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

Abstract

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.

Primary Eye Care in Eastern Nepal

“…The PEC knowledge and skills of primary healthcare workers (PHCWs) in Tanzania, Kenya and Malawi was shown to be low. 12 Similar results were found in Ethiopia and Nigeria. 13,14 Other studies have evaluated the effectiveness and long-term impact of PEC training.…”

“…This is higher when compared to other similar studies: 56% in Tanzania, Malawi and Kenya, 49.5% in Ethiopia and 72.3% in Nigeria. [12][13][14] This number is still low, however, considering cataract remains the leading cause of blindness in the Sagarmatha region despite surgical provision by SCEH and suggests that recognition at the community level needs to be improved in order to reduce cataract blindness.…”

Prevalence and determinants of self-reported ocular morbidity and utilization of eye services in Sri Lanka: results from a national population-based survey

“…Integration of eye health into primary health care provides an opportunity to improve access to eye care services at the community level [24]. Delays in presentation of potentially sight-threatening acute conditions like injuries and red eyes can be reduced by effective primary health care and a responsive referral system.…”

“…Delays in presentation of potentially sight-threatening acute conditions like injuries and red eyes can be reduced by effective primary health care and a responsive referral system. Primary eye care encompasses the diagnosis, treatment and referral of eye conditions at the lowest level of the health system and is generally delivered by primary health care workers [24]. Unfortunately the skills of primary level personnel are often poor and basic competencies are also not achieved in many countries [25,26].…”

Addressing the human resources for health crisis through task-shifting and retention: results from the Africa Health Systems Initiative Support to African Research Partnerships program

“…Primary health care workers provide primary eye care services in Kenya, Tanzania, Malawi, and Madagascar. However, as research described in this supplement shows, their competency scores are low [ 2 ], as are the sensitivity and specificity of these signs and symptoms [ 3 ], indicating that this task-shifting strategy might need to be refined and/or training strengthened to provide higher quality eye care. The same team recommends that non-physician cataract surgeon training should be supplemented with improvements in equipment, transportation, human resources and organizational support [ 4 ], suggesting a health systems approach may be necessary for properly integrating strategies such as task-shifting.…”