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Okoroafor SC, Dela Christmals C. Health Professions Education Strategies for Enhancing Capacity for Task-Shifting and Task-Sharing Implementation in Africa: A Scoping Review. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; Publish Ahead of Print:00005141-990000000-00082. [PMID: 37341562 DOI: 10.1097/ceh.0000000000000517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
BACKGROUND To compensate for the shortage of health workers and effectively use the available health workforce to provide access to health services at various levels of the health system, several countries are implementing task-shifting and task-sharing (TSTS). This scoping review was conducted to synthesize evidence on health professions education (HPE) strategies applied to enhance capacities for TSTS implementation in Africa. METHODS This scoping review was conducted using the enhanced Arksey and O'Malley's framework for scoping reviews. The sources of evidence included CINAHL, PubMed, and Scopus. RESULTS Thirty-eight studies conducted in 23 countries provided insights on the strategies implemented in various health services contexts including general health, cancer screenings, reproductive, maternal, newborn, child and adolescent health, HIV/AIDS, emergency care, hypertension, tuberculosis, eye care, diabetes, mental health, and medicines. The HPE strategies applied were in-service training, onsite clinical supervision and mentoring, periodic supportive supervision, provision of job aides, and preservice education. CONCLUSION Scaling up HPE based on the evidence from this study will contribute immensely to enhancing the capacity of health workers in contexts where TSTS are being implemented or planned to provide quality health services based on the population's health needs.
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Affiliation(s)
- Sunny C Okoroafor
- Dr. Okoroafor: Technical Officer, Health Systems Strengthening, Universal Health Coverage-Life Course Cluster, World Health Organization Country Office for Uganda, Kampala, Uganda. Dr. Dela Christmals: Associate Professor, Centre for Health Professions Education, Faculty of Health Sciences, North-West University, Potchefstroom Campus, Potchefstroom, South Africa
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Okoroafor SC, Christmals CD. Task Shifting and Task Sharing Implementation in Africa: A Scoping Review on Rationale and Scope. Healthcare (Basel) 2023; 11:1200. [PMID: 37108033 PMCID: PMC10138489 DOI: 10.3390/healthcare11081200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 04/14/2023] [Accepted: 04/20/2023] [Indexed: 04/29/2023] Open
Abstract
Numerous studies have reported task shifting and task sharing due to various reasons and with varied scopes of health services, either task-shifted or -shared. However, very few studies have mapped the evidence on task shifting and task sharing. We conducted a scoping review to synthesize evidence on the rationale and scope of task shifting and task sharing in Africa. We identified peer-reviewed papers from PubMed, Scopus, and CINAHL bibliographic databases. Studies that met the eligibility criteria were charted to document data on the rationale for task shifting and task sharing, and the scope of tasks shifted or shared in Africa. The charted data were thematically analyzed. Sixty-one studies met the eligibility criteria, with fifty-three providing insights on the rationale and scope of task shifting and task sharing, and seven on the scope and one on rationale, respectively. The rationales for task shifting and task sharing were health worker shortages, to optimally utilize existing health workers, and to expand access to health services. The scope of health services shifted or shared in 23 countries were HIV/AIDS, tuberculosis, hypertension, diabetes, mental health, eyecare, maternal and child health, sexual and reproductive health, surgical care, medicines' management, and emergency care. Task shifting and task sharing are widely implemented in Africa across various health services contexts towards ensuring access to health services.
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Affiliation(s)
- Sunny C. Okoroafor
- Universal Health Coverage—Life Course Cluster, World Health Organization Country Office for Uganda, Kampala, Uganda
- Centre for Health Professions Education, Faculty of Health Sciences, North-West University, Potchefstroom Campus, Building PC-G16, Office 101, 11 Hoffman Street, Potchefstroom 2520, South Africa
| | - Christmal Dela Christmals
- Centre for Health Professions Education, Faculty of Health Sciences, North-West University, Potchefstroom Campus, Building PC-G16, Office 101, 11 Hoffman Street, Potchefstroom 2520, South Africa
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Yasmin S, Schmidt E. Primary eye care: opportunities for health system strengthening and improved access to services. Int Health 2022; 14:i37-i40. [PMID: 35385864 PMCID: PMC8986357 DOI: 10.1093/inthealth/ihab062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/06/2021] [Accepted: 09/15/2021] [Indexed: 11/12/2022] Open
Abstract
Primary eye care (PEC) is a vital component of primary healthcare (PHC) and is the cornerstone for the progress towards universal eye health coverage. While the concept of PEC is not new, with the increased focus of the global eye-health agenda on equity and people-centred care, it is critical to review experiences of delivering PEC in low- and middle-income countries and to identify common lessons learnt. This commentary builds on the available evidence and focuses specifically on three recently published evaluations of PEC in Sightsavers-supported programmes in Tanzania, Sierra Leone and Pakistan. It argues that systems thinking is critical in the delivery of PEC interventions, as only this approach can ensure that the integration of PEC into PHC is delivered in a comprehensive, coherent and sustainable way.
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Affiliation(s)
- Sumrana Yasmin
- Sightsavers, 3-A, Street 7, Sector G-10/2, Islamabad, 44000, Pakistan
| | - Elena Schmidt
- Sightsavers, 35 Perrymount Road, Haywards Heath, RH16 3BW, UK
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Xulu-Kasaba Z, Mashige K, Naidoo K. Knowledge, Attitudes and Practices of Eye Health among Public Sector Eye Health Workers in South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12513. [PMID: 34886238 PMCID: PMC8656467 DOI: 10.3390/ijerph182312513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 11/21/2021] [Accepted: 11/22/2021] [Indexed: 11/17/2022]
Abstract
In South Africa, primary eye care is largely challenged in its organisational structure, availability of human and other resources, and clinical competency. These do meet the standard required by the National Department of Health. This study seeks to assess the levels of knowledge, attitudes, and practices on eye health amongst Human Resources for eye health (HReH) and their managers, as no study has assessed this previously. A cross-sectional study was conducted in 11 districts of a South African province. A total of 101 participants completed self-administered, close-ended, Likert-scaled questionnaires anonymously. Binary logistic regression analysis was conducted, and values of p < 0.05 were considered statistically significant. Most participants had adequate knowledge (81.6%), positive attitudes (69%), and satisfactory practices (73%) in eye health. HReH showed better knowledge than their managers (p < 0.01). Participants with a university degree, those aged 30-44 years, and those employed for <5 years showed a good attitude (p < 0.05) towards their work. Managers, who supervise and plan for eye health, were 99% less likely to practice adequately in eye health when compared with HReH (aOR = 0.012; p < 0.01). Practices in eye health were best amongst participants with an undergraduate degree, those aged 30-44 years (aOR = 2.603; p < 0.05), and participants with <5 years of employment (aOR = 26.600; p < 0.01). Knowledge, attitudes, and practices were found to be significantly moderately correlated with each other (p < 0.05). Eye health managers have poorer knowledge and practices of eye health than the HReH. A lack of direction is presented by the lack of adequately trained directorates for eye health. It is therefore recommended that policymakers review appointment requirements to ensure that adequately trained and qualified directorates be appointed to manage eye health in each district.
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Affiliation(s)
- Zamadonda Xulu-Kasaba
- Discipline of Optometry, School of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa; (K.M.); (K.N.)
| | - Khathutshelo Mashige
- Discipline of Optometry, School of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa; (K.M.); (K.N.)
| | - Kovin Naidoo
- Discipline of Optometry, School of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa; (K.M.); (K.N.)
- Department of Optometry, University of New South, Wales Sydney, NSW 2052, Australia
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Mathenge WC, Hillgrove T, Gisagara E, Uwaliraye P, Hess O, Byamukama E, Intili A, Nyemazi A, Nkurikiye J. The Rwanda National Blindness Survey: Trends and use of the evidence to change practice and policy. AFRICAN VISION AND EYE HEALTH 2021. [DOI: 10.4102/aveh.v80i1.576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Maseko SN, van Staden D, Mhlongo EM. The Rising Burden of Diabetes-Related Blindness: A Case for Integration of Primary Eye Care into Primary Health Care in Eswatini. Healthcare (Basel) 2021; 9:835. [PMID: 34356213 PMCID: PMC8307827 DOI: 10.3390/healthcare9070835] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/27/2021] [Accepted: 06/01/2021] [Indexed: 11/16/2022] Open
Abstract
There is a rampant increase in diabetes prevalence globally. Sub-Saharan Africa (SSA) is projected to carry the largest burden of diabetes (34.2 million) by 2030. This will inevitably cause a parallel increase in diabetes-associated complications; with the predominant complications being blindness due to diabetic retinopathy and diabetic cataracts. Eye programs in developing countries remain inadequate, existing as stand-alone programs, focused on the provision of acute symptomatic care at secondary and tertiary health levels. Over 60% of people with undiagnosed diabetes report to eye care facilities with already advanced retinopathy. While vision loss due to cataracts is reversible, loss of vision from diabetic retinopathy is irreversible. Developing countries have in the last two decades been significantly impacted by infectious pandemics; with SSA countries committing over 80% of their health budgets towards infectious diseases. Consequently, non-communicable diseases and eye health have been neglected. This paper aimed to highlight the importance of strengthening primary health care services to prevent diabetes-related blindness. In SSA, where economies are strained by infectious disease, the projected rise in diabetes prevalence calls for an urgent need to reorganize health systems to focus on life-long preventative and integrated measures. However, research is critical in determining how best to integrate these without further weakening health systems.
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Affiliation(s)
- Sharon Nobuntu Maseko
- Department of Optometry, School of Health Sciences, University of Kwa-Zulu Natal, Durban 4001, South Africa;
| | - Diane van Staden
- Department of Optometry, School of Health Sciences, University of Kwa-Zulu Natal, Durban 4001, South Africa;
| | - Euphemia Mbali Mhlongo
- Department of Nursing, School of Nursing and Public Health, University of Kwa-Zulu Natal, Durban 4001, South Africa;
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Aghaji A, Burchett HED, Mathenge W, Faal HB, Umeh R, Ezepue F, Isiyaku S, Kyari F, Wiafe B, Foster A, Gilbert CE. Technical capacities needed to implement the WHO's primary eye care package for Africa: results of a Delphi process. BMJ Open 2021; 11:e042979. [PMID: 33741664 PMCID: PMC7986885 DOI: 10.1136/bmjopen-2020-042979] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE The aim of the study was to establish the technical capacities needed to deliver the WHO African Region's primary eye care package in primary healthcare facilities. DESIGN A two-round Delphi exercise was used to obtain expert consensus on the technical complexity of each component of the package and the technical capacities needed to deliver them using Gericke's framework of technical feasibility. The panel comprised nine eyecare experts in primary eyecare in sub-Saharan Africa. In each round panel members used a 4-point Likert scale to indicate their level of agreement. Consensus was predefined as ≥70% agreement on each statement. For round 1, statements on technical complexity were identified through a literature search of primary eyecare in sub-Saharan Africa from January 1980 to April 2018. Statements for which consensus was achieved were included in round 2, and the technical capacities were agreed. RESULTS Technical complexity statements were classified into four broad categories: intervention characteristics, delivery characteristics, government capacity requirements and usage characteristics. 34 of the 38 (89%) statements on health promotion and 40 of the 43 (93%) statements on facility case management were considered necessary technical capacities for implementation. CONCLUSION This study establishes the technical capacities needed to implement the WHO Africa Office primary eye care package, which may be generalisable to countries in sub-Saharan Africa.
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Affiliation(s)
- Ada Aghaji
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- Department of Ophthalmology, University of Nigeria Faculty of Medical Sciences, Enugu, Nigeria
| | - Helen E D Burchett
- Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
| | | | - Hannah Bassey Faal
- African Vision Research Institute, Durban, South Africa
- Department of Ophthalmology, University of Calabar, Calabar, Nigeria
| | - Rich Umeh
- Department of Ophthalmology, University of Nigeria Faculty of Medical Sciences, Enugu, Nigeria
| | - Felix Ezepue
- Department of Ophthalmology, University of Nigeria Faculty of Medical Sciences, Enugu, Nigeria
| | | | - Fatima Kyari
- Department of Ophthalmology, Baze University, Abuja, Nigeria
| | | | - Allen Foster
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Clare E Gilbert
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
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Rono H, Bastawrous A, Macleod D, Bunywera C, Mamboleo R, Wanjala E, Burton M. Smartphone-Guided Algorithms for Use by Community Volunteers to Screen and Refer People With Eye Problems in Trans Nzoia County, Kenya: Development and Validation Study. JMIR Mhealth Uhealth 2020; 8:e16345. [PMID: 32558656 PMCID: PMC7334755 DOI: 10.2196/16345] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/17/2019] [Accepted: 12/15/2019] [Indexed: 01/18/2023] Open
Abstract
Background The provision of eye care services is currently insufficient to meet the requirements of eye care. Many people remain unnecessarily visually impaired or at risk of becoming so because of treatable or preventable eye conditions. A lack of access and awareness of services is, in large part, a key barrier to handle this unmet need. Objective This study aimed to assess whether utilizing novel smartphone-based clinical algorithms can task-shift eye screening to community volunteers (CVs) to accurately identify and refer patients to primary eye care services. In particular, we developed the Peek Community Screening app and assessed its validity in making referral decisions for patients with eye problems. Methods We developed a smartphone-based clinical algorithm (the Peek Community Screening app) using age, distance vision, near vision, and pain as referral criteria. We then compared CVs’ referral decisions using this app with those made by an experienced ophthalmic clinical officer (OCO), which was the reference standard. The same participants were assessed by a trained CV using the app and by an OCO using standard outreach equipment. The outcome was the proportion of all decisions that were correct when compared with that of the OCO. Results The required sensitivity and specificity for the Peek Community Screening app were achieved after seven iterations. In the seventh iteration, the OCO identified referable eye problems in 65.9% (378/574) of the participants. CVs correctly identified 344 of 378 (sensitivity 91.0%; 95% CI 87.7%-93.7%) of the cases and correctly identified 153 of 196 (specificity 78.1%; 95% CI 71.6%-83.6%) cases as not having a referable eye problem. The positive predictive value was 88.9% (95% CI 85.3%-91.8%), and the negative predictive value was 81.8% (95% CI 75.5%-87.1%). Conclusions Development of such an algorithm is feasible; however, it requires considerable effort and resources. CVs can accurately use the Peek Community Screening app to identify and refer people with eye problems. An iterative design process is necessary to ensure validity in the local context.
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Affiliation(s)
- Hillary Rono
- Clinical Research Department, International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.,Kitale County and Referral Hospital, Kitale, Kenya
| | - Andrew Bastawrous
- Clinical Research Department, International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.,Peek Vision Foundation, London, United Kingdom
| | - David Macleod
- Medical Research Council Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Cosmas Bunywera
- Kitale County and Referral Hospital, Kitale, Kenya.,Peek Vision Foundation, London, United Kingdom
| | | | | | - Matthew Burton
- Clinical Research Department, International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.,Moorfields Eye Hospital NHS Trust, London, United Kingdom
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Damari B, Mahdavi A, Hajian M. How to improve Iranians' vision health: on the national policy of preventing Iranians' blindness. Int J Ophthalmol 2019; 12:114-122. [PMID: 30662850 DOI: 10.18240/ijo.2019.01.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 11/27/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To review vision health situation of Iranian community, analyze its determinants, and discuss the adopted improvement strategies by the Iran Ministry of Health and Medical Education (MOHME). METHODS This was a rapid situation analysis with a qualitative approach in three parts of recognition, orientation and implementation. The data were gathered via review of upstream documents, national and international experiences, and experts and stakeholders' opinions. RESULTS Eradicating trachoma, increasing human resources, increasing educational and research centers and promotion of ophthalmic technologies were important achievements in the field of vision health in Iran. Through these achievements, it seemed that the pattern of causes of blindness and low vision was similar to that of the developed countries. However, the review of Iranians' vision health indicators showed that a considerable percent of the blindness and low vision was avoidable through a national program demanding 3 types of interventions in social determinants of health (SDH), community education, and increasing the access to health care services by integrating the necessary services in primary health care system. CONCLUSION Managing the issue requires attentions from a national committee for preventing blindness with participation of all stakeholders, implementing a national survey on vision health, preparation of the primary level health centers including employment and education of community health workers (Behvarzes), optometrists and general practitioners, fair distribution of specialized human resources and establishing at least one specialized center in each province for referring patients from the primary levels.
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Affiliation(s)
- Behzad Damari
- Neuroscience Institute, Tehran University of Medical Sciences, Tehran 1416833481, Iran
| | - Alireza Mahdavi
- Ministry of Health and Medical Education, Tehran 1467664961, Iran
| | - Maryam Hajian
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran 1445613113, Iran
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Yip JLY, Bright T, Ford S, Mathenge W, Faal H. Process evaluation of a National Primary Eye Care Programme in Rwanda. BMC Health Serv Res 2018; 18:950. [PMID: 30526579 PMCID: PMC6286556 DOI: 10.1186/s12913-018-3718-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 11/15/2018] [Indexed: 12/05/2022] Open
Abstract
Background Visual impairment is a global public health problem, with an estimated 285 million affected globally, of which 43% are due to refractive error. A lack of specialist eye care in low and middle-income countries indicates a new model of care would support a task-shifting model and address this urgent need. We describe the features and results of the process evaluation of a national primary eye care (PEC) programme in Rwanda. Methods We used the Medical Research Council process evaluation framework to examine the implementation of the PEC programme, and to determine enablers and challenges to implementation. The process evaluation uses a mixed methods approach, drawing on results from several sources including a survey of 574 attendees at 50 PEC clinics, structured clinical observations of 30 PEC nurses, in-depth interviews with 19 key stakeholders, documentary review and a participatory process evaluation workshop with key stakeholders to review collated evidence and contextualize the results. Results Structured clinical assessment indicated that the PEC provided is consistent with the PEC curriculum, with over 90% of the clinical examination processes conducted correctly. In 4 years, programme monitoring data showed that nearly a million PEC eye examinations had been conducted in every health centre in Rwanda, with 2707 nurses trained. The development of the eye health system was an important enabler in the implementation of PEC, where political support allowed key developments such as inclusion of eye-drops on the essential medicines list, the inclusion of PEC on insurance benefits, the integration of PEC indicators on the health management information systems and integration of the PEC curriculum into the general nursing school curriculum. Challenges included high turnover of primary care nurses, lack of clarity and communication on the future funding of the programme, competing priorities for the health sector and sustained supervision to assure quality of care. Conclusions A model of a national primary eye care programme is presented, with service delivery to all areas in Rwanda. Key learning from this evaluation is the importance of strengthening the eye health care system, together with a strong focus on training primary care nurses using a PEC curriculum. Electronic supplementary material The online version of this article (10.1186/s12913-018-3718-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jennifer L Y Yip
- International Centre for Evidence on Disability, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1V, UK. .,International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK.
| | - Tess Bright
- International Centre for Evidence on Disability, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1V, UK
| | | | - Wanjiku Mathenge
- Rwanda International Institute of Ophthalmology and Dr Agarwal's Eye Hospital, Kigali, Rwanda
| | - Hannah Faal
- Africa Vision Research Institute, Durban, South Africa, University of Calabar, Calabar, Nigeria
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Strengthening primary eye care in South Africa: An assessment of services and prospective evaluation of a health systems support package. PLoS One 2018; 13:e0197432. [PMID: 29758069 PMCID: PMC5951550 DOI: 10.1371/journal.pone.0197432] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 05/02/2018] [Indexed: 11/19/2022] Open
Abstract
Visual impairment is a significant public health concern, particularly in low- and middle-income countries where eye care is predominantly provided at the primary healthcare (PHC) level, known as primary eye care. This study aimed to perform an evaluation of primary eye care services in three districts of South Africa and to assess whether an ophthalmic health system strengthening (HSS) package could improve these services. Baseline surveys were conducted in Cape Winelands District, Johannesburg Health District and Mopani District at 14, 25 and 36 PHC facilities, respectively. Thereafter, the HSS package, comprising group training, individual mentoring, stakeholder engagement and resource provision, was implemented in 20 intervention sites in Mopani District, with the remaining 16 Mopani facilities serving as control sites. At baseline, less than half the facilities in Johannesburg and Mopani had dedicated eye care personnel or sufficient space to measure visual acuity. Although visual acuity charts were available in most facilities, <50% assessed patients at the correct distance. Median score for availability of nine essential drugs was <70%. Referral criteria knowledge was highest in Cape Winelands and Johannesburg, with poor clinical knowledge across all districts. Several HSS interventions produced successful outcomes: compared to control sites there was a significant increase in the proportion of intervention sites with eye care personnel and resources such as visual acuity charts (p = 0.02 and <0.01, respectively). However, engaging with district pharmacists did not improve availability of essential drugs (p = 0.47). Referral criteria knowledge improved significantly in intervention sites (p<0.01) but there was no improvement in clinical knowledge (p = 0.76). Primary eye care in South Africa faces multiple challenges with regard to organisation of care, resource availability and clinical competence. The HSS package successfully improved some aspects of this care, but further development is warranted together with debate regarding the positioning of eye services at PHC level.
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Agyapong VIO, Farren C, McAuliffe E. Improving Ghana's mental healthcare through task-shifting- psychiatrists and health policy directors perceptions about government's commitment and the role of community mental health workers. Global Health 2016; 12:57. [PMID: 27716339 PMCID: PMC5045644 DOI: 10.1186/s12992-016-0199-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 09/21/2016] [Indexed: 12/25/2022] Open
Abstract
Background The scarcity of mental health professionals places specialist psychiatric care out of the reach of most people in low and middle income countries. There is growing interest in the effectiveness of task shifting as a strategy for targeting expanding health care demands in settings with shortages of qualified health personnel. Given this background, the aim of our study was to examine the perceptions of psychiatrists and health policy directors about the policy to expand mental health care delivery in Ghana through a system of task-shifting from psychiatrists to community mental health workers (CMHWs). Methods A self-administered semi-structured questionnaire was developed and administered to 11 psychiatrists and 29 health policy directors. Key informant interviews were also held with five psychiatrists and four health policy directors. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed thematically. Results Almost all the psychiatrists and 23 (79.3 %) health policy directors were aware of the policy of the Government of Ghana to improve on the human resource base within mental health through a system of task-shifting. Overall, about half of the psychiatrists and 9 (31 %) health policy directors perceived there is some professional resistance to the implementation of the policy of task shifting. The majority of respondents were of the view that CMHWs should be allowed to assess, diagnose and treat most of the common mental disorders. The respondents identified that CMHWs usually perform two sets of roles, namely; officially assigned roles for which they have the requisite training and assumed roles for which they usually do not have the requisite training. The stakeholders identified multiple challenges associated with current task shifting arrangements within Ghana’s mental health delivery system, including inadequate training and supervision, poor awareness of the scope of their expertise on the part of the CMHWs. Conclusion Psychiatrists and health policy directors support the policy to expand mental health service coverage in Ghana through a system of task-shifting, despite their awareness of resistance from some professionals. It is important that the Government of Ghana upholds its commitment of expanding mental healthcare by maintaining and prioritizing its policy on task shifting and also providing the necessary resources to ensure its success.
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Affiliation(s)
- Vincent Israel Opoku Agyapong
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, 1E1 WMC 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada. .,Department of Behavioural Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. .,Centre for Global Health, University of Dublin, Trinity College, Dublin, Ireland.
| | - Conor Farren
- Department of Psychiatry, University of Dublin, Trinity College, Dublin, Ireland
| | - Eilish McAuliffe
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Courtright P, Mathenge W, Kello AB, Cook C, Kalua K, Lewallen S. Setting targets for human resources for eye health in sub-Saharan Africa: what evidence should be used? HUMAN RESOURCES FOR HEALTH 2016; 14:11. [PMID: 26984773 PMCID: PMC4794905 DOI: 10.1186/s12960-016-0107-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 03/09/2016] [Indexed: 05/13/2023]
Abstract
With a global target set at reducing vision loss by 25% by the year 2019, sub-Saharan Africa with an estimated 4.8 million blind persons will require human resources for eye health (HReH) that need to be available, appropriately skilled, supported, and productive. Targets for HReH are useful for planning, monitoring, and resource mobilization, but they need to be updated and informed by evidence of effectiveness and efficiency. Supporting evidence should take into consideration (1) ever-changing disease-specific issues including the epidemiology, the complexity of diagnosis and treatment, and the technology needed for diagnosis and treatment of each condition; (2) the changing demands for vision-related services of an increasingly urbanized population; and (3) interconnected health system issues that affect productivity and quality. The existing targets for HReH and some of the existing strategies such as task shifting of cataract surgery and trichiasis surgery, as well as the scope of eye care interventions for primary eye care workers, will need to be re-evaluated and re-defined against such evidence or supported by new evidence.
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Affiliation(s)
- Paul Courtright
- />Kilimanjaro Centre for Community Ophthalmology International c/o Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Wanjiku Mathenge
- />Rwanda International Institute of Ophthalmology, Kigali, Rwanda
- />Dr. Agarwal’s Eye Hospital, Kigali, Rwanda
| | | | - Colin Cook
- />Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Khumbo Kalua
- />Blantyre Institute of Community Ophthalmology, Blantyre, Malawi
| | - Susan Lewallen
- />Kilimanjaro Centre for Community Ophthalmology International c/o Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
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Senyonjo L, Lindfield R, Mahmoud A, Kimani K, Sanda S, Schmidt E. Ocular morbidity and health seeking behaviour in Kwara state, Nigeria: implications for delivery of eye care services. PLoS One 2014; 9:e104128. [PMID: 25165984 PMCID: PMC4148257 DOI: 10.1371/journal.pone.0104128] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 07/10/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is currently limited information as to which conditions are most prevalent in communities in developing countries. This makes effective planning of eye services difficult. METHODS 3,899 eligible individuals were recruited and examined in a cross-sectional survey in Asa Local Government Area, Nigeria. Those who self-reported an ocular morbidity were also asked about their health-seeking behaviour. Health records of local facilities were reviewed to collect information on those presenting with ocular morbidities. RESULTS 25.2% (95% CI: 22.0-28.6) had an ocular morbidity in at least one eye. Leading causes were presbyopia and conditions affecting the lens and conjunctiva. The odds of having an ocular morbidity increased with age and lower educational attainment. 10.1% (7.7-13.0) self-reported ocular morbidity; 48.6% (40.4-56.8) of them reported seeking treatment. At the facility level, 344 patients presented with an ocular morbidity over one month, the most common conditions were red (26.3%) or itchy (20.8%) eyes. CONCLUSION Ocular morbidities, including many non vision impairing conditions, were prevalent with a quarter of the population affected. The delivery of eye care services needs to be tailored in order to address this need and ensure delivery in a cost-effective and sustainable manner.
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Affiliation(s)
- Laura Senyonjo
- Sightsavers, Haywards Heath, West Sussex, United Kingdom
- * E-mail:
| | - Robert Lindfield
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Abdulraheem Mahmoud
- Department of Ophthalmology, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | - Kahaki Kimani
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | | | - Elena Schmidt
- Sightsavers, Haywards Heath, West Sussex, United Kingdom
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Kalua K, Gichangi M, Barassa E, Eliah E, Lewallen S, Courtright P. A randomised controlled trial to investigate effects of enhanced supervision on primary eye care services at health centres in Kenya, Malawi and Tanzania. BMC Health Serv Res 2014; 14 Suppl 1:S6. [PMID: 25079942 PMCID: PMC4108898 DOI: 10.1186/1472-6963-14-s1-s6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Knowledge and skills of primary health care workers (PHCWs) in primary eye care have been demonstrated to be inadequate in several districts of Kenya, Malawi, and Tanzania. We tested whether enhanced supervision, focused on improving practical skills over two years, would raise the scores of these workers on a test of basic knowledge and skills. Methods This was a randomised controlled trial. All primary health care (PHC) facilities within two districts of each country were enrolled and randomly assigned by district (Kenya, Malawi) or by health care facility (Tanzania) to receive quarterly skills-based supervision by a district eye coordinator or to continue existing routine supervision. At baseline, a test of basic knowledge and skills in five key areas was administered to PHCWs, and visual acuity (VA) charts and working torches were provided. After two years the test was administered again. Changes in test scores were compared between the intervention (enhanced supervision) and the non-intervention (routine supervision) facilities. Results All 137 facilities in the six districts were enrolled including 343 PHCWs. At baseline, no facility had a visual acuity chart and 18 (13%) had a working torch; the average total skills scores were 6.04 and 6.38 (maximum of 12) in the non-intervention and the intervention facilities, respectively. After two years, 16 intervention facilities (23.2%) had a visual acuity chart correctly placed and 19 (27.5%) had a working torch, compared to 4 (5.9%) and 6 (8.8%), respectively, in the routine supervision facilities. At the facility level, the change in overall test scores was +1.84 points in the intervention sites compared to +0.42 points in the non-intervention sites (p<0.001). Staff turnover included about 75% of the staff by the end of the study. Conclusion The improvements in the enhanced supervision facilities were very modest and of questionable clinical significance. The low impact of the intervention may be due to the high turnover of PHCWs or high absenteeism. A better understanding of the quality of eye care at PHC facilities and influencing factors are urgently needed before continuing to invest resources in the scale up of this model of task shifting in Africa.
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Lanktree E, Corluka A, Cohen M, Larocque R. 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. HUMAN RESOURCES FOR HEALTH 2014; 12 Suppl 1:I2. [PMID: 25860785 PMCID: PMC4108860 DOI: 10.1186/1478-4491-12-s1-i2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
| | | | - Marc Cohen
- Global Health Research Initiative, Ottawa, Canada
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Kalua K, Gichangi M, Barassa E, Eliah E, Lewallen S, Courtright P. Skills of general health workers in primary eye care in Kenya, Malawi and Tanzania. HUMAN RESOURCES FOR HEALTH 2014; 12 Suppl 1:S2. [PMID: 25860909 PMCID: PMC4108885 DOI: 10.1186/1478-4491-12-s1-s2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Primary 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. METHODS A 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. RESULTS Three-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. CONCLUSION The 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.
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Affiliation(s)
- Khumbo Kalua
- Department of Ophthalmology, University of Malawi, College of Medicine, Blantyre, Malawi
- Blantyre Institute for Community Ophthalmology, Lions Sight First Eye Hospital, Blantyre, Malawi
| | | | | | - Edson Eliah
- Kilimanjaro Centre for Community Ophthalmology Tanzania, PO Box 2265, Moshi, Tanzania
| | - Susan Lewallen
- Kilimanjaro Centre for Community Ophthalmology Tanzania, PO Box 2265, Moshi, Tanzania
- Kilimanjaro Centre for Community Ophthalmology International, Division of Ophthalmology, University of Cape Town, South Africa
| | - Paul Courtright
- Kilimanjaro Centre for Community Ophthalmology Tanzania, PO Box 2265, Moshi, Tanzania
- Kilimanjaro Centre for Community Ophthalmology International, Division of Ophthalmology, University of Cape Town, South Africa
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