Abstract
BackgroundOver two-thirds of Africans have no access to eye care services. To increase access, the World Health Organization (WHO) recommends integrating eye care into primary health care, and the WHO Africa region recently developed a package for primary eye care. However, there are limited data on the capacities needed for delivery, to guide policymakers and implementers on the feasibility of integration. The overall purpose of this study was to assess the technical capacity of the health system at primary level to deliver the WHO primary eye care package. Findings with respect to service delivery, equipment and health management information systems (HMIS) are presented in this paper.MethodsThis was a mixed-methods, cross sectional feasibility study in Anambra State, Nigeria. Methods included a desk review of relevant Nigerian policies; a survey of 48 primary health facilities in six districts randomly selected using two stage sampling, and semi-structured interviews with six supervisors and nine purposively selected facility heads. Quantitative study tools included observational checklists and questionnaires. Survey data were analysed descriptively using STATA V.15.1 (Statcorp, Texas). Differences between health centres and health posts were analysed using the z-test statistic. Interview data were analysed using thematic analysis assisted by Open Code Software V.4.02.ResultsThere are enabling national health policies for eye care, but no policy specifically for primary eye care. 85% of facilities had no medication for eye conditions and one in eight had no vitamin A in stock. Eyecare was available in < 10% of the facilities. The services delivered focussed on maternal and child health, with low attendance by adults aged over 50 years with over 50% of facilities reporting ≤10 attendances per year per 1000 catchment population. No facility reported data on patients with eye conditions in their patient registers.ConclusionA policy for primary eye care is needed which aligns with existing eye health policies. There are currently substantial capacity gaps in service delivery, equipment and data management which will need to be addressed if eye care is to be successfully integrated into primary care in Nigeria.
Highlights
Over two-thirds of Africans have no access to eye care services
Primary health care (PHC) services, on the other hand, are widely accessible to the majority of the population in urban and rural areas, and the World Health Organization’s (WHO) Global Action Plan (WHO Global action plan (GAP)) 2014–2019 recommends that eye care becomes an integral component of PHC and health systems development [7]
In this paper we report the findings of a policy document review and facility survey in relation to service delivery, health management information systems (HMIS) and equipment, technology and consumables
Summary
Over two-thirds of Africans have no access to eye care services. To increase access, the World Health Organization (WHO) recommends integrating eye care into primary health care, and the WHO Africa region recently developed a package for primary eye care. The majority (approximately 70%) of people in Africa do not have access to eye care [4] as most eye care services are in secondary and tertiary facilities in urban areas [5], reducing access by rural populations This is significant because inequitable access to eye health services is responsible for the majority of blindness and visual impairment [6]. Primary health care (PHC) services, on the other hand, are widely accessible to the majority of the population in urban and rural areas, and the World Health Organization’s (WHO) Global Action Plan (WHO GAP) 2014–2019 recommends that eye care becomes an integral component of PHC and health systems development [7]. The recent WHO World Report on Vision recommends primary health care systems as the vehicle to deliver “integrated people-centred eye care.” [8]
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