Strengths and weaknesses of eye care services in sub-Saharan Africa: a meta-synthesis of eye health system assessments

Abstract

Background In sub-Saharan Africa (SSA), the delivery of eye care services continues to be undermined by health systems performance bottlenecks. There is a growing focus by partners in the sector on the analysis of the different components of eye care within the wider health system context to diagnose and manage interactions in ways that achieve more effective improvements. However, there has been no attempt to date to systematically synthesize these studies. In this study, we conducted a meta-synthesis of eye health system assessments to gain a more comprehensive understanding of the current systems and how they can be strengthened across different SSA contexts. Methods We conducted a comprehensive search for eye health system assessment reports using global and regional websites of the WHO and other organizations supporting eye care in sub-Saharan Africa. A range of online databases with no language restrictions (PubMed, EMBASE, MEDLINE, PsycINFO and CINAHL) were searched for peer-reviewed publications referring to eye health system assessment (EHSA) or eye care service assessment tool (ECSAT). Assessments were included if they used the ECSAT or EHSA tool; were conducted in sub-Saharan Africa; and had been completed with full reports available in the public domain by January 15, 2019. A combination of framework and thematic syntheses was used. Results Our search strategies yielded a total of 12 assessments conducted in nine countries using the ECSAT/EHSA tool in Sub-Saharan Africa. Eight assessments met our inclusion criteria: four were from West Africa, two from East Africa and two from Southern Africa. Across the eight countries, findings show considerable progress and improvements in the areas of governance, organisation, financing, provision, and coverage of eye care. However, several systemwide weaknesses were found to continue to impede quality eye health service planning and delivery across the countries included in this review. Conclusions These findings highlight the need for national governments and iNGOs to invest in conducting and wider use of these assessments. Such analyses are particularly useful in building links between different system elements and in finding innovative, more flexible solutions and partnerships – needed to address avoidable vision loss in resource poor settings.

Assessment of eye health care services of Bangladesh using eye care service assessment tools

“…Across the eight countries, findings show considerable progress and improvements in the areas of governance, organization, financing, provision, and coverage while some weaknesses were found those impede quality eye health service planning and delivery. 9 Assessment of eye care service is essential part for improvement of service delivery quality at the same time it also plays a vital role in integration of eye care service into broader health system. Universal eye health coverage is a long-term goal of a country's public health sector and the government of Bangladesh has put in place important governance mechanisms to ensure eye health system development and its integration in the broader health system.…”

School-based vision screening in Quetta, Pakistan: a qualitative study of experiences of teachers and eye care providers

“…One of the main barriers to accessing eye care services in many low-and middle-income countries (LMICs) is the limited number and unequal distribution of eye care providers, who tend to be located in large urban centres and therefore inaccessible for a large proportion of the population, particularly those in rural and remote areas [9,10]. Families in such locations often cannot take their children to health facilities for regular vision check-ups due to time and transport constraints [11].…”

Situation Analysis of Uncorrected Refractive Errors in Sub-Saharan Francophone African Countries

“…[17][18][19] Despite all the efforts made by the actors involved in the partnership of the Vision 2020 objective, most SSA states remain far from achieving the sustainable development objectives related to the of the Right to Sight initiative. [20][21][22][23][24][25][26] The current observation is that the situation in French Sub-Saharan African (FSSA) countries remains even more worrying because of the mismatch between the growing needs of the population and current availability of eye health services. [12,20,[27][28][29] The implementation of coordination strategies and the real weight of the eye health program in national health systems su ciently demonstrated the limits of its governance policies.…”

“…[28,29] It is clear that beyond the production of policy documents, most states in this region only contribute to the provision of premises and rely on the support of partners and non-governmental organizations (NGOs) which seem to be more involved in actions to combat visual impairment. [3,25,30] One of the characteristics of this region is also the lack of data on the real state of eye diseases. Very few FSSA countries have statistics on the prevalence of refractive errors in the population.…”

“…Very few FSSA countries have statistics on the prevalence of refractive errors in the population. [25] The few publications carried out either in schools or hospitals often indicate a lack of data for an entire region and do not allow the development of a management plan based on documented knowledge of the URE situation. [31,32] Governance problems, associated with human resources problems, nancing problems for healthcare, infrastructure and consumables, led us to initiate this study, the objective of which is to analyze the situation of UREs in FSSA with the stakeholders involved in the eye health system.…”