Can we scale up a comprehensive school-based eye health programme in Zambia?

Abstract

Background Globally, 19 million children have preventable vision impairment simply because refractive and eye health services are inaccessible to most of them. In Zambia, 50,000 school children need spectacle provision. The School-based Eye Health Programme (SEHP) has been identified worldwide as a proven strategy to address childhood blindness. Given the great benefits of it, the Zambian government intends to scale up the programme. This scalability assessment aims to identify and evaluate the essential components of an effective SEHP, determine roles, assess existing capacities within user organisations, identify environmental facilitating and inhibiting factors, and estimate the minimum resources necessary for the scaling up and their proposed scale-up strategies. Methods Five elements (innovation, user organisation, resource team, environment, and strategies for horizontal and vertical scaling-up) were assessed guided by the ExpandNet-WHO Nine Steps for Developing a Scaling-Up Strategy. Literature reviews and stakeholders' interviews were conducted to collect data for this assessment. Subsequently, twenty questions in the Worksheets for Developing a Scaling-up Strategy were used to systematically reporting the assessment outcome. Results Additional components of SEHP incorporated in Zambia's model enhanced the innovation's credibility and relevance. The resource team was relatively competent in the pilot, and the same team will be employed during the scaling-up. Political instability, the lack of supply chain, and unstable financial supports were identified as inhibiting factors. The objectives of SEHP were aligned with the National Eye Health Strategic Plan 2017–2021 that support the institutionalisation of the SEHP into the existing School Health and Nutrition Programme. For the pace of expansion, replicating SEHP to another district rather than a province will be more realistic. Conclusion Scaling up a comprehensive SEHP in Zambia is feasible, provided if sufficient funding is available. Additionally, the pace must be adapted to the local context to ensure that every component within the SEHP is intact.