Page 167 - DISINVESTMENT AND IMPLEMENTATION OF VISION SCREENING TESTS BASED ON THEIR EFFECTIVENESS

Implementing paediatric vision screening in urban and rural areas in Cluj county, Romania
DISCUSSION
Implementing the screening programme in Cluj County proved much more difficult in the rural areas as compared to the cities, where the children were screened by resident nurses at kindergartens. In rural areas kindergartens do not have nurses and the alternative chosen, screening by family doctors’ nurses at the family doctors’ offices, did not work well. The urban kindergartens were attended by many children, meaning the nurses could screen many children in a short time. Children were screened by nurses they see every day and know and trust. The nurses also saw the parents on a daily basis, making it relatively easy to explain screening to parents and to hand out and collect consent forms.
Our impression was that implementation of vision screening in rural areas was hampered by a lack of healthcare infrastructure, competing preventive healthcare priorities, travel distances, lack of access to many children at the same place at the same time and lack of awareness among parents. Less than half the rural nurses followed the screening course, representing less than half the rural communes. Participation may have been low because, though the course itself was free, nurses had to travel to Cluj-Napoca for it and neither travel expenses nor lodging were reimbursed, whereas the courses were held on Saturday and Sunday.
Contrary to their urban counterparts, almost half of the rural nurses who did attend the course, did not screen children. Some did not want to screen, because they were too busy or reluctant to do the paperwork. There is also a shortage of doctors in the country that is far worse in rural than in urban areas. In Cluj County there are more than twice as many family doctors in urban areas as compared to rural areas.11 Vision screening has to compete for limited resources with other forms of preventive care, such as vaccinations, while health services in rural areas are substandard to begin with21 and for one-third of the rural population, reaching a doctor’s office requires more than 30 minutes of travel one-way.22
The rural family doctors’ nurses had to go through more trouble to screen children than the nurses in the cities. Compared to the cities it was difficult the reach the eligible children and especially to find larger groups of children together. Participation of parents was hampered by a lack of awareness of the benefits of preventive health care in general. Most people in the rural areas only go to the doctor when they are ill. A lack of knowledge about a amblyopia also played a role.
The evaluation of a cervical cancer screening pilot in Cluj County found similar disparities between rural and urban areas: participation among family doctors in rural areas, where
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