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Debra R Bartholomew, Blaine Winford, Petra Bridgemohan, Deo Singh, Subash Sharma, Rajrishi Sharma, Alastair Gray, Rupert R A Bourne, Tasanee Braithwaite; Health system dynamics analysis of eyecare services in Trinidad and Tobago and progress towards Vision 2020 Goals. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5066.
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© ARVO (1962-2015); The Authors (2016-present)
Vision 2020, a global initiative to eliminate avoidable blindness by 2020, was launched in the Caribbean region in 2000. This study aimed to provide the first comprehensive overview of the eyecare system in Trinidad and Tobago and assess progress towards Vision 2020 indicators, to facilitate priority setting.
Structured surveys were administered to seven stakeholder groups, including the general population, eyecare providers and patients. Reports, registers and policy documents were reviewed. A health system dynamics framework was used to synthesise the data.
In 2014, Trinidad and Tobago’s population of 1.22 million were served by a pluralistic eyecare system. The Government provided free primary, secondary and emergency eyecare services, through 108 health centres and 5 hospitals (0.26 ophthalmologists and 1.32 ophthalmologists-in-training per 50,000 population). Glaucoma medications and cataract surgery were available. The eye departments were relatively well equipped, with a few key exceptions, and out-patient satisfaction was generally high. Private sector optometrists (4.37 per 50,000 population), and ophthalmologists (0.93 per 50,000 population) provided 80% of all eyecare, including the majority of specialist surgery. Only 19.3% of the population reported having private health insurance, revealing significant out-of-pocket expenditure on eyecare. There was regional variation in private sector eyecare coverage relative to population density. Following the recent National Eye Survey, Trinidad and Tobago has achieved 15 out of 29 Vision 2020 process indicators.
This study combines novel population-based data and broad stakeholder feedback to provide a comprehensive overview of the pluralistic eyecare system in Trinidad and Tobago. The health system dynamics framework and stakeholder surveys are recommended as helpful tools for exploring potential barriers to reducing avoidable vision loss, which may be of use for eyecare system analysis elsewhere in the Caribbean and internationally.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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