A health system consists of all the organisations, people and actions concerned with promoting, restoring and maintaining health (WHO, 2007).
Each health system can be analysed through 6 building blocks: human
resources, information systems, medical products and technologies, financing, service delivery, and leadership and governance.
These six blocks are interconnected and good management of each block is
essential to establish a functional service and improve the availability, quality and access to services. A well-managed health system improves outcomes at the community level with services that are responsive to changing needs, efficient, productive and cost-effective.
The health system and diabetic eye disease
Those health system building blocks concerned with the long term prevention of blindness from diabetic retinopathy need to put in place clear health care standards to enable the effective management of both diabetes and diabetic eye diseases.
Diabetes health care standards
1. Prevention of type 2 diabetes: The Ministry of Health promotes strategies to reduce risk of type 2 diabetes by promoting healthy lifestyles, obesity reduction and prevention of smoking.
2. Identification of people with diabetes: The Ministry of Health develops and implements strategies to identify people with diabetes in the population.
3. Empowering people with diabetes: All persons with diabetes will receive a service which encourages good diabetes knowledge, management of diabetes and a healthy lifestyle.
4. Clinical care of people with diabetes: Clinical care for children, young people and adults should include:
Diabetic eye disease health care standards
5. Examination of the retina: The Ministry of Health promotes and develops services so that all people with diabetes receive an eye examination for diabetic retinopathy at least every 2 years.
6. Clinical care by an eye specialist for people with diabetic retinopathy: The Ministry of Health promotes and develops services so that all high-risk people receive ongoing care from an eye specialist.
7. Treatment for vision-threatening diabetic retinopathy: The Ministry of Health promotes and develops protocols and systems of care to ensure that all people with sight-threatening diabetic retinopathy receive appropriate and effective care to reduce their risk of visual loss.
Managing diabetes and diabetic eye diseases
Once the necessary health care standards are in place, some key activities also need to be put in place to ensure strong links between the management of diabetes and the management of diabetic eye diseases.
Targeted action by eye health workers
Three groups need to be targeted by eye health workers to prevent blindness from diabetic retinopathy:
At the community level
Eye health workers should:
People who known to have diabetes Eye health workers should:
People with vision threatening diabetic retinopathy
Eye health workers should:
Constraints on managing diabetic eye disease
To address these challenges needs local planning and management of the interlinked blocks within the health system.