Exploring the merits of a diabetes eye care programme: The example of the Pacific Eye Institute’s Diabetes Eye Care Programme in Fiji

Abstract

Externally-funded health programmes are intended to help the needy, reduce disease burdens and provide support for low- to middle-income countries. They assist in a number of practical ways including the provision of disease-specific health services, the training of local health workers, and the upgrading of existing services. To accomplish these activities successfully, some crucial conditions need to be met. Such conditions have been suggested through numerous public health models, frameworks, and multi-lateral agreements. However, few are considered satisfactory for understanding the enormous complexities of how non-communicable disease programmes affect health systems in the context of Pacific Island Countries. As such, rather than attempting to validate an ‘incomplete’ model, grounded theory can be used a methodological approach; capable of generating knowledge that would contribute to this gap in the literature. The study aims to understand what merits and effects a dedicated health programme has on a low- or middle income country health system, using the Pacific Eye Institute’s diabetes eye care programme as an example. The combination of key informant interviews, Strauss and Corbin’s inductive approach to theory building, and Colin Eden’s systems approach to cognitive mapping, were adopted. The results indicate that for a diabetes eye care programme to be delivered successful in the Pacific, its policies and actions need to enable four key aspects of public health: access, integration, demand and prevention. Planners implementing a health programme should expect trade-offs in their decision making. Donors and non-governmental organisations will need to find a balance when addressing issues pertaining to leadership and local autonomy; long-term sustainability and equitable access; fostering local capacity, and whether to develop organic health services or coordinate visiting teams. Ultimately, all externally-funded health programmes must address big picture issues concerning equity and programme responsiveness. For the Pacific Eye Institute and its donors, further debate is needed surrounding its role at regional and national levels, as well as further research into how disruptions to the health system might be avoided.