A strategic management framework for eye care service delivery organisations in developing countries.
Blindness is one of the most debilitating health disorders and avoidable blindness is a major international health problem. The World Health Organization has estimated that globally, there are 45 million persons who are blind - a figure that is expected to increase to approximately 76 million by the year 2020. Approximately 80% of blindness is avoidable and can be prevented or cured with appropriate service delivery efforts. Research suggests that the combined annual global GDP loss from blindness in 2000 was more than $40 billion. Yet blindness has received relatively little attention in worldwide efforts to promote health and it is not at present a high health priority in many countries. Consequently, unless there are alternative and more efficient and extended endeavours to address this situation and model an approach that will provide a long-term solution, avoidable blindness will continue. In recent years, eye care service delivery organisations have assumed a greater level of responsibility for addressing the problem of avoidable blindness. A number of successful approaches have been designed and implemented to expand the delivery of eye care services. The approaches have focused on the development of organisational capacity and on sustainability, and they have effectuated a reduction in avoidable blindness in particular target populations. However, despite their importance, contemporary eye care service delivery models have largely been neglected in the literature and few formal organisational approaches to eye care have been developed and documented. There are few definitive independent studies available that outline the bases of these approaches and no explicit and standardised methodologies that can assist service delivery organisations to replicate the approaches. Objective and comprehensive research is accordingly required to promote current and new approaches to eye care and to develop ways of facilitating their adoption. The thesis attempts to address this problem by developing a theory–based, case study–supported practical methodology to identify, support the progression of, and measure the strategic and operational objectives of eye care service delivery organisations. The research seeks to identify the issues relevant to the management of eye care service delivery organisations and subsequently evaluate whether they can be incorporated into a distinct and explicit management framework. It seeks to present the value of the process and the possibility that it can be accomplished elsewhere and in dissimilar organisations. By developing a widely applicable management framework, the research's primary contribution is that it extends eye care organisational management theory to assist in the facilitation of blindness reduction. A conceptual management framework is developed in the thesis which unifies contemporary eye care organisational approaches with the Balanced Scorecard management framework. The framework was devised for and evaluated by undertaking two case studies – one in India and one in South Africa. The significance of developing such a framework is demonstrated at various points throughout the thesis. The research process reveals the potential applicability of the framework – the Strategic Management Framework (SMF). The research concludes that the SMF is able to support and enhance organisational development, performance management, and scenario analyses in eye care service delivery organisations operating in developing countries. Although the framework developed in the thesis is specific to eye care organisations it is flexible enough to be transferable to other healthcare organisations in developed countries. The final conclusion of the thesis is that, while the SMF is not in itself a solution to the problem of avoidable blindness, it is an appropriate and practical management tool which will improve existing, and assist in the establishment of new, eye care service delivery organisations. In this context, the research makes a number of significant and original contributions to prevention of blindness literature and theory.
blindness, vision, vision disorders, eye, public health services, rural health services, community health services, regional medical programs, developing countries
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