Commentary: Human resource in school screening: Right enrollment and appropriate training: An important prerequisite.

India is a vast country with varied culture, literacy rate, and socioeconomic status. In view of this, it might be difficult to achieve a universal and uniform school eye health programme which ought to be a reality, in the near future.[1] School screening programs at present are carried out by both government and non-governmental organizations. To enable universal and uniform school eye health programme,[1] we need to have personnel at the grass root level both in health and education sectors who will be highly instrumental in screening school children. This will enable us to achieve “early detection, early referral and early management of eye problems in children, main area of focus being amblyopia.” The various personnel who come in contact with children are teachers from education department, and paramedical ophthalmic assistants (PMOAs), primary health centre (PHC) staffs, Accredited Social Health Activists (ASHAs), and other community health workers under health department. Finding out the cadre best suited for vision screening is necessary.[2] Irrespective of their cadre, all of them need prior training before they are allotted for screening school children. If one has to analyze the role of teachers logically: teachers are the closest to our children after parents, so one can think freely and conveniently that they will be able to identify eye problems in children much more easily than others, with prior training. But needless to say, they are overburdened with many projects related both to education and health departments and therefore it is humanly impossible, at times, to concentrate on eye health in children although they would be the ideal personnel. There are few drawbacks as put forth by Gurvinder Kaur, Koshy et al. in their study showed that vision screening by teachers resulted in high false-positive rates, thereby increasing the workload of the ophthalmology team.[3] Study in Iran by Ostadimoghaddam et al. inferred that teachers lacked sensitivity required for case detection and attributed this to lack of sufficient repeated training to teachers in detecting visual acuity.[4] So this emphasizes the importance of training and re-training of teachers and also other personnel. Khandekar et al. conducted a study in Oman wherein they did vision screening with the help of nurses where sensitivity of 68.34% and specificity of 99.23% was found when the results of screening by nurses was compared against results of practicing optometrists.[5] As regards to taking help from PMOAs, PHCs staffs, ASHAs and other community health workers in school screening, all of them need prior training in vision checking, and detection of eye problems and their results need to be cross checked with that obtained from optometrists. Considering the large population size in India, we need to take help from all the above-mentioned personnel in school eye health programmes so as to reach the unreached. Along with this, it is also essential to consider additionally, certain personnel working in health related sectors in school screening programmes as is very nicely elaborated and compared in Dole et al.[2] study. They concluded that people from a social work background with more sensitization towards community eye work and those who have worked for any duration of time in an eye hospital environment with basic educational background are the best candidates for being trained as new cadre of vision screeners. People with no background in community work or eye hospital as mentioned above are comparatively less ideal candidates.[2] To conclude, in order to reduce childhood blindness, it is imperative to screen school children in our country with the help of various personnel preferably with background knowledge of community or hospital health work. However, prior, adequate and frequent training in vision checking, detecting eye problems in children and timely referral to nearby higher centers is required to all personnel who are enrolled in school screening irrespective of the cadre that they hail from.