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COVID-19 and Ophthalmology in African Eye Units

3 July 2020


Established in 2004, the VISION 2020 LINKS Programme builds long-term partnerships between eye care institutions in Africa and the UK that increase the capacity of health systems for eye care in low-and middle-income countries (LMICs) by giving eye health workers the knowledge and skills to prevent and treat eye diseases.

Over the course of the last 16 years, the programme has seen 30 VISION 2020 LINKS established between training institutions in Africa and the UK. Many of the LINKS have benefitted from funding from the Health Partnerships Scheme and its predecessor, the International Health Links Funding Scheme, managed by THET with funding from DfID. It was apparent that many LINKS were addressing similar eye care issues and the decision was made to establish Networks of LINKS. The Networks address specific training needs – such as diabetic retinopathy (DR), retinoblastoma (Rb) and Train the Trainers – across Africa. Like individual LINK health partnerships, the Networks take a whole-team, multidisciplinary approach to training, fully involving Ministries of Health in each country to ensure that service development and delivery are integrated into national plans and budgets, for sustainability.

The onset of the COVID-19 pandemic presented particular challenges to eye workers, who, like ENT specialists and dentists, are particularly at risk from exposure to the disease and need to ensure adequate protection. The response of the VISION 2020 LINKS Programme has been multi-faceted.

Firstly, as face-to-face training via health partnerships is not possible at present, and as requested by numerous African LINK partners, the LINKS Programme team worked with colleagues at the International Centre for Eye Health (ICEH) at LSHTM to develop and promote resources for COVID-19 via the internet. The LINK partners in Africa span 13 countries and, with contacts in eye departments in most of the hospitals in these countries, the reach of the resources produced has been both wide and well-targeted.

The first priority was to deliver guidance for eye health workers; so the team published a comprehensive article in the Community Eye Health Journal, which is free and widely read by eye health workers in LMICs. In addition to providing links to relevant international guidelines, the article provided essential information for eye health workers on how to protect themselves from COVID-19 infection and advice on which patients need to be treated as emergency cases to save their sight.

Following requests from VISION 2020 LINK partners in Africa, the next step was to organise a Zoom conference entitled ‘COVID-19 and Ophthalmology in African Eye Units’, which took place in April. The aim of this collaborative conference was to share and discuss the most recent guidelines and experiences, and to address the key questions posed by the LMIC participants. The Conference benefited from input from the then President of the Royal College of Ophthalmologists (RCOphth) in the UK, Mike Burdon, and the President of the College of Ophthalmology of Eastern, Central and Southern Africa, John Nkurikiye, as well as ICEH faculty and other African partners. It covered topics such as reducing eye care services and maintaining emergency eye care as well as how to reduce transmission between patients and eye care specialists in the clinic. African partners shared their experiences and there was a Question and Answer session followed by a discussion on the way forward.

The conference was attended by over 270 people and feedback was very positive, with 96% of survey responders reporting that the seminar was either ‘very’ or ‘extremely’ useful. It was recorded and is available on the Community Eye Health Journal website.

The LINKS Programme has also found creative ways of maintaining health partnerships in the time of coronavirus. As well as resources specifically related to COVID-19, other training opportunities are being made available online. For example, participants in the Diabetic Retinopathy Network, DR-NET, have all been given the opportunity to register for the diabetic retinopathy MOOC produced by the International Centre for Eye Health at LSHTM. This enables eye health workers to gain practical knowledge to reduce risk of vision loss from diabetic eye disease.

One of the projects that was discussed during the conference was the ‘Training the Trainers’ (TTT) programme that has been running for several years as part of the VISION 2020 LINK between the College of Ophthalmologists of Eastern, Central and Southern Africa (COECSA) and the UK RCOphth. It was funded in its early days by the Health Partnerships Scheme with the aim of raising the standards of ophthalmology training in the COECSA region. It has progressed in recent years thanks to funding from the Queen Elizabeth Diamond Jubilee Trust and through the drive and commitment of the Head of Education at the RCOphth, Melanie Corbett.

There are now 120 ophthalmologists in the COECSA region who have undertaken TTT training up to the level of the three-day Supervisor Course and are applying their learning in the way they teach their trainees (MMeds). Over 30 ophthalmologists are at the higher level of National Lead, Faculty or Facilitator, and are able to lead or assist in locally-run TTT training courses. Miss Corbett led a remote Advanced TTT course in April and invited the COECSA Trainers to join for a one-hour section on Tele-Learning, which is of great importance to the Africa partners at present.

During the Covid-19 webinar, COECSA training Leads and senior faculty were invited to remotely join the RCOphth ‘Advanced TTT’ course at the end of April, building on the COECSA TTT Programme. In this course, Miss Corbett first described the scope of tele-learning and how best to tailor it to different needs.  Ideas from simultaneous small group discussions were then shared, to facilitate learning across the nations. In a COECSA-specific symposium in the afternoon, delegates from the last course in Dar Es Salaam described their recent achievements in implementing TTT techniques and processes into their units.

Miss Corbett said:

“This was the first time that the RCOphth has delivered such an intense, interactive course remotely, and the first time that UK and COECSA delegates have been taught together in the same session. It was an innovative and exciting step forward in the development of TTT training delivery by the RCOphth and we look forward to further developing this joint training.”

– VISION 2020 LINKS programme team

Examples of PPE shown and discussed during the video conference. 

Photo credit | Archana Kulkarni

On arrival to the clinic. 

Photo credit | Elmien Wolvaardt