Knowledge, skills, and productivity in primary eye care among health workers in Tanzania: need for reassessment of expectations?

Byamukama, Emmanuel; Courtright, Paul

doi:10.1016/j.inhe.2010.07.008

Cited by 35 publications

(41 citation statements)

References 15 publications

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“…An interview questionnaire for the PHCW was designed and pre-tested in the pilot study [5]. Part 1 of the questionnaire captured demographic information, training history and content, and whether he or she currently manages eye patients.…”

Section: Methodsmentioning

confidence: 99%

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Skills of general health workers in primary eye care in Kenya, Malawi and Tanzania

et al. 2014

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BackgroundPrimary eye care (PEC) in sub-Saharan Africa usually means the diagnosis, treatment, and referral of eye conditions at the most basic level of the health system by primary health care workers (PHCWs), who receive minimal training in eye care as part of their curricula. We undertook this study with the aim to evaluate basic PEC knowledge and ophthalmologic skills of PHCWs, as well as the factors associated with these in selected districts in Kenya, Malawi, and Tanzania.MethodsA standardized (26 items) questionnaire was administered to PHCWs in all primary health care (PHC) facilities of 2 districts in each country. Demographic information was collected and an examination aimed to measure competency in 5 key areas (recognition and management of advanced cataract, conjunctivitis, presbyopia, and severe trauma plus demonstrated ability to measure visual acuity) was administered.ResultsThree-hundred-forty-three PHCWs were enrolled (100, 107, and 136 in Tanzania, Kenya, and Malawi, respectively). The competency scores of PHCW varied by area, with 55.7%, 61.2%, 31.2%, and 66.1% scoring at the competency level in advanced cataract, conjunctivitis, presbyopia, and trauma, respectively. Only 8.2% could measure visual acuity. Combining all scores, only 9 (2.6%) demonstrated competence in all areas.ConclusionThe current skills of health workers in PEC are low, with a large per cent below the basic competency level. There is an urgent need to reconsider the expectations of PEC and the content of training.

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Section: Methodsmentioning

confidence: 99%

“…With respect to the delivery of eye care, problems have also been documented in the management of urgent eye conditions in PHC facilities [4]. Recently, a pilot study in Tanzania tested knowledge of priority eye conditions among PHCW and found it inadequate to deal with those [5]. …”

Section: Introductionmentioning

confidence: 99%

Skills of general health workers in primary eye care in Kenya, Malawi and Tanzania

et al. 2014

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“…Rowe et al, proposed that health worker performance is rarely improved by dissemination of written guidelines, but that supervision and audit were often effective [5]. A pilot study in one district of Tanzania documented the inadequate skills of PHCWs in PEC [6]. …”

Section: Introductionmentioning

confidence: 99%

“…It was recognized that data were limited and more research was required. A study in Tanzania on knowledge, skills, and productivity in primary eye care among health workers found that there was poor understanding of basic ocular conditions among primary health care workers [19]. It is apparent from these articles that the absence of a clear definition of primary eye care, what should be integrated, and who should be tasked poses challenges to the concept of PEC in practice.…”

Section: Introductionmentioning

confidence: 99%

A randomised controlled trial to investigate effects of enhanced supervision on primary eye care services at health centres in Kenya, Malawi and Tanzania

Kalua

Gichangi

Barassa

et al. 2014

BMC Health Serv Res

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BackgroundKnowledge and skills of primary health care workers (PHCWs) in primary eye care have been demonstrated to be inadequate in several districts of Kenya, Malawi, and Tanzania. We tested whether enhanced supervision, focused on improving practical skills over two years, would raise the scores of these workers on a test of basic knowledge and skills.MethodsThis was a randomised controlled trial. All primary health care (PHC) facilities within two districts of each country were enrolled and randomly assigned by district (Kenya, Malawi) or by health care facility (Tanzania) to receive quarterly skills-based supervision by a district eye coordinator or to continue existing routine supervision. At baseline, a test of basic knowledge and skills in five key areas was administered to PHCWs, and visual acuity (VA) charts and working torches were provided. After two years the test was administered again. Changes in test scores were compared between the intervention (enhanced supervision) and the non-intervention (routine supervision) facilities.ResultsAll 137 facilities in the six districts were enrolled including 343 PHCWs. At baseline, no facility had a visual acuity chart and 18 (13%) had a working torch; the average total skills scores were 6.04 and 6.38 (maximum of 12) in the non-intervention and the intervention facilities, respectively. After two years, 16 intervention facilities (23.2%) had a visual acuity chart correctly placed and 19 (27.5%) had a working torch, compared to 4 (5.9%) and 6 (8.8%), respectively, in the routine supervision facilities. At the facility level, the change in overall test scores was +1.84 points in the intervention sites compared to +0.42 points in the non-intervention sites (p<0.001). Staff turnover included about 75% of the staff by the end of the study.ConclusionThe improvements in the enhanced supervision facilities were very modest and of questionable clinical significance. The low impact of the intervention may be due to the high turnover of PHCWs or high absenteeism. A better understanding of the quality of eye care at PHC facilities and influencing factors are urgently needed before continuing to invest resources in the scale up of this model of task shifting in Africa.

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“…In this study, 32 of 35 (91%) of patients who were counselled to have cataract surgery and who got to the hospital actually had operable cataract. This is encouraging, especially since another study of the ability of ''primary health workers'' to recognize and appropriately refer operable cataract was much lower [8]. On the other hand, we do not know how many operable cataracts may have been missed in the field.…”

Section: Discussionmentioning

confidence: 94%

Uptake of cataract surgery in Sava Region, Madagascar: role of cataract case finders in acceptance of cataract surgery

Razafinimpanana¹,

Nkumbe

Courtright

et al. 2012

Int Ophthalmol

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The number of people coming for cataract surgery in Madagascar remains low and most ophthalmologists could do many more surgeries than currently done. Knowing why people identified with cataract do not accept surgery will help to design programs that use existing resources more effectively. The study was carried out in Sava Region of Madagascar. People with blinding (<6/60) cataract were identified by cataract case finders in the community, interviewed, and given a referral card for surgery at the hospital. We then monitored uptake of surgery at the hospital. Overall, 142 people were identified, interviewed and referred. Among the referrals, 35 (24.6%) presented at the hospital for surgery. The most important factors associated with acceptance were proximity to hospital (people from Sambava district were twice as likely to present as people from more distant districts) and perceived price of transport and food (being higher for people not accepting). The actual price of surgery was not the main barrier to acceptance of surgery; instead it appears that distance to the hospital and the willingness to pay are important predictors. Strategies to improve uptake need to be revised in order to ensure that people have access to and use cataract surgical services.

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Knowledge, skills, and productivity in primary eye care among health workers in Tanzania: need for reassessment of expectations?

Cited by 35 publications

References 15 publications

Skills of general health workers in primary eye care in Kenya, Malawi and Tanzania

Skills of general health workers in primary eye care in Kenya, Malawi and Tanzania

A randomised controlled trial to investigate effects of enhanced supervision on primary eye care services at health centres in Kenya, Malawi and Tanzania

Uptake of cataract surgery in Sava Region, Madagascar: role of cataract case finders in acceptance of cataract surgery

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