School of Hygid and Tropical Medicine, welcome everybody and a special welcome to our panellists here today. This is our, I think, our fourth Community I Health Journal webinar. Here, would you say hi, open up your turn on your camera for us? That would be great. Thank you. Here is our communications officer here at ICH and without his technical wizardry and communication skills, these webinars would never happen. So we're really grateful to you here. Thank you so much. Great. Yeah, welcome. So we're going to start today. So today's webinar is a combination and I've got the two issues here. We've got our community engagement journal and then we also, we followed up a couple of issues later with the catrat. I think it might be a mirror image if you're looking at a catrat issue. And the reason we decided to combine them is because there was so much overlap and catrat being the biggest cause of preventable blindness in low and low income countries worldwide. You know, and you can't really, you can't provide catrat services without the community being involved and engaged. People need to know about it. They need to want to come forward and customers who are satisfied will go and promote the ICS service and convince others to come for surgery as well. So we decided to combine these two issues. And without any more introduction, I'm going to ask Fatima Kiari, who's an ophthalmologist and also an ICS colleague. Fatima, please introduce yourself and then give us a brief overview of the catrat issue. Thank you. Hello everyone. Good morning. Fatima Kiari, I work as an ophthalmologist at the University of Abuja Teaching Hospital. And I'm also an associate professor at the London School of Hydrogen and Tropical Medicine. So I would like to share my screen now. And okay. So we're just going to be talking about the improving catrat services issue, which was talking about better access, better outcomes and better value. I would just like to acknowledge two of my residents who I believe thoroughly read the journal and came up with a summary of which this is what I have, I am presenting to you. So the focus of the issue is a balanced approach to outcomes and outlay together with strong partnerships to create a catrat service that puts patients at the centre and deliver eye health for all. And when we talk about partnerships, what are we really talking about? So it's not just about the hospital because it's patient centres, we need to know what matters to them, ask for their feedback, know what they want. And then the community can also be very useful in terms of service delivery and also in identifying catrat patients because they live among themselves, as well as after care following surgery. Then of course the hospital management, where the hub of the service is, increasing the scope of sustainable service provision with a balance between income generation and cost containment. So in this issue we talked about, how can we balance the two? We know that we would like to increase the services but it's always at a cost. And then the hospital management is always trying to cut cost or at least contain cost. So we need to know how else we can do the income generation and that gives us the sustainable service. Then of course the eye care personnel is very important to the system, the roles, the responsibilities. And then there has to be respect within eye care personnel and team. And there has to be a transparent and fair human resources policy. So the issue talked about this and gave examples of how teamwork can actually increase. So these strong partnerships can help to produce a high volume, high quality and affordable catrat surgical service. Okay, so we can't really talk about a catrat service in this day without talking about effective catrat surgical coverage, which is the ECST. It's the new global target recommended by the World Health Organization and it's not only talking about measuring quantity but also measuring quality. So both are measured. In the previous catrat surgical coverage measure it was just about quantity. How much of people that need catrat surgery actually have it compared to those that need it? So in terms of who are the people that have, how many people have had catrat surgery and how many people actually need it, including those that have had it and those that haven't had it, which is the denominator. So this is the new global target. So it's not just about numbers. It also increased the, it also stated the visual outcome of catrat surgery as a parameter to consider. And here there's a cut-off point of a presenting visual activity of 612 or better, which is really a high bar. In the previous WHO recommendation of what is good outcome is 618 or better. So this is quite a high bar, which means there has to be an improved quality. There has to be increased output. And then of course equitable access. We have to consider children. How do we, how do children access the service and how do women access the service? Older adults, even though catrat is mostly for adults, but we also need to pay special attention to how older adults access the service and of course people with disabilities. So I'll just mention a few key highlights of how these were discussed in the journal. So there are articles that focused on the patient-centred approach and we'll see the article that discussed patient feedback and how that feedback was integrated into the system to improve the service of that hospital. And then the patient reported outcome measures. So we're not always fixated on visual outcome 612. You know, what does that mean to patients and how does that affect their daily living activities? For example, look at the photo I have here, which is out of the journal as well. So acknowledgement to the photo, the journal for the photos. This is just the lady who has had catrat surgery not I guess this her first day post up and she's already back to her usual work and she's happy with it. And then there is an article that also talked about service operational policies being friendly to patients to improve access. We have to think about how we can engage patients, how we can make them happy in the environment. So there's a journal article that talks about that. Then of course the focus on patients needs. Then we have a few articles also that talked about teamwork and efficiency, where we have highly organised an efficient team-based approach. That could be in terms of efficient operationalisation of the system. Like what we see here is the two-bedded theatre. Even if it's one surgeon, the surgeon can swing quickly between the two tables. Like finish one before the next one is set up. It started on the second table and before the first table is set up, the surgeon has started on the other table. So it's quite efficient. And then we talk about bulk purchase. This has been a long-term strategy. You put resources together to buy a lot of consumables, for example, to reduce the cost. Quality monitoring and improving the process shifting. This article talked about shifting from biometrics, ultrasound biometrics to immersion ultrasound biometrics, which improves the IO power prediction accuracy. And that just changed the outcome of the cataract surgery in terms of surgery-induced refractive errors. Then taking advantage of economies of scale by sharing infrastructure and salary costs between more patients. So this teamwork and these strategies to improve efficiency are all discussed in the journal. And then finally, its equitable access is also discussed in the journal. We have to think of how we can address those that have barriers, that face specific barriers. Here we have an example of women by enhancing the experience of care, increasing their awareness, and reducing their non-medical costs. Because oftentimes when we talk about cataract service, surgical service, we think of the medical costs. But we do have non-medical costs and largely women affected. Then increasing demand and uptake. I think I was glad to see that systematic review showed that outreach cataract surgical services are really still very much needed. And in some communities, in some countries, that is what will really scale up demand and also uptake. Then reducing financial barriers, which is another key component of cataract surgical service. You have to think about multiple sources of funding. So this is it. We talked about all these three important parameters in the journal. The patient approach, the teamwork, and increasing efficiency and ensuring equitable access. Thank you very much. Brilliant Fatima, thank you for a really thorough overview of a really complex and in-depth issue covering a huge amount of ground. Really grateful to you. I was just thinking, we were going to go on with Serona next to talk about the community issue. But I just very quickly want to give a couple of minutes to our participants. Are there any urgent questions that you have about for Fatima on some of the topics mentioned? I might be able to take two questions and then I'll ask you to just jot down your questions for when we have a little bit of a longer time. So I'm just looking. There's no hands up just now. But yeah, so if you can, I think there's a way to add questions here. Can you just take us through how participants in the webinar can post their questions? There's a Q&A function, isn't there? Yeah, if everyone wants to put any questions in the Q&A option at the bottom, and then we can ask those to the panellists either now or later when we have a bit more time for questions. That's also the chat option as well, if you just wanted to put anything else in the chat that's not a question for panellists. But you can raise your hand as well if you'd like to speak and we can put your audio on as well. Fantastic, yeah, because I'm just a way there's such a lot of ground that Fatima's covered. So yeah, we welcome your question. So yeah, get your questions prepared for the next session. So Fatima, thank you ever so much. That was brilliant, really, really great. Serana, can I ask you to unmute and put on your camera so we can see you? And then Serana was involved in putting together our community engagement issue. So would you take us through some of the key findings and principles in that issue? Thank you. Thanks so much, Elmine. And hi everyone. Hello from Pakistan. I'm Serana Yasmin. I'm Deputy Technical Director for our iHealth and Reflective Error Portfolio at Sitesavers. Also work very closely with World Health Organization and IAPB in the field of vision care. So referring back to the issue on community engagement that Elmine talked about, in this issue we explored why engaging with communities in the work that we do is crucial to ensure access to eye care for all. I'm going to share some key learning and messages that emerge from different articles. So as part of this issue, we applied a health system strengthening lens to community engagement and explored what needs to be done to ensure universal iHealth coverage with a very specific focus on identifying challenges of reaching the most vulnerable population groups and then how we can work with communities to find the right solutions. The issue also highlighted why it is important for us to involve the community, not only in the design and planning and implementation processes but also making sure that they are engaged in monitoring the quality and impact of eye care interventions and then their role in advocacy that cannot be underestimated. The choices of making sure that we have the right advocacy messages in place and the chances of advocacy success are always high when communities are part of it and they own it. So we all know that health system strengthening lead to equitable access to eye care and one key message from the issue is moving eye health for all is critical to making progress towards universal health coverage. This would give access to all individual and communities to the health services that they need, where they need them, when they need them, without making sure that without incurring any financial issues. So for this to happen integration of eye care in universal health coverage and delivering integrated people-centered eye care for all is central. So making sure that we apply a health system strengthening framework that's the way we'll be able to address the barriers that we face in terms of inclusive service delivery, eye health workforce, data and evidence, governance and quality of care. The need to embrace technology and innovation is also highlighted and you'll find really good examples about it that we can learn from and also integrate into our work. The article on demand-side financing mechanism also share really good examples and tools that can help us to increase access while making sure that we are effectively using our resources, improving the efficiency of service provider and empowering communities along the way. Next slide please. So there is no doubt that meaningful engagement of communities is really important if you want to maximize the impact of our work and a strong starting point is to better understand what a community means and that means including people with disabilities, women and girls and other vulnerable groups. So active and continuous engagement with communities going to help us to understand their need so we can plan and deliver eye care services accordingly and this then is going to have a ripple effect in terms of generating demand and improving uptake of services and we are going to hear about it from Suresh apparently shortly. Social behavior change communication also been identified as a key strategy that support communities to make long-term change in their behavior and that includes how they look after their eye health and how and when they seek eye care. So we need to factor that into our work and also make sure that we invest in this area properly and last but not the least accountability for us as a sector to be accountable to our respective communities and then also making sure that we empower communities to hold all eye care stakeholders accountable including national and local governments. So in some way community engagement and integrated people-centered eye care has a tremendous potential to ensure equitable, inclusive eye care that meets the need of our communities. Thank you very much. Back to you, Elmi. Hello, Simran. Thank you so much for that amazing overview. It's such an important topic and actually when both you and Fatima were talking and you know I'm always learning so much both in putting together the issue editing the articles learning what all the authors are writing and then when we have a chance to reflect at the webinars you know I'm really thinking I think I was even at the beginning of this meeting I was thinking that you know the more we engage with the community the more we can kind of get people to come in for services you know I'm thinking from the community as a resource but actually with community engagement it's about serving the community it's about being humble as eye care workers and actually I would like the panel to please put on your camera because I think this is a really good place to start our panel discussion so if everybody can in the panel please feel free to turn on your cameras you as well it'd be lovely to see you as well yeah it's how do we serve so maybe the first thing that's required and perhaps everybody who's here will already think like that it's only me who's got a slightly mercenary approach to eye care and health care but it's to think that we are really here to serve the community and you know in all aspects so you know women people who usually marginalised as well so how do we reach out beyond that the eye clinic and make sure that we are engaging with community so Simrana maybe first question to you how does this work in practice because it all is there's lots of big words and there's lots of concepts but taking it from that United Nations World Health Organisational Level down to as eye care practitioners what should eye care practitioners do you know do differently how does it look in practice I think as a starting point Elmen really important is the context so we talk about community engagement from this bigger lens which is looking at it from global perspective and then kicks in your regional perspective and then national and within national then you have your state or provincial and district level settings and socio-economic cultural dynamics are really different from context to context so just making sure that we are aware of those sensitivities when we start engaging with communities is really important like from my perspective if we manage to make sure that we have a really good understanding of the respective community let's say for example we want to start an eye care program or service then having that insight that what works for this community and making sure that we connect with all the relative stakeholders in the community to get their feedback in what works for them rather than coming up with the you know blueprint recipe that works somewhere else is important and then identifying within the community community champions who are our allies and help us to take this agenda forward is also going to be really critical so if we manage to check these two boxes in the best possible way I think we will be on a good start fantastic fantastic thank you so much anybody in the panel faith I see you are nodding there because that's your area of speciality and we'll hear from you a little bit more later on but just to respond to that point from Simranna please unmute yourself and come in on that thank you good afternoon so I just want to I agree so much with Simranna when she says that you have to take a program that works for the people in that particular area and not duplicate something else it may not work in another place yes so you have to consider so many other things before you go and implement a project in an area yeah absolutely absolutely and thank you and Demisi I'm just looking at you because you know the article you wrote for us in the journal and the cataract issue was about taking an eye unit and just completely increasing massively increasing the cataract surgical output and that had so much to do with community engagement so where do you start and practice you know as an eye health practitioner which seems like sort of a chicken and egg you need the community to do the eye care and you need good eye care to get the community so where's a good place to start yeah thank you Elmin no I completely agree with what Simranna said and phase added you know the community context is very important and it is different with different communities if you're working in a pastoralist area or in a different area the culture the you know the way you address the community the way you reach the community is different from my perspective to your question I worked there and I was sharing my experience at Sabati hospital in western Kenya where I worked for six years as a hospital director assigned there and looking at the potential the huge catchment area the hospital service and the need around what we did was we looked at two approaches one was institution based that you know the service that we provide at the center for those who come looking for the service at the center like any other hospital the second approach was also to reach out to the community 50, 60, 100 kilometers away where the services are not there and we try to address their needs by going out there so the two approaches are a little bit different the hospital based approach worked very well first we worked on ourselves on the institution no building systems bringing the capacity in terms of looking into our equipment our staff our working environment our patient flow no making trying to make a patient center from the moment that patients come into the the compound to be properly communicating with them addressing their needs respectfully managing them and so on and improving the efficiency of the system on the ground in a way like where we even went to the level of probably operating patients who have come from far almost the same day if they are ready and if they are you know preparing them counseling them because usually we lose patients if we return them back they put a lot of effort to come from 60 kilometers you know a blind bi-laterally blind person with the help and probably sometimes they come selling their resources an hogs a cow and returning them back is like sending them or condemning them to not to have service or not to come back and so on so we worked strongly in improving the capacity the systems on the ground worked on our staff in the way they handle our patients more effective efficiently and not giving appointments no sometimes you know patients coming in the morning sitting out there not being attended well all that you know brings in a negative impression by the patients and a negative you know word of mouth to the community and so on so we improved on that and that improved the institution based service both in numbers in quality and in outcome as well the second approach with the you know the outreach service that we expanded and there as well is where the especially the community engagement the community issue comes in outreach services usually work strongly if you have people on different communities where you go people who reach out and who know the community who know the culture who know the tradition who will reach out to them influence them that we are coming as a team there is a service they should be also a good organization on the ground in terms of know where you do the consultations where do you do the surgeries and in a very strong you know using local radios or the churches the public gatherings and so on so that they reach out to the people so that people are informed people are informed that there is a good service coming to them so they benefit from that that is an important component of the outreach service good mobilization sending out good information and then again still your quality of service provision you shouldn't be minimizing it as much as possible the quality or the standard of service that you have been offering at your center you still keep that quality sometimes when you are out of your center there are challenges that will hold you back a little bit and so on but we still try to maintain that quality service and also work with schools other centers where the operative environment is also good enough not substandard and so on so it's mobilization it's reaching out working with people influencing the community on the ground they can be alliance clubs they can be community organisations women's organizations and so on we did work with various community level organizations in terms of doing our outreach and reaching out to the needy in the outreach service so what we did was a little bit different for both aspects of service delivery you admitted it oh yes thank you thank you I just noticed thank you so much thank you so much that's really helpful to see the perspective both are usually needed aren't they and Hannah I was just looking at you you were involved very much with the community issue and you wrote about the last mile you know reaching people at the last mile and I think that probably dovetails quite well with what Demacy was saying that you know having to reach so hospitals and centers need to reach right out into the community so I just wondered if you have some thoughts and thoughts to share and tips and some you know approaches or principles on that I think much much of what we did has been mentioned but let me share very practical examples a lot of us are in it we would probably be an ophthalmologist or a nurse at the hospital and I would draw from my own experience of what I had to do in the Gambian one is to take care of the team at the base hospital and one success factor was to have a person responsible for that community engagement that we had a nurse who knew the culture and everything concerned with the community to lead on that aspect within the hospital base then the second point was to make ourselves understand what the community is so at the community level who does the patient go to who do they consult what are the systems what are the traditional so we educated ourselves first to understand what that's led by this lead person at the hospital then we designed a way to contact the community using this person as the lead person so in bite size you cannot do the whole country at once so you would select a geographical area and then use that person to transmit or change or understand what I have in is with the traditional systems the women's groups the community health workers just shaking hand and making friends with the community first so they understand us and we understand them and we made that the third aspect was that whoever was working at the community we helped them in a bite size with we understood that they would be taking care of 5,000 population area so the work is not too much for them and then the next level would be 10,000 and whatever they were doing the integration is so important that eye health is not seen as an asylum it is seen as whatever else is going on in the community and because that person is working in all other areas the success is that if they are talking about the child they would mention eye health if they are measuring blood pressure they would mention so integrating into whatever they did so that was so to summarise half the person at the institution who would be responsible have a team that person as some runner said is context familiar context knowledgeable and then that person would guide the rest of the team at the main hospital and then that person would transmit and be a bridge between the institution and the and the community the when you think of community most times we think of that last mile as you say but the last mile could exist in the prison the last mile could exist in schools the last mile could exist in the markets so that concept of that person who is not being reached is the last mile and how do you do that you can integrate eye health into anything they're doing in health but you can also see them as a resource so the health system would be a resource so whatever resource they are using to see the child resource they're using to see the non-communicable diseases you would then push in eye health into that so that you use that resource because in eye health you may not have the resources but if you piggyback eye health into them any other program or any other captive population we piggyback and that has to be an objective a set objective with strategies and plans and people who would be responsible for integrating into those resources the third resource that is very good is the community development they are responsible for water or agriculture or nutrition or the non-health government system so integrating into that I cannot overemphasize the point of the people at the third level or the institution having a team responsible for making this happen a bridge person that would link the tertiary to the community and a way of measuring that actually absolutely being successful in in in those areas so apart from measuring the quality and the quantity let's also have a way within the team of measuring whether we are achieving that last mile whether we are achieving the integration absolutely Hannah thank you so much those are powerful words and I'm really glad we're recording this meeting because we're going to post the webinar online and we can listen back and take notes I'm definitely taking notes thank you so much and what you're saying about measurement is so so important and that links back to what Demisi was saying and far too much to you as well I'm so glad you highlighted the effective cataract surgical rate concept when you when you spoke because it actually that's a really good measure not only of the of the actual visual outcome the usable visual outcome for the patient so it's not about just the number of cataract operations it's about cataract surgery that gives people good usable vision but it also measures that against the need then people in the community who still need surgery so actually now on a national level it's it's now possible actually everybody's now being encouraged to use that as a measurement by the World Health Organization Fátima, I'd love to hear a bit more about that from you I'm just aware of time we're going to be hearing from serration from faith as well we've got a video recorded an interview with faith but that's maybe unless there's other questions we can come back to that issue at the end of the next two rapid fire presentations so hold that thought and I think if I'm correct the next would be faith if we're going to hear will you show us the video of faith thank you so much we're not hearing the sound yet so my name is Fátima Langarth I work in Thernwick Hospital Bormett County as a project manager coordinating vision impact project in Bormett County our role is to ensure that we link we are actually like a bridge between the patient and the healthcare system so we strengthen the health the health system we use the existing health systems at a time phase and we are lucky here in Bormett that our health community health strategy is very bright vibrant we have all the community health volunteers in all the community units it's well structured it's well managed it's well supervised such that if you go to a community unit right now and call for the 10 community health volunteers they'll all come so our our role there is to link that to the to our health so for example we through the vision impact project we need screeners and we use community health assistance to screen so our role here is to ensure that the community health assistance gets the best and very high quality training on identification and prevention and referral of eye problems or eye conditions so we take them through a rigorous three days training on primary eye care and disability inclusive development training and we also do a five days training on PIC because this is the system that we use in referral in identification also and in data collection and referral of our of our patients so we ensure that they are well trained we also train them to mentor the community health volunteers because we don't train the community health volunteers so we train them so that as they work with the community health volunteer he mentors them so that once they live then we have a sustainability plan so that the community health volunteers will also be sensitive that we need to refer patients who have white spots or patients with allergies or the tiari red eyes or children who have screens we need to refer them so um so we ensure that they get good training we also train a OSUP or a family skills upgrade cost to nurses and clinical officers this also maintains this with our staff who will work in the dispensaries and health centers so we take the services closer home to the people so we also ensure that they also undergo a three months training here in general hospital and by the time they go back to their facilities they are able to identify treats and also refer cases too either the secondary facility which is our country referral hospital or to terminal hospital they also of course conduct the treatment outreaches together with staff from the county referral hospital and the tertiary facility terminal hospital so they also conduct the treatment outreaches so by providing them that quality training then in the treatment outreaches we don't we minimise the chances of missing out on very important critical aspects yes Brilliant thank you I'm so glad you can be with us today as well Faith that was great um I think just a very quick question I'd love you to elaborate on I mean you do a huge amount of training and ensusing people in the community to engage and train it must take a huge amount of energy so how do you motivate community members um sorry these different volunteers and and you know role players as Hannah was talking these different people who are already engaging with communities how do you get them enthusiastic about iHealth and and um you know achieve what you do please unmute yourself yeah there we go thanks okay so um for us uh iHealth here in Bomet county it's like something that is new we know of course there is high health but to the community volunteers it's something that is relatively programs that have not been done if I can say so so people are really still very excited very enthusiastic about it you teach somebody and already they are saying that they can relate to a person they saw in the community or even their own relatives so um we are not having a bit of a challenge getting them interested also in the community people are really interested they come in very large numbers to the treatment outreaches and so it's very important that we maintain very high standards of trainings both for the screeners and also for the health care health staff yes fantastic thank you so much faith brilliant i'm going to move on quickly to Suresh to talk to us about because Suresh your article was really kind of started off during the pandemic yes and so please introduce yourself take us through what you've done and then I'm going to open up the floor for the panellists to ask any questions of both faith and yourself for both of you about your work and then also open up to our our participants and attendees at the webinar so please start jotting down your questions you can start putting questions in the Q&A as soon as you're ready and but Suresh please take it away yeah yes thank you thank you very much this I'm carrying my slide so good evening to all and thanks for the opportunity for sharing the work that has been done by partners of LICO and LICO is also a part of the member because this is a collective work done by roughly 14 high hospitals so along with me there is Mr Eson Eson who was a part who was a principal author of this article so this basically was an initiative that was been started during the time of COVID when all of us have been stuck with the COVID lockdowns and we are not doing any outreach programs to reach out to the communities to take care of their ICANNs this is when it started so as we all know I saw Hannah from Madam talking about the demand side challenges and Fatima talking about all those aspects so during the time of pandemic it was much worse and because we were not sure when we will be when the demand will rebound and when we will have access to all these patients to take care of ICANN and we also don't know when we will be organizing outreach program and we are also not sure whether the during the time of lockdown whether the patient perspectives and expectations from the providers also might have changed so everything we had only the questions in our mind but we never had any answers to those questions when we started this program and all of us in this forum will agree that that outreach program is another key strategies that we all apply in a day to day situation to reach out to the community members but the outcome of the program which you will see is that there is a lot more people that needs to be served so in a way or other we need to identify an alternative strategies are an supplement to an existing ICANN activities so thanks to COVID which has pushed us to think of some supplement to an existing program that is a community outreach program so really we must thank the COVID for giving us this opportunity so as Dhanafan madam was telling I like the words he was reaching the last mile so also taking that into the context also like if you want to provide an ICANN to the community somebody needs to own it so whether we can make that community organization within the community own the ICANN problems of the community whether the students ICANN whether the students can where the schools can own the high health of the students whether the industries because you want to with the the industry wants to be more productive their employees needs to have a good vision whether they can own the ICANN problems of their of their employees and also how do we best build the referral network among all these organizations as always within the community if all these people taken ownership in their own community then almost like what Hannah madam was telling that we will be able to try to reach the last mile in the community so this was the big challenge that we had we were thinking of having it so still now if you see everybody we have been talking about the all the outreach program what we do is most likely is driven by the hospitals so can we make a shift instead of having in hospital driven outreach program to a community driven outreach program so that there is an ownership within the community so that they can drive the outreach program irrespective of the providers whoever is there so this was the approach which we have taken during those periods and it was an it was a collaborative program so there were 14 high hospitals who came forward during that time to pilot this initiative and there are 11 high hospitals from India one from Bangladesh one from Kenya and one from Nigeria and even though we have taken seven approaches in this pilot but in the paper we will see we will we have reported only six approaches which is related to the community related programs one approach was extremely on the secondary secondary cataract surgery which you are not reported because it is not exactly related with the community engagement program that was the only reason which why we will see only the six approaches mentioned in the paper and in this program Aravindai hospital was a part of a learner we also our hospitals also engaged in this program Allah and in the 11 hospitals there are two high hospitals of Aravindai hospital if you see this outcome really we are very much happy because in the 8 because it started everything started in the February 2021 and it ended in the September 2021 if you see during this eight months period all these 14 high hospital has performed a total surgeries of 20,900 cataract surgery and interestingly 18 percentage of the cataract surgeries which is close to 4,000 surgeries came through the approaches what they implemented during this eight months period so I will go through this in brief considering the time I will just briefly go through what are these seven approaches we try to implement which the partners try to implement in their hospitals if you see the first one which I told we have not reported in the article which is on the other eye cataract surgery because we know that if that's a sort of a kick patient if it's coming from routine eye examination the other eye can be operated so that is the first approach we have taken and then the second approach is that as Demisi was mentioning about in his things the patient should be satisfied so that whether it is within the hospital or outside the hospital so we have taken that as a known of the thing the patients those who are satisfied by receiving the services in the hospital whether they can be motivated to refer further for the patients in their community to the hospitals so how do we liberate the existing satisfied customer of our own services whether it can be an outreach program or it can be a hospital based program so how do we liberate the existing satisfied patients those who can refer patients and then in the during the pandemic we are not supposed to conduct a huge gatherings to undertake an outreach program so there is a hospital will undertake an this approach of having a mini they termed as a mini screening program where they will target only one village in a day whether it can be in one village or a two village in a day where it is only minimum two or three people goes like for an example an ophthalmic assistant and a driver and a counselor so three member team will go they will they will not do mic announcement publicity they will mobilize the patient with the help of the community members and then they bring the patients not more than 15 to 20 in a they like maximize 15 is there what minimum 10 to 15 is what they bring in a bus with the with all social distancing so they used to organize small small camps in each villages even though it's a time consuming but they used to get a good outcome out of those programs then as we all know that the the the hospitals those who have been engaged already with the community partnership or with the community members they have a very very trustworthy community members so again how do we leverage these community members are philanthropists or like for an example any school teachers are a priest go over there in the community who is a well-wisher of the organization how do we leverage them so that they can refer directly patients to the hospitals so in this also we have done a lot of referral because we don't want because during the pandemic we don't want the patients to come for an eye examination and go back without surgery because of any systemic problem or some other thing so we had a very good referral card where the patients before coming to the hospital they will undergo they will they will measure their blood pressure they will measure plus random blood sugar if needed they will get their physician opinion then they come for the surgery so that there is a drop out of the patients who has come for the surgery has not been sent back without any surgeries and also it was full freedom given to the community members to to let us know in the referral letter whether this patient will be able to pay for the surgeries or the hospitals need to treat him for free of cost because of the trust that the hospital and the community has all the hospitals has accepted whatever been recommended by the community members if the community members tells please treat this patient as a free patient he was given free surgery if he was advised that please try to collect only the subsidized charge it was adhered so those who need a feco-surgery are something then they used to give us a paying surgery so that the trust that between the community and the hospital had a huge impact on this then there is another program which was exclusively implemented only in Kenya which is a door-to-door training by a cataract finder in this program what they did is typically they have enrolled engage two community members it is persons from those community who have been trained in a primary eye care in visual acuity understanding eye problems and they have given and also in addition to all this examination kit they were given a motorbikes so they used to you will see the photographs in the article also so they used to go in the motorbike in the community screen the primary screening they will do the primary screening and try to identify all the cataract patients and also refer them to the base hospital for the surgery if in turn they were not if the patients are far away they are not able to go on their own to the hospital once in a week they have to collect the patient those are identify the cataract surgery the hospital used to send the vehicle to pick them up for the service and also drop them back and then the one more approach which worked very well in the eastern and the western part of the country of India is here I really I accept that that way that all the service what we provide it needs to be customized as per the community so this program was very successful only in the eastern part and the western part of the Indian country where the hospitals tried to tie up with the already practicing optometries in the community so they were already selling glasses dispensing glasses to the public so the hospitals made a very good memorandum of understanding with the optometries so that the people coming over there if they have any cataract and any other if the patients need any other eye services they refer to the particular hospital for eye surgeries in turn this opto in turn this optometries just finish your thought thank you go first yes yes yes in turn this optometries were benefited by the follow-up because the poor property glasses was been given by this optometrist fantastic that's that's such a good time with the existing system I'm going to unfortunately have to stop you there because we we wanted to have a bit of time for questions and I know some of the panellists will have to leave in one minute but thank you so much there's a lot more information on that article in the journal itself so please have a read and it very much stuffed us with what everyone else has been saying about working with those existing systems so well done thank you for sharing sharing that with us and sorry we had to cut your short and before we open up for questions I'm very very quickly just going to share a link in the chat as soon as I can work out how to get to the chat we have a very quick few minute survey that I'm just going to share with everybody it's a link so let me just see if I can hold on a minute it's not working anyway I'll share it as soon as I can we would love you to fill out a survey just to give us some feedback about the webinar and you know any feedback on that but they start with the questions there's a comment from Tulsi to agree that he's also experienced some challenges there and then Boniface Madishona says community driven outreach is an interesting innovation it brings a sense of ownership of the program to the community and is really keen to have details of the findings of that collaborative research effort so thank you for sharing your email address there Madishona so I think that's probably a question something for you Suresh yeah so please Taig we'll share that details it's really really fantastic research so please raise your hands I'm just thinking Hugh would you come back on camera and just see how we can ask people to to ask questions how what's the best way so we've got just raised our hands in the at the bottom with your reactions you can raise hand and then we can allow you to speak yes I'm not sure if I'm saying anyone right at the moment and I've just put the link in the chat it's a bit dug it's bit.ly forward slash C E H J Web and we'd be delighted if you could pop in there and and ask you know and just let us know what you sort of the webinar and and what we can do so any other questions anything I'm just I do me see thank you for putting up your hand please go for it yeah yeah no it is interesting to to hear from Fatma on on the patient reported outcome quality you know measures which is prom which is interesting which probably measures not only like we're routinely doing the visual acuity and compares the vision of the patient but it tends to measure the quality of life that cut that cataract surgical outcome has brought to the patient if there any comparison or any correspondence done between the two because that one tends to be more objective and if there any correspondence or like matching in terms of analysis of how do the two come together in reality if there any study done to prove that because I read on the article that I didn't get to that level of a detail to understand it better yeah yes and demisi thank you for bringing this up actually I was also going to talk about that you know the effective cataract surgical coverage really talks about visual acuity in relation to the quality of the cataract surgery and we have things like patient related outcomes there has been I haven't really seen a study that compares the two or maybe to correlate the two more to say but what I have seen is studies that even with poorer visual poorer visual outcomes patients are still happy and satisfied you know so I think there's a lot more to patient satisfaction and patient related outcomes more than just the visual acuity so that is one of the things that we actually look at when we're discussing the effective cataract surgical coverage because it's focusing more on the visual acuity but there are other outcomes just like I was going to even mention like the sabatiya eye hospital there are other outcomes that have actually improved the experience the patient experience and even the post-operative you know patient experience not just the visual acuity so there are so many parameters that need to be considered but I think it's just about setting a standard and setting should I say a consistent perhaps parameter that can be measured across board so we give the visual acuity in terms of effective cataract surgical coverage notwithstanding that it's actually gives some kind of pressure on the system especially in the systems where we cannot really produce that kind of output like in Nigeria I know I've only seen one survey one documentation of where they actually reached the WHO recommendation for good in 80% of those that had cataract surgery and now we're even raising the bar we're making it 612 rather than you know the previous 618 so it's really going to be a bit of a pressure I think we need more support not just in terms of skills but also in terms of resources the kind of resources that would how do we measure the prediction of the post op you know visual outcome how do we get the intraoclern lenses that that person requires gauged on the ultrasound or the recommended IOL so these are really things that we have to put in place before we can actually say we need to have that effective cataract surgical coverage if not we'll continue to have those quality gaps you know reflecting on our books so I think we should also delve in other other outcomes that really help the patient Fantastic that's brilliant Fatima thank you so much and Nasiru I would like to invite you to to speak please you've got a question thank you very much not necessarily a question really but to add to comment just raised by Fatima that it could be a pleasure raising the back we currently support a state IPA program to implement our patients file the program then it's human resource capacity in one of the states in India quality was a watchword from the beginning back in 2018-2019 and our quality measure then was 618 and then with the effective coverage now it's back to now a higher threshold of 612 and I recall we started without biometri and our quality was around 50% or there about so resources have to be fooled enable us have biometri now we do biometri and then you have the IORL challenge you do biometri you don't have the actual range of powers sometimes we have to contemplation because the IORL are completely off what ordinarily we provide for an outcome so we have to be sharing them too and at the moment we are around 70% first day post-op too it is really a pleasure but like you said we are trying to build up the resource insist on skills support each other because you generally have a team of surgeons you need to support each other to see each one improving over time and happy we are all reasonably happy that we are growing so that's my continuity with you fantastic fantastic Fatima did you want to just comment on that no I absolutely agree with him you know and that is just what I'm saying he just brought out you know from the field experience which is actually what is going on and on all that so I think resources you know supporting the practitioners to provide the resources I mean to have the resources to provide that quality is very crucial yeah fantastic thank you so much and on that point we've gone slightly over time but I hope you'll agree that was really worth it now Sirius thank you so much was really good to hear from you and a huge thank you to all of our panellists and all of you for attending I hope you saw the link in the chat I posted one last time we'd love to hear feedback from you about the review and if you have any further questions there's some free text please feel free to add them there and all of your input in feedback will you know either go into future journal articles or journal topics or into future webinars so we're really keen to hear from our readers about your needs and a final huge thank you to Hugh our comms officer if you never have your title rights sorry just for arranging the webinar and yeah for keeping everything going and all the technical side so grateful for your time and again thanks to the panellists and all of you please keep reading the journal tell your colleagues about it tell them about the webinar we'll send out a link I think Hugh to all the everybody who's registered you'll get an email with the link you know to all the recordings and so on it will be on our website as well so yeah keep on keep on going and thank you for all the work you do to improve eye health globally really appreciate all of you have a lovely rest of your day and a good week bye bye everyone bye bye thanks Elmi bye thank you bye bye