Major new research programme could fast-track health service improvement in low and middle-income countries

Photograph: Rolex / Joan Bardeletti

A partnership including The International Centre for Eye Health (ICEH) and Peek Vision have been awarded a Wellcome Trust Collaborative Award in Science, which will be used for a series of research projects with the potential to redefine how health services can be optimised.

The Collaborative Awards allow independent research groups to work together on projects where they can collectively amplify their skills for a common goal. Partnering with the Ministry of Health Kenya and the University of Botswana, the team have been awarded £3.8m to expand on Peek Vision’s smartphone-based eye health systems, which allow eye health programmes in low- and middle-income countries to improve access to their services. 

“The problem with gathering evidence to help eye service delivery is that the research cycle is so long, resulting in the evidence not always translating into practice,” says Professor Andrew Bastawrous, lead investigator at ICEH. “For randomised controlled trials it can be many years. This grant will help us to find ways to radically improve that for eye health and other areas.”

Eye health services using Peek can screen for eye health conditions by using a smartphone app to conduct vision checks and then track patients through the health system. The data can be accessed in real-time, allowing them to monitor the performance of services and appropriately respond to changes in their programmes.

The award will build on this existing methodology and software to enable users to test multiple improvements to their current screening and referral programmes at the same time. It will be possible to test several factors affecting the effectiveness of a service, for example the frequency or content of text alerts, or which solutions to local challenges (e.g. type of transport to treatment) work best.

By running several of these tests in rapid sequence or in parallel, the results could mean that successful, evidence-based changes to the health service can be implemented immediately. Programme implementers will be able to test their hypotheses in a real-world, uncontrolled setting, without the need for comprehensive research or statistical know-how.

“This project is a stellar example of how mobile health can be utilised in very simple ways to great effect,” Says Professor Josip Car, Director, Centre for Population Health Sciences and Director, WHO Collaborating Centre for Digital Health and Health Education at the Nanyang Technological University, Singapore. “The learnings from this study could have far-reaching consequences, not only in eyecare, but for the improvement of any complex health system. By using a process where hypotheses can be tested in quick succession or in parallel, and the results implemented immediately, the team are showing us how mHealth can truly be the future of healthcare, deeply integrated into its delivery, and providing huge benefit for patients worldwide.”

The award, for implementation within Kenya and Botswana over 5 years, will aim to improve eye health within the target countries, while assessing this new trial framework.

“One third of the planet lacks access to basic eye care, with eighty percent of blindness and vision impairment being due to conditions we can effectively treat today with interventions such as glasses and cataract surgery,” Prof Bastawrous continues. “The vast majority of these people are in lower and middle-income countries. In eye health we have already delivered some fantastic innovations, now we need to focus on innovating delivery. This award is a fantastic opportunity to work further with our partners and provide a radical new way to assess eye health interventions, for the benefit of people and countries who need it most.”

ICEH would like to thank The Wellcome Trust and National Institute for Health Research (using Official Development Assistance (ODA) funding) for funding the award.

For more information please contact iceh@lshtm.ac.uk

Previous projects:

Smartphone-based screening for visual impairment in Kenyan school children

Implementing a School Vision Screening Program in Botswana Using Smartphone Technology

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