Improvement studies for equitable and evidence-based innovation: an overview of the 'IM-SEEN' model.

BACKGROUND: Health inequalities are ubiquitous, and as countries seek to expand service coverage, they are at risk of exacerbating existing inequalities unless they adopt equity-focused approaches to service delivery. MAIN TEXT: Our team has developed an equity-focused continuous improvement model that reconciles prioritisation of disadvantaged groups with the expansion of service coverage. Our new approach is based on the foundations of routinely collecting sociodemographic data; identifying left-behind groups; engaging with these service users to elicit barriers and potential solutions; and then rigorously testing these solutions with pragmatic, embedded trials. This paper presents the rationale for the model, a holistic overview of how the different elements fit together, and potential applications. Future work will present findings as the model is operationalised in eye-health programmes in Botswana, India, Kenya, and Nepal. CONCLUSION: There is a real paucity of approaches for operationalising equity. By bringing a series of steps together that force programme managers to focus on groups that are being left behind, we present a model that can be used in any service delivery setting to build equity into routine practice.

Education of eye health professionals to meet the needs of the Pacific.

Vision impairment has significant impact on quality of life and substantial economic consequences. Yet, in the Pacific Islands, as in other low resource settings, it is predominantly caused by chronic conditions that can be treated or prevented. A whole of health approach is required to rectify this, and must include an increase in workforce capacity, both in size and effectiveness, by providing competency-based education for eye care professionals. Training in curative clinical skills is not sufficient: broader competencies--including those for chronic conditions, issues of care quality, integration into the wider health care system, and commitment to professionalism and life-long learning--need to be addressed. Using current best practice approaches in education, and taking into consideration local needs, The Pacific Eye Institute, an initiative of The Fred Hollows Foundation New Zealand, aims to produce graduates with these core competencies who are capable of effectively and acceptably working in community or hospital settings to provide sustainable high quality, comprehensive eye care with ongoing desirable and consistent eye health outcomes.