Page 151 - DISINVESTMENT AND IMPLEMENTATION OF VISION SCREENING TESTS BASED ON THEIR EFFECTIVENESS

Implementing paediatric vision screening in urban and rural areas in Cluj county, Romania
groups: Hungarians and Roma, who make up 15% and 3%.12 Roma are a disadvantaged group, who live in segregated communities and suffer worse health than the majority population.13 The implementation made no distinction between different ethnic groups and did not keep track of ethnicity.
Screening personnel and training
The programme was implemented in the city of Cluj-Napoca by the DASM (Department of Social and Medical Assistance), a municipal organisation that provides social and medical services and maintains medical offices in over 100 kindergartens and schools. In the small cities and rural areas the implementation was handled by the UMF-Cluj (University of Medicine and Pharmacy). Both set up project teams to handle their respective parts of the study. The overall local coordination of the study, as well as the development of the screening protocol and training of the screeners, was handled by the UMF-Cluj. Both the DASM and the UMF-Cluj drafted implementation plans covering objectives, target population, screening protocol, vision charts, training, care pathways and follow up.
In Romania, 83% of children aged three to five were enrolled in kindergarten in 2017.11 There are no figures on attendance, but many children attend only sporadically.14 Because kindergartens in cities have resident nurses, the decision was made to train these to screen. In the public kindergartens in Cluj-Napoca, children were screened by nurses employed by the DASM. These nurses had vision screening added to their job descriptions, if they did not object.
In the small cities the nurses working at the public kindergartens were employed by the municipalities, but were contracted to screen children by the UMF-Cluj. The nurses, having a medical background, were allowed to screen children. Also, the nurses see the children and parents every day and already have a relationship with them. In rural kindergartens there usually are no resident nurses. Therefore, the implementation had to be adapted and it was decided that the rural children would be screened by the family doctor’s nurse at the family doctor’s practice instead. At the time, this was considered to be the best option, also in line with the Ministry of Education and Ministry of Health’s joint regulation 5298/2011: “Where there are no medical and dental practices in kindergartens and schools, the medical assistance shall be performed by doctors and dentists from the respective localities or from nearby localities.” The rural family doctors’ nurses were also contracted by the UMF-Cluj. All nurses who screened children received €7,- gross (around €4,- net) per child screened in addition to their salary.
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