Abstract
BackgroundVISION 2020 is a global initiative launched in 1999 to eliminate avoidable blindness by 2020. The objective of this study was to undertake a situation analysis of the Zambian eye health system and assess VISION 2020 process indicators on human resources, equipment and infrastructure.MethodsAll eye health care providers were surveyed to determine location, financing sources, human resources and equipment. Key informants were interviewed regarding levels of service provision, management and leadership in the sector. Policy papers were reviewed. A health system dynamics framework was used to analyse findings.ResultsDuring 2011, 74 facilities provided eye care in Zambia; 39% were public, 37% private for-profit and 24% owned by Non-Governmental Organizations. Private facilities were solely located in major cities. A total of 191 people worked in eye care; 18 of these were ophthalmologists and eight cataract surgeons, equivalent to 0.34 and 0.15 per 250,000 population, respectively. VISION 2020 targets for inpatient beds and surgical theatres were met in six out of nine provinces, but human resources and spectacles manufacturing workshops were below target in every province. Inequalities in service provision between urban and rural areas were substantial.ConclusionShortage and maldistribution of human resources, lack of routine monitoring and inadequate financing mechanisms are the root causes of underperformance in the Zambian eye health system, which hinder the ability to achieve the VISION 2020 goals. We recommend that all VISION 2020 process indicators are evaluated simultaneously as these are not individually useful for monitoring progress.
Highlights
VISION 2020 is a global initiative launched in 1999 to eliminate avoidable blindness by 2020
The survey questionnaire was adapted from the VISION 2020 situation analysis data collection tool and from a list of essential equipment for a functional eye unit compiled by International Agency for the Prevention of Blindness (IAPB) [7,8]
We found access to eye care services constrained by the physical lack of providers in remote parts of the country and by the financial barriers created by the user fees charged in 75% of all facilities [25]
Summary
VISION 2020 is a global initiative launched in 1999 to eliminate avoidable blindness by 2020. “VISION 2020: The Right to Sight” is an international initiative launched in 1999 by the World Health Organisation (WHO) and the International Agency for the Prevention of Blindness (IAPB). The aims are to eliminate avoidable blindness by 2020 and prevent the projected doubling of the burden of visual impairment between 1990 and 2020 [2]. An essential prerequisite for achieving the VISION 2020 goals is that these services are well integrated into national health systems. All 193 WHO member states have formally pledged to invest in eye care and the large majority of countries have formed VISION 2020 committees and drafted national eye care plans [4]. The implementation of these plans varies widely across countries and remains the biggest challenge for reaching the set goals
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