COECSA, Journal, Ophthalmology
From research to scaling-up programs: case study of Peek school eye health program in Trans-Nzoia county, Kenya


Eye care program
Mobile phone
Visual impairment and blindness
School screening
Eye health services
Scale up

How to Cite

HK, R. ., N, M. ., A, M. ., E, W. ., J, K. ., M, G. ., C, B. ., A, B. ., & MJ, B. . (2020). From research to scaling-up programs: case study of Peek school eye health program in Trans-Nzoia county, Kenya. The Journal of Ophthalmology of Eastern, Central and Southern Africa, 24(1). Retrieved from


There are barriers to accessing eye health services by children especially in Low and Middle-Income Countries
(LMIC), where the prevalence of visual impairment is highest. We report the process of scaling up the Peek
school screening program that was initially tested in a randomized clinical trial in Trans-Nzoia county, Kenya.
The initial steps involved forming an advisory group that possessed expertise in technical, technological,
managerial, and program management. The team used the PRIME framework to develop a theory of change
on how the intervention would work at scale-up. The team led the project implementation through the three
phases of the PRIME framework (formative, implementation and scale up phases).
In this study we report on this process and influencing factors. We conclude that it is feasible to translate
research to scaled-up programs in LMICs. Important tools in this process include stakeholder mapping and
engagement. The Peek school screening model is acceptable and effective in screening for visual impairment
in this population.



United Nations. UN Resolution on Universal

Health Coverage. 2012.



draft/index.shtml&Lang=E (accessed 31/ 03 /


World Health Organization. Preventing blindness

in children: report of a WHO/IAPB scientific

meeting, Hyderabad, India, 13-17 April 1999.

Blindness and Deafness Unit & International

Agency for the Prevention of Blindness. Geneva

World Health Organization, 2000.

Journal of Ophthalmology of Eastern Central and Southern Africa July 2020

Flaxman SR, Bourne RRA, Resnikoff S, et al.

Global causes of blindness and distance vision

impairment 1990–2020: a systematic review and

meta-analysis. The Lancet Global Health 2017;

:(12): e1221-e34.

World Health Organization. Visual impairment

and blindness. Fact Sheet N°282. Updated

August 2014 ed: WHO; 2014.

Pascolini D, Mariotti SP. Global estimates of

visual impairment: 2010. Br J Ophthalmol. 2012;

(5): 614-618.

Barasa E, Otieno SA, Karimurio J. The

prevalence and pattern of visual impairment and

blindness among primary school pupils in Kitale

Municipality, Kenya. J Ophthalmol Eastern

Central Southern Africa. 2013; 17(2): 66 -69.

Muma M, Kimani K, Kariuki W. Prevalence of

refractive errors in primary school children of

a rural district of Kenya. J Ophthalmol Eastern

Central Southern Africa. 2013; 13(3): 48-51.

Rono HK, Bastawrous A, Macleod D, et al.

Smartphone-based screening for visual

impairment in Kenyan school children: a cluster

randomised controlled trial. The Lancet Global

Health. 2018; 6(8): e924-e32.

Gilbert C, Foster A. Childhood blindness in the

context of VISION 2020--the right to sight. Bull

World Health Org. 2001; 79(3): 227-232.

Stewart-Brown SL, Haslum M. Screening of

vision in school: could we do better by doing

less? Br Med J. 1988; 297(6656): 1111-13.

Burnett AM, Yashadhana A, Lee L, Serova N,

Brain D, Naidoo K. Interventions to improve

school-based eye-care services in low- and

middle-income countries: a systematic review.

Bull World Health Org. 2018; 96(10): 682-694.

Bright T, Felix L, Kuper H, Polack S. A systematic

review of strategies to increase access to health

services among children in low and middle

income countries. BMC Health Services Res.

; 17(1): 252.

Syed A, Polack S, Eusebio C, et al. Predictors

of attendance and barriers to cataract surgery in

Kenya, Bangladesh and the Philippines. Disabil

Rehab. 2013; 35(19): 1660-67.

Bastawrous A, Armstrong MJ. Mobile health use

in low- and high-income countries: an overview

of the peer-reviewed literature. J R Soc Med.

; 106(4): 130-142.

Deloitte, Groupe Speciale Mobile Association. Sub-

Saharan Africa Mobile Observatory 2012, 2012.

Free C, Phillips G, Watson L, et al. The

effectiveness of mobile-health technologies to

improve health care service delivery processes: a

systematic review and meta-analysis. PLoS Med.

; 10(1): e1001363.

Bastawrous A, Rono HK, Livingstone IT, et al.

Development and validation of a smartphonebased

visual acuity test (peek acuity) for clinical

practice and community-based fieldwork. JAMA

Ophthalmol. 2015; 133(8): 930-937.

Lodhia V, Karanja S, Lees S, Bastawrous A.

Acceptability, usability, and views on deployment

of Peek, a mobile Phone mHealth intervention

for eye care in Kenya: Qualitative Study. JMIR

mHealth uHealth 2016; 4(2): e30.

County Government of Trans Nzoia. FACTS &

FIGURES: Trans Nzoia County. 2018. www. (accessed 06

June 2019).

Ministry of Education. The Kenya National Special

Needs Education Policy. 2009; 2009. p. 1-65.

Connell JP, Kubisch AC. Applying a theory

of change approach to the evaluation of

comprehensive community initiatives: Progress,

prospects and problems. New Approaches to

evaluating community initiatives. 1998; 2(15-

: 1-16.

Hanlon C, Fekadu A, Jordans M, et al. District

mental healthcare plans for five low- and middleincome

countries: commonalities, variations and

evidence gaps. Br J Psych. J Mental Sci. 2016;

Suppl 56: s47-54.

Lund C, Tomlinson M, De Silva M, et al. PRIME:

a programme to reduce the treatment gap for

mental disorders in five low- and middle-income

countries. PLoS Med. 2012; 9(12): e1001359.

Breuer E, De Silva MJ, Shidaye R, et al. Planning

and evaluating mental health services in low- and

middle-income countries using theory of change. Br

J Psych: J Mental Sci. 2016; 208 (Suppl 56): s55-62.

Karimurio J. Evaluation report: up-scaling

screening of children using portable eye

examination kit (Peek) in schools in Trans Nzoia

County, Kenya. Operation Eyesight Universal

Not published.

Breuer E, De Silva MJ, Fekadu A, et al. Using

workshops to develop theories of change in five

low and middle income countries: lessons from

the programme for improving mental health care

(PRIME). Intern J Mental Health Systems. 2014;

(1): 15.

Tomas A, Maipelo J, Keitumetse T, et al.

Implementing a School Vision Screening Program

in Botswana Using Smartphone Technology.

Telemedicine and e-Health; 0(0): null.

Ministry of Health. Kenya Health Policy 2014-

Nairobi: Ministry of Health, 2011.

Mendelow AL. Association for Information

Systems AIS Electronic Library (AISeL)

Environmental Scanning-The Impact of the

Stakeholder Concept. ICIS 1981 Proceedings

; 1981; 1981.


Download data is not yet available.