Abstract
BackgroundVisual impairment is a public health problem in sub-Saharan Africa, affecting nearly 5% of the population. Efforts to combat avoidable causes have been hampered by weak health systems and little evidence exists to suggest what interventions may be effective to improve the situation. Despite this, there are calls to promote some specific interventions, one of which being the closer integration of eye health services into health systems, often focusing on training primary health workers to deliver basic eye health services. This study seeks to understand how eye health services are delivered by primary health workers who have received training and what constraints remain to effective service provision.MethodsThis was a qualitative investigation into the experiences of 20 primary health workers trained in primary eye care and eight key informants working within specialist eye health services or regional and district health management positions in two districts in Tanzania.ResultsDespite feeling confident in their own eye care skills, most primary health workers felt constrained in the services they could provide to their communities by insufficient resources needed for diagnosis and treatment, and by lack of systematic supportive supervision to their work. Specialist ophthalmic staff were aware of this issue, although for the most part they felt it was not within their capacity to remedy and that it fell within the remit of general health managers. Many participants discussed the low support to eye health from the national government, evidenced through the lack of dedicated funding to the area and traditional reliance on outside funds including international charities.ConclusionsAlthough training of primary health workers is useful, it is recognised that is not sufficient to address the burden of eye health disease present in rural communities in Tanzania. It is likely that broader engagement with the general health system, and most likely with the private sector, will be necessary to improve the coverage of eye health care to remote and poor communities such as those in Morogoro. Further investment is needed to develop innovative approaches to delivering eye health services, including preventative, curative and rehabilitative services.
Highlights
Visual impairment is a public health problem in sub-Saharan Africa, affecting nearly 5% of the population
The study identified a number of challenges in the integration of eye care activities into general primary health systems; these barriers related to the wider health system environment; general eye health system; and primary eye care
Despite full information provided at the beginning of the interview, the research may have been perceived as linked to further training or provision of financial or inkind support. Conclusions this is a small scale qualitative study implemented in two districts of one region in Tanzania, the findings raise a number of important questions and policy implications
Summary
Visual impairment is a public health problem in sub-Saharan Africa, affecting nearly 5% of the population. In 2010 there were an estimated 4.8 million blind people, and 16.6 million people with moderate and severe visual impairment in sub-Saharan Africa (SSA) [1] This equates to an all-age prevalence in SSA of 1.2 and 3.8% respectively, compared with 0.4 and 2.7% globally, highlighting the disproportionate burden of visual impairment found in SSA compared with other regions. A study in Nigeria found that patients with red or itchy eyes were the most likely to visit a hospital for care, whereas people experiencing pain in their eyes were more likely to visit a pharmacist close to their home [4] The implications of such health seeking behaviour may be that specialist eye health providers may be spending a lot of clinical time on conditions such as red and itchy eyes that could be dealt with by lower health cadres, rather than more potentially serious conditions which require specialist attention
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