Reaching into the district: strengthening the eye care team.

DANIEL ETYA’ALE INTERVIEW Continued HUMAN RESOURCES Reaching into the district: strengthening the eye care team work in the country, and the need to work together to fight the problem. Second, development, acceptance and ownership of an agreed national action plan; and third the clearest definition possible of the roles of the various stakeholders and eye care providers within the country at all levels of programme implementation. What positive changes have you seen in Africa over the last three years? First and foremost, a real enthusiasm for VISION 2020 when this has been presented to the ministries of health and eye care professionals – the response so far has been more than we had anticipated. Second, a better understanding of the causes, magnitude and distribution of blindness and available services in each country and within country in each region. We believe that we now have sufficient information for most countries with which to safely plan VISION 2020 programmes and activities. Third, and most encouraging, a coming together of the various parties (governments, NGOs and professional groups) to work together under the mandate of VISION 2020. This move towards closer and more functional partnership in eye care is probably the single most important development over the last three to five years. The problem of blindness is so enormous that no single agency can solve it alone – we must do our utmost to respect each other and work together if we are to reduce the number of people still becoming unnecessarily blind in Africa. What are the major challenges facing VISION 2020 in Africa in the next three years? There is still such a big gap between what needs to be done and what is done. Currently we hardly meet 20 per cent of current needs and much of that service provision is largely dependant on NGOs. Also, the use of existing resources – people, equipment, infrastructure and money – is still largely inefficient; and there is definitely a need for new resources, both in terms of finances and human resource development. For reasons of sustainability and despite their limited resources, African governments should be the major eye care service providers in the longterm. Therefore, a challenge for NGOs and other partner agencies is to assist governments in ways that will not only expand and accelerate current activities, but also, and more importantly, lead to the creation of functioning, nationwide and effective eye care services. Eye care has the potential to be financially self-sustaining because, for example, of the need and sale of spectacles for presbyopia and other refractive errors. So the major challenges for the next three years are availability and use of resources, and partnership between governments, WHO, NGOs and other interested parties and the eye care professionals. For useful resources, please see page 47. 36 Hannah Faal Immediate Past President, International Agency for the Prevention of Blindness (IAPB). Eye Care Programme Consultant, West Africa, Sight Savers International, P. O. Box 950, Banjul, The Gambia. From individual patient care to population care VISION 2020: The Right to Sight has provided a vision and a common goal for eye care programmes. It has provided the paradigm shift, or change in the way of thinking, from individual patient care to population care, a shift from each person doing a job or task, to a group working to eliminate avoidable blindness. Such a common goal needs a team approach. The VISION 2020 approach proposes that activities should be planned and implemented for a defined population and geographical coverage and promotes the concept of a manageable unit of a population of 500,000 to one million, termed a VISION 2020 delivery unit. Recommendations on targets for services and resources required have been made as unit ratios of the delivery unit, for example two to four ophthalmologists, four to ten ophthalmic nurses per delivery unit. This implies that there is a team responsible for the eye health of the population of a VISION 2020 delivery unit. The concept of teamwork The term team is not commonly used by eye care providers who are more familiar with groups of professionals such as ophthalmologists, ophthalmic nurses, optometrists, support staff, management etc. The concept of teams and team building is more familiar to the management culture. Management has used the team concept and team building whether in the factory or in organisations to achieve efficiency, effectiveness, job satisfaction and a shared vision. Dr Meredith Belbin, one of the world’s leading experts on team building, has conducted research into group interactions and concludes that all members of an organisation have a dual role. The first role, the functional one, is obvious: an eye care provider belongs to the team because s/he is an ophthalmologist, ophthalmic nurse, records officer, anaesthetist, hospital administrator or whatever. The second role, the team role is defined by Dr Belbin as “a tendency to behave, contribute and inter-relate with others in a particular way”. Members of the team vary in their tendencies, some like action-oriented roles, others are best at people-oriented roles, while others perform the thinking roles for the team. Belbin has identified nine Team-Role types. 1,2,3 Belbin’s Team Roles Role Contributions and Allowable weaknesses Action-oriented roles SHAPER Challenging, dynamic, thrives on pressure. Has the drive and courage to overcome obstacles. Prone to provocation, offends people’s feelings. IMPLEMENTER Disciplined, reliable, conservative and efficient. Turns ideas into practical actions. Can be somewhat inflexible. Slow to respond to new possibilities. COMPLETER / FINISHER Painstaking, conscientious, orderly, anxious, searches out errors and omissions. Can finalise something that has been started with complete thoroughness. Delivers on time. Inclined to worry unduly. Weak delegator. People-oriented roles CO-ORDINATOR TEAMWORKER RESOURCE INVESTIGATOR Thinking roles PLANT Mature, confident, a good chairperson. Clarifies goals, promotes decision making, delegates well. Can often be seen as manipulative, off loads personal work. Co-operative, mild, perceptive and diplomatic. Listens, builds, averts friction. Very good with awkward people and places the group’s interests before their own. Can be indecisive in crunch situations. Curious, communicative, extrovert, innovative, explores new areas and opportunities. Develops contacts. Requires close involvement with people, skilled in the use of resources and fits easily into management teams. Over-optimistic. Loses interest once initial enthusiasm has passed. Requires challenge, non-finisher. Creative, imaginative, unorthodox. Solves difficult problems. Ignores incidentals. Too preoccupied to communicate effectively. MONITOR / EVALUATOR Sober, strategic and discerning. Sees all options, judges accurately. Lacks drive and ability to inspire others. SPECIALIST Single-minded, (...truncated)