Reaching the poor with eye services. Experiences from the family practice unit, Manaus County, Brazil
Blindness is often concentrated in poor areas and socially deprived communities, making blindness prevention a social and political challenge. The blindness prevention program at the Family Practice Unit in Manaus County, Brazil, has developed a model to reach patients through the public health system. The approach aims to detect patients in the community and refer them to ophthalmologists based at the clinic. Two ophthalmologists work with family practitioners and community health workers to whom they provide training on how to screen and refer patients. Barriers such as distance, culture, costs, and lack of information are broken down with this approach.
Between the years 2000 and 2003, 15,129 patients were seen at the ophthalmology service of the Family Practice Programme in the city of Manaus. The projection for the year 2004 is 8,640 consultations among the four centers distributed at the north, south, east and west areas of the city. In 2003, 110 diabetic patients sent by family practitioners and community health workers were evaluated, demonstrating the need to improve the screening of diabetic patients in the city. Refractive errors were the reason for consultation in 80 per cent of the patients during 2000-2003. Conjunctivitis, eyelid problems, cataract, and glaucoma were other frequent causes of consultation. Only 6.8 per cent of the patients seen at the unit were referred to the general hospital for further diagnosis and treatment.
Demand for eye care services in this area has increased continuously since the start of this programme. The location of the unit in the community, the focus of the clinic on the poor, and the emphasis on information, seem to have created an efficient and popular service. Brazil has about 50 million people assigned to these Family Practice Units by the Public Health System. If each unit had an ophthalmology service like Manaus, Brazil could make a great impact on prevention of blindness at the community level. The model might also be applicable to other countries.