The eye health system and social influence on health decision making − An example from couching in Nasarawa State, Nigeria

Abstract

Introduction: The health systems assessment approach is applied to eye health to assess its readiness to meet the goals of the global action plan for eye care. The overall blindness prevalence in Nigeria is 0.78% (1.17 million people are blind of which 84% is avoidable). Cataract accounts for 43% of blindness. With a surgical rate of 300/million/year, couching is still being undertaken with 42.7% of eyes that had cataract treatment having been couched. Aims: This study assesses the eye health system of Nasarawa State, Nigeria and to find out why couching is still being practiced. Settings and Design: A mixed qualitative and quantitative method was used. Subjects and Methods: Questionnaires and interview guidelines were adapted from the International Agency for Prevention of Blindness/Eye Health Systems Assessment manuals. Health systems building blocks of governance, finance, human resources and service delivery along with traditional system were assessed, and their strengths and weaknesses were identified. Results: Eighteen interviews were conducted. There is no eye care coordinator to supervise eye care functions in the state. Eye care is not separately financed from the general healthcare. Seventy percent of healthcare expenditure is from out-of-pocket payments. There are enough but inequitably distributed eye care workers to meet the recommendations of vision 2020 for the population. The cataract surgical rate is less than 200/million/year and less than 100 surgeries/surgeon/year. Couching is encouraged through strong community influence despite the poor visual outcome. Conclusion: The Nasarawa State eye health system has the resources to meet the eye care demands of the population; however, it lacks co-ordination, and ineffective service delivery makes the surgical output low, thereby encouraging couching.