Abstract
Purpose: :
To map the provision of low vision services globally and identify the critical success factors (CSF) for low vision service coverage.
Methods: :
Data were generated from a survey distributed to Vision 2020 contacts, government, and non-government organizations (NGOs) in 195 countries during 2006-2007 and also from key informants. Themes from the survey were: policies and guidelines on low vision; provision of services; infrastructure and equipment; coverage and barriers; and human resources. These formed the service-related variables examined for associations with service coverage. External variables comprised socio-economic and demographic data of the countries. Coverage, defined as better (>10%) and poorer (≤10%), was the outcome measure. The classification and regression tree (CART), using the Chi-squared Automatic Interaction Detection (CHAID) growing method, were used to identify and prioritize the CSFs of low vision services.
Results: :
Data from primary and secondary sources were obtained from 178/195 of the countries surveyed. Of the 131 who responded regarding the coverage of low vision services, 101 (77.1%) countries have ≤10% coverage; 30 (22.9%) countries have >10%. The risk estimate of 8.4% indicated that the category predicted by the model (better or poorer coverage) is correct for 91.6% of the countries. The results revealed that countries where >50% of children obtain low vision devices when prescribed (Χ2=39.58, p=0.000); presence of national referral guidelines (Χ2 =10.19, p=0.001); having >3 rehabilitation officers per 10 million of population (Χ2 =7.99, p=0.005) and availability of government funding (Χ2 =4.13, p=0.042) are critical factors associated with better coverage of low vision services. When socio-economic and demographic data of the countries were added into the CART model - the higher the percentage of population urbanized (Χ2 =13.77, p=0.004) and at least some private expenditure on health as percentage of total expenditure on health (Χ2 =14.19, p=0.017) were shown to impact on greater coverage.
Conclusions: :
Having access to equipment, adequate numbers of trained rehabilitation staff, establishing referral networks, and government support are critical factors in the better coverage of low vision services.
Keywords: clinical (human) or epidemiologic studies: health care delivery/economics/manpower • low vision