Health Systems Intervention

The article presents active provider-initiated recall systems as preferable to passive patient-initiated screening. The intervention package contains three co-designed components agreed with government stakeholders. One doctor and one medical assistant from each intervention facility receive four days of training. Training covers the National Protocol for three days and the Simple App on the fourth day. A one-page A3 desk aid summarising key protocol points is provided to each intervention facility. The study recommends a national diabetic retinopathy screening strategy for Ethiopia. Patients should receive reminders and scheduled appointments rather than being expected to self-refer. The National Protocol component covers screening, diagnosis, medication, lifestyle counselling, follow-up, referral, and team-based care. Healthcare providers should actively counter the misconception that no symptoms means no disease.