Primary eye care in rural sub-Saharan Africa

Abstract

Primary eye care in rural sub-Saharan Africa is reviewed. In the context of eye care delivered by village health workers (VHW's) living in and supported by the community, such a system of health care does not exist in Africa today. There are no VHW's, and primary health care is currently a matter of experimentation and conjecture only. However, most basic eye care is rendered by non-ophthalmologists; such care consists of screening, treatment of infections and inflammations, and in some cases, cataract surgery. Lower levels of non-ophthalmic general health workers are being tasked to promote measures to prevent trachoma and xerophthalmia/nutritional blindness by intervention at the village level. Preliminary results of such programs are encouraging, and warrant further evaluation and expansion.

Evidence for integrating eye health into primary health care in Africa: a health systems strengthening approach

“…In general however, documented longer-term outcomes for eye health training have been less encouraging [14,30,74-76,100]. Evidence from evaluations of the quality of these interventions is sparse: for example whether the skills and knowledge presented in the initial training are appropriate to the context to which health personnel return, or are indeed acquired or retained.…”

“…• Realistic expectations about which eye care services can most appropriately be implemented and learnt by different cadres in the limited time available during either in-service training or as part of a pre-service course [44,48,106]. …”

“…Furthermore, evidence is lacking about the delivery of comprehensive eye health services or of the effectiveness of eye care service provision within either vertical or horizontal approaches [14,30,58,74-76,99,100] or the procurement, management and maintenance systems for equipment and supplies. This may be due to a lack of documentation, sufficient research, application of available research for planning [173], or to the genuine lack of effective eye care interventions at primary level.…”

Evidence for integrating eye health into primary health care in Africa: a health systems strengthening approach

“…In general however, documented longer-term outcomes for eye health training have been less encouraging [14,30,74-76,100]. Evidence from evaluations of the quality of these interventions is sparse: for example whether the skills and knowledge presented in the initial training are appropriate to the context to which health personnel return, or are indeed acquired or retained.…”

“…• Realistic expectations about which eye care services can most appropriately be implemented and learnt by different cadres in the limited time available during either in-service training or as part of a pre-service course [44,48,106]. …”

“…Furthermore, evidence is lacking about the delivery of comprehensive eye health services or of the effectiveness of eye care service provision within either vertical or horizontal approaches [14,30,58,74-76,99,100] or the procurement, management and maintenance systems for equipment and supplies. This may be due to a lack of documentation, sufficient research, application of available research for planning [173], or to the genuine lack of effective eye care interventions at primary level.…”

Incorporating primary eye care into primary health care: Piloting a perceived visual disability questionnaire based model in rural southern India – An observational study

“…[ 8 ] In one of the models studied, PHC workers are required to check vision,[ 9 ] in addition to PHC work. [ 10 ] It is important to find a model where community health workers (CHWs) in PHC can effectively screen without being overworked. [ 11 ]…”

Setting targets for human resources for eye health in sub-Saharan Africa: what evidence should be used?

“…Conditions such as vitamin A deficiency and measles-related corneal problems, trachoma, and onchocerciasis were once considered synonymous with blindness in SSA. These were the conditions that originally inspired the concept of “primary eye care” [ 26 ] because they lend themselves to action by general health workers at the community level. Successful broad-based measles immunization and vitamin A supplementation efforts throughout Africa and focal large-scale initiatives against trachoma and onchocerciasis mean that these conditions are rapidly decreasing as causes of vision loss [ 5 , 6 ].…”

Evidence for integrating eye health into primary health care in Africa: a health systems strengthening approach

“…In general however, documented longer-term outcomes for eye health training have been less encouraging [14,30,74-76,100]. Evidence from evaluations of the quality of these interventions is sparse: for example whether the skills and knowledge presented in the initial training are appropriate to the context to which health personnel return, or are indeed acquired or retained.…”

“…• Realistic expectations about which eye care services can most appropriately be implemented and learnt by different cadres in the limited time available during either in-service training or as part of a pre-service course [44,48,106]. …”

“…Furthermore, evidence is lacking about the delivery of comprehensive eye health services or of the effectiveness of eye care service provision within either vertical or horizontal approaches [14,30,58,74-76,99,100] or the procurement, management and maintenance systems for equipment and supplies. This may be due to a lack of documentation, sufficient research, application of available research for planning [173], or to the genuine lack of effective eye care interventions at primary level.…”

Incorporating primary eye care into primary health care: Piloting a perceived visual disability questionnaire based model in rural southern India – An observational study

“…[ 8 ] In one of the models studied, PHC workers are required to check vision,[ 9 ] in addition to PHC work. [ 10 ] It is important to find a model where community health workers (CHWs) in PHC can effectively screen without being overworked. [ 11 ]…”

Setting targets for human resources for eye health in sub-Saharan Africa: what evidence should be used?

“…Conditions such as vitamin A deficiency and measles-related corneal problems, trachoma, and onchocerciasis were once considered synonymous with blindness in SSA. These were the conditions that originally inspired the concept of “primary eye care” [ 26 ] because they lend themselves to action by general health workers at the community level. Successful broad-based measles immunization and vitamin A supplementation efforts throughout Africa and focal large-scale initiatives against trachoma and onchocerciasis mean that these conditions are rapidly decreasing as causes of vision loss [ 5 , 6 ].…”

Evidence for integrating eye health into primary health care in Africa: a health systems strengthening approach

“…In general however, documented longer-term outcomes for eye health training have been less encouraging [14,30,74-76,100]. Evidence from evaluations of the quality of these interventions is sparse: for example whether the skills and knowledge presented in the initial training are appropriate to the context to which health personnel return, or are indeed acquired or retained.…”

“…• Realistic expectations about which eye care services can most appropriately be implemented and learnt by different cadres in the limited time available during either in-service training or as part of a pre-service course [44,48,106]. …”

“…Furthermore, evidence is lacking about the delivery of comprehensive eye health services or of the effectiveness of eye care service provision within either vertical or horizontal approaches [14,30,58,74-76,99,100] or the procurement, management and maintenance systems for equipment and supplies. This may be due to a lack of documentation, sufficient research, application of available research for planning [173], or to the genuine lack of effective eye care interventions at primary level.…”

Incorporating primary eye care into primary health care: Piloting a perceived visual disability questionnaire based model in rural southern India – An observational study

“…[ 8 ] In one of the models studied, PHC workers are required to check vision,[ 9 ] in addition to PHC work. [ 10 ] It is important to find a model where community health workers (CHWs) in PHC can effectively screen without being overworked. [ 11 ]…”

Setting targets for human resources for eye health in sub-Saharan Africa: what evidence should be used?

“…Conditions such as vitamin A deficiency and measles-related corneal problems, trachoma, and onchocerciasis were once considered synonymous with blindness in SSA. These were the conditions that originally inspired the concept of “primary eye care” [ 26 ] because they lend themselves to action by general health workers at the community level. Successful broad-based measles immunization and vitamin A supplementation efforts throughout Africa and focal large-scale initiatives against trachoma and onchocerciasis mean that these conditions are rapidly decreasing as causes of vision loss [ 5 , 6 ].…”