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

Abstract

BackgroundThe impact of unmet eye care needs in sub-Saharan Africa is compounded by barriers to accessing eye care, limited engagement with communities, a shortage of appropriately skilled health personnel, and inadequate support from health systems. The renewed focus on primary health care has led to support for greater integration of eye health into national health systems. The aim of this paper is to demonstrate available evidence of integration of eye health into primary health care in sub-Saharan Africa from a health systems strengthening perspective.MethodsA scoping review method was used to gather and assess information from published literature, reviews, WHO policy documents and examples of eye and health care interventions in sub-Saharan Africa. Findings were compiled using a health systems strengthening framework.ResultsLimited information is available about eye health from a health systems strengthening approach. Particular components of the health systems framework lacking evidence are service delivery, equipment and supplies, financing, leadership and governance. There is some information to support interventions to strengthen human resources at all levels, partnerships and community participation; but little evidence showing their successful application to improve quality of care and access to comprehensive eye health services at the primary health level, and referral to other levels for specialist eye care.ConclusionEvidence of integration of eye health into primary health care is currently weak, particularly when applying a health systems framework. A realignment of eye health in the primary health care agenda will require context specific planning and a holistic approach, with careful attention to each of the health system components and to the public health system as a whole. Documentation and evaluation of existing projects are required, as are pilot projects of systematic approaches to interventions and application of best practices. Multi-national research may provide guidance about how to scale up eye health interventions that are integrated into primary health systems.

A cross‐sectional survey of optometrists and optometric practices in Ghana

“…Human resources for the development of ocular health have been identified as one of the crucial steps toward achieving the VISION 2020: Right to Sight goals; however, the eye‐care human resources to population ratios in developing countries, including Ghana, are woefully inadequate . Health‐care delivery in Ghana comes under four main categories; public, private for profit, mission/non‐governmental organisations and the traditional herbal system .…”

“…5,6 Human resources for the development of ocular health have been identified as one of the crucial steps toward achieving the VISION 2020: Right to Sight goals; however, the eye-care human resources to population ratios in developing countries, including Ghana, are woefully inadequate. 7,8 Healthcare delivery in Ghana comes under four main categories; public, private for profit, mission/non-governmental organisations and the traditional herbal system. 9,10 Financing of public health care, including eye-care services, is operated under the national health insurance scheme (NHIS), which provides equitable access and financial coverage for basic health-care services for the population in Ghana.…”

Formative research for the development of an Eye Health Strategic Planning and Evaluation Framework and a Checklist: A health systems approach

“…Issues concerning the use of a specific program models have been raised in Africa and Asia . “One size cannot fit all”.…”

“…Issues concerning the use of a specific program models have been raised in Africa and Asia. 8,61 "One size cannot fit all". It is essential to recognize that all program development must be designed with the local context in mind.…”

“…To ameliorate this situation, the health sector focus in low‐ and middle‐income countries is being aligned to and integrated within public health services . Different eye health‐care strategies are being trialed, and the scale‐up of eye health services through the public health system has growing appeal . There is also recognition that eye health care can no longer be a stand‐alone operation to the public health system.…”