Evaluation of Diabetic Retinopathy Screening Services at Secondary Health Facilities in Anambra State

Timely screening for diabetic retinopathy at secondary health facility level can significantly reduce the burden of diabetes-related blindness by enabling early detection and prompt referral for treatment. This study evaluates the structure, process, and outcomes of diabetic retinopathy screening services at secondary health facilities in Anambra State, South East Nigeria. A mixed-methods evaluation design will be employed. Using Donabedian's structure-process-outcome framework, data will be collected from ten general hospitals with diabetes clinics across three senatorial zones of the state. Structure assessment will examine availability of trained personnel, fundus photography or direct ophthalmoscopy equipment, and referral protocols. Process data will include the proportion of diabetic patients screened annually and documentation practices. Outcome data will assess the rates of detected retinopathy and successful specialist referrals. Key informant interviews with diabetologists, ophthalmic nurses, and facility managers will complement quantitative findings. Anambra State has a well-documented diabetes burden in its urban and semi-urban populations, yet routine retinopathy screening at secondary facilities is not systematically practised. This study identifies service delivery bottlenecks and provides evidence for Anambra State Ministry of Health to redesign its diabetic retinopathy screening pathway. Recommendations will emphasise training of medical officers in fundoscopy, procurement of non-mydriatic fundus cameras, and linkage of general hospital diabetes registers with ophthalmology referral tracking systems. Keywords: diabetic retinopathy screening, secondary health facilities, Anambra State, Donabedian, diabetes