A situational analysis of ocular health promotion in the South African primary health‐care system

Abstract

Ocular health promotional activities were absent in other provinces. This may be a major contributing factor to poor ocular health promotion in South Africa and hence, the high prevalence of blindness and visual impairment. Therefore, it is recommended that an integrated ocular health promotional model (directorate and policies) be developed and be part of the South African primary health-care system.

Strengthening primary eye care in South Africa: An assessment of services and prospective evaluation of a health systems support package

“…Other than this study there have been few, if any, comprehensive assessments of primary eye care services in South Africa. Even routine monitoring and evaluation of eye services has been lacking, with some eye care managers reporting no monitoring and evaluation methods [ 18 ] and one study noting a complete absence of eye health data collection at PHC level [ 35 ] in agreement with findings in this study. The paucity of eye care data in South Africa is a critical problem which hinders effective monitoring and ultimately improvement of eye health services in the country.…”

“…We found that distance VA charts were not available in all facilities and where they were available, patients were most often assessed at the incorrect distance, compromising the VA measurements. It is not surprising that vision screening is inadequate, as 81% (43/53) of South African provincial health directorate managers reported that they do not include vision screening in their health promotional programs [ 18 ], minimising the importance of this service. Similar problems with VA screening are evident in other African countries, where healthcare workers have been shown to lack competence in assessing VA, including use of the incorrect patient-chart distance [ 37 , 38 ].…”

“…In South Africa, eye care is largely provided at the primary healthcare (PHC) level, known as primary eye care [ 17 ], with referral to higher level institutions where the need arises. The country does not have a dedicated directorate for eye healthcare, nor is there an integrated eye health promotional policy [ 18 ], resulting in inadequate eye care services as has also been described in other African countries [ 19 ]. Challenges in the South African eye care programme include insufficient human resources [ 20 , 21 ], unaffordable or unavailable medication [ 22 , 23 ], unsatisfactory programme evaluation [ 18 ] and inadequate service coverage for Vitamin A supplementation, vision assessments, spectacle provision, cataract surgery and screening for eye complications in patients with diabetes [ 20 – 22 , 24 – 28 ].…”

“…The country does not have a dedicated directorate for eye healthcare, nor is there an integrated eye health promotional policy [ 18 ], resulting in inadequate eye care services as has also been described in other African countries [ 19 ]. Challenges in the South African eye care programme include insufficient human resources [ 20 , 21 ], unaffordable or unavailable medication [ 22 , 23 ], unsatisfactory programme evaluation [ 18 ] and inadequate service coverage for Vitamin A supplementation, vision assessments, spectacle provision, cataract surgery and screening for eye complications in patients with diabetes [ 20 – 22 , 24 – 28 ]. In addition, coordination between the different levels of the eye health system is lacking, with poor communication, a complex referral system and problems transporting patients to specialised services [ 23 ].…”

Eye care utilization pattern in South Africa: results from SANHANES-1

“…In South Africa, eye care services are readily available in urban centers and may be generally lacking in rural communities. Underutilization of eye-care services in South Africa may be attributed to the lack of ocular health promotional structures and activities in the primary health care system [52].…”