The Promise of Toolkits

Rènée du Toit

The Promise of Toolkits

To solve technical problems while aiming for self-reliance

Despite potential, rigour and evidence base

“the usefulness of toolkits in the field has often not lived up to expectations”

WHR 2008. PHC: Now more than ever

Why??

• Under-estimates the complexity of the problems

• If accepted as an off the shelf solution: limits engagement with countries.

Engaging Science: Thoughts, deeds, analysis and action Wellcome Trust Report

PEC ToolkitCollection of materials: 1. Existing 2. Fill gaps3. New ideas

I cannot

see close

by

Did it happen

suddenly or

gradually over time

Refer

Referurgently

Reassure

Refer OR provide

presbyopic spectacles if available

LOSS OF VISION

My vision is blurry

Measure distance

vision

Measure distance

vision

Gradual loss

ReassureVision normal

Vision abnormal in one or both eyes

Vision abnormal

Measure near

visionVision normal

Vision normal

Vision abnormal in one or both eyes

Sudden loss in one or both eyes

WHO - algorithm

Toolkit1. Training course• Health promotion and

prevention • ‘Curative’ care• Health systems information2. Implementation tools

Referral

Tertiary

Secondary

Primary

Service delivery: Accessible care

Appropriate referral pathways exist

Well trained staff / equipped facilities Human resources:

competent referral decisions;

patient informationRetains competency

Finance: can people afford

it? universal access Leadership: implementation

Guidelines / algorithmsFeedback on referral

(continuing education, continuity of care)

HIS: # of people seen

# referred, # reported, # correctly referred; evaluation of referral pathways & services

Equipment and supplies:

sufficient at primary and referral level

Health systems

support for referral

pathways

Implementation toolsSelect training materials• Who?• Where?• What must they do?

Set up support required• Do they have what they

need?• How can we be sure of

the quality of care?• Can this be scaled up?• Is it sustainable?

• mobile phones: enter symptoms into a decision-tree based algorithm

• mobile broadband or SMS/MMS to connect to a remote doctor for a consultation

New ideas

http://clickmedix.com/

• first aid• recognise and refer / reassure (most common

eye conditions)

skills required by different groups

• integrate eye health into other messages• tailor these to the audience • be creative / imaginative in promoting

health promotion and prevention

• evidence based guidelines / expert group consensus on guidelines/algorithms

• health systems support for implementation

quality & sustainability

• guidelines / expert group consensus on guidelines/algorithms

• adapt & pilot & improveevidence based

The answer is…..

• We don’t have all the answers• The answer will not be simple• The answer is not only a hammer

"If the only tool you have is a hammer, you will see every problem

as a nail.” Maslow

Any suggestions?

• Content of toolkit – what will be useful to you?

• What can you contribute?• Any volunteers to piloting algorithms /

processes?