Human resource and governance challenges in the delivery of primary eye care: a mixed methods feasibility study in Nigeria

Ada Aghaji,Helen E D Burchett,Shaffa Hameed,Ngozi Oguego,Clare Gilbert

doi:10.1186/s12913-021-07362-8

Abstract

BackgroundTo increase access to eye care, the World Health Organization’s Africa Region recently launched a primary eye care (PEC) package for sub-Saharan Africa. To determine the technical feasibility of implementing this package, the capacity of health systems at primary level needs to be assessed, to identify capacity gaps that would need to be addressed to deliver effective and sustainable PEC. This study reports on the human resource and governance challenges for delivering PEC in Anambra State, Nigeria.MethodsDesign: This was a mixed methods feasibility study. A desk review of relevant Nigerian national health policy documents on both eye health and primary health care was conducted, and 48 primary health care facilities in Anambra state were surveyed. Data on human resource and governance in primary health facilities were collected using structured questionnaires and through observation with checklists. In-depth interviews were conducted with district supervisors and selected heads of facilities to explore the opportunities and challenges for the delivery of PEC in their facilities/districts. Data were analysed using the World Health Organization’s health system framework.ResultsA clear policy for PEC is lacking. Supervision was conducted at least quarterly in 54% of facilities and 56% of facilities did not use the standard clinical management guidelines. There were critical shortages of health workers with 82% of facilities working with less than 20% of the number recommended. Many facilities used volunteers and/or ad hoc workers to mitigate staff shortages.ConclusionOur study highlights the policy, governance and health workforce gaps that will need to be addressed to deliver PEC in Nigeria. Developing and implementing a specific policy for PEC is recommended. Implementation of existing national health policies may help address health workforce shortages at the primary health care level.

Highlights

It is estimated that 338 million people are blind or severely to moderately visually impaired [1]
The purpose of this study was to assess the feasibility of integrating the World Health Organization (WHO) African Region (AFRO) primary eye care (PEC) package into the health system at primary health care (PHC) level in Nigeria, to allow policy makers and planners to make informed decisions about how the health system needs to be strengthened to deliver PEC [17]
This paper reports the findings of a mixed methods study of PHC facilities in Nigeria, highlighting the workforce and governance capacities to deliver PEC

Summary

Introduction

It is estimated that 338 million people are blind or severely to moderately visually impaired [1]. Over 90% of the causes of vision loss are potentially avoidable e.g., cataract and refractive error, and over 90% of those affected live in low- and middle-income countries (LMICs) [2]. The prevalence of blindness increases with advancing age and is highest in those aged 50 years and above [3]. The estimated global prevalence of blindness is 0.49% among all ages, while the estimate for older adults (> 50 years) is at least 1.82%. Sub-Saharan Africa has the highest prevalence of blindness in older adults, which is estimated to be 4.19% in males and 4.36% in females [4]. To increase access to eye care, the World Health Organization’s Africa Region recently launched a primary eye care (PEC) package for sub-Saharan Africa. This study reports on the human resource and governance challenges for delivering PEC in Anambra State, Nigeria

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Discussion

Conclusion