The British Journal of Ophthalmology · 7 authors, 4 centres
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This study compared two school eye health delivery models in Zanzibar and found that an integrated model, where eye health activities were part of a school feeding programme, achieved better performance in reach, effectiveness, and adoption than a model delivering eye health alone.
This non-randomised study compared an integrated (IM) and a vertical (VM) school eye health delivery model in Zanzibar using the RE-AIM framework. The IM was implemented within a school feeding programme, while the VM delivered only eye health interventions. The study assessed performance indicators and conducted stakeholder interviews. The IM achieved higher screening coverage (96% vs. 90%), voluntary follow-up rate (63.6% vs. 46%), and spectacle compliance (71% vs. 13.3%) compared to the VM. Teachers in the IM also demonstrated higher screening validity (76% vs. 58%) and completed activities within two months. These improvements were attributed to effective coordination between implementers, motivated teachers, and timely implementation after training. However, both models showed low spectacle-wearing compliance and ceased activities after funding ended, indicating poor sustainability. Limitations include potential confounding from the pre-existing school health programme and the pilot scale of the study. The findings suggest an integrated approach is more effective for school eye health screening but requires a sustainability plan for long-term success.
