Health systems analysis of eye care services in Zambia: evaluating progress towards VISION 2020 goals

BMC Health Services Research

Elena Schmidt¹  Karl Blanchet²  Ulla Kou Griffiths³  Fiammetta Maria Bozzani³ 

[1] Sightsavers, Haywards Heath, West Sussex, UK;International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK;Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH London, UK

关键词: VISION 2020;    Health systems analysis;    Eye care;   

Others  :  1133999
DOI  :  10.1186/1472-6963-14-94

 received in 2013-06-29, accepted in 2014-02-25,  发布年份 2014

【 摘 要 】

Background

VISION 2020 is a global initiative launched in 1999 to eliminate avoidable blindness by 2020. The objective of this study was to undertake a situation analysis of the Zambian eye health system and assess VISION 2020 process indicators on human resources, equipment and infrastructure.

Methods

All eye health care providers were surveyed to determine location, financing sources, human resources and equipment. Key informants were interviewed regarding levels of service provision, management and leadership in the sector. Policy papers were reviewed. A health system dynamics framework was used to analyse findings.

Results

During 2011, 74 facilities provided eye care in Zambia; 39% were public, 37% private for-profit and 24% owned by Non-Governmental Organizations. Private facilities were solely located in major cities. A total of 191 people worked in eye care; 18 of these were ophthalmologists and eight cataract surgeons, equivalent to 0.34 and 0.15 per 250,000 population, respectively. VISION 2020 targets for inpatient beds and surgical theatres were met in six out of nine provinces, but human resources and spectacles manufacturing workshops were below target in every province. Inequalities in service provision between urban and rural areas were substantial.

Conclusion

Shortage and maldistribution of human resources, lack of routine monitoring and inadequate financing mechanisms are the root causes of underperformance in the Zambian eye health system, which hinder the ability to achieve the VISION 2020 goals. We recommend that all VISION 2020 process indicators are evaluated simultaneously as these are not individually useful for monitoring progress.

【 授权许可】

   
2014 Bozzani et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Pascolini D, Mariotti SP: Global estimates of visual impairment: 2010. Br J Ophthalmol 2012, 96:614-618.
• [2]World Health Organization and International Association of Preventable Blindness: VISION 2020: The right to sight: Global Initiative for the Elimination of Avoidable Blindness: action plan 2006-2011. Geneva: WHO; 2007.
• [3]Pizzarello L, Abiose A, Ffytche T, Duerksen R, Thulasiraj R, Taylor H, Faal H, Rao G, Kocur I, Resnikoff S: VISION 2020: the right to sight: a global initiative to eliminate avoidable blindness. Arch Ophthalmol 2004, 122:615-620.
• [4]World Health Organization: WHA 62.1: prevention of avoidable blindness and visual impairment. Geneva: WHO; 2009.
• [5]Gilson L (Ed): Health policy and systems research: A methodology reader. Geneva: WHO; 2012.
• [6]Hussein A: The use of triangulation in social sciences research: can qualitative and quantitative methods be combined? J Comp Soc Work 2009, 1:1-12.
• [7]International Agency for the Prevention of Blindness: IAPB standard list of equipment, drugs and consumables for VISION 2020 eye care service units. Geneva: WHO; 2010.
• [8]World Health Organization: A framework and indicators for monitoring VISION 2020–The Right to Sight: The global initiative for the elimination of avoidable blindness. Geneva: WHO; 2002.
• [9]World Health Organization: Strategies for the prevention of blindness in national programmes–A primary health care approach. Geneva: WHO; 1997. van
• [10]Olmen J, Criel B, van Damme W, Marchal B, van Belle S, van Dormael M, Hoeree T, Pirard M, Kegels G: Analysing health system dynamics–A framework. In Studies in Health Services Organization, Volume 28. 2nd edition. Edited by Kegels G, De Brouwere V, Criel B. Antwerp: ITG Press; 2012.
• [11]Blanchet K, Gilbert C, Lindfield R (Eds): Eye Health Systems Assessment (EHSA): How to connect eye care with the general health system. London: International Centre for Eye Health; 2012.
• [12]World Health Organization: Everybody’s business: strenghtening health systems to improve health outcomes: WHO's framework for action. Geneva: WHO; 2007.
• [13]Ministry of Health: National eye health strategic plan Zambia (year 2012-2015). Lusaka: Ministry of Health; 2011.
• [14]Ministry of Health: National strategic plan on prevention of eye disease in Zambia 2006-2011. Lusaka: Ministry of Health; 2006.
• [15]Ministry of Health: National Health Strategic Plan 2011-2015. Lusaka: Ministry of Health; 2011.
• [16]Lozano R, Wang H, Foreman KJ, Rajaratnam JK, Naghavi M, Marcus JR, Dwyer-Lindgren L, Lofgren KT, Phillips D, Atkinson C, Lopez AD, Murray CJL: Progress towards millennium development goals 4 and 5 on maternal and child mortality: an updated systematic analysis. Lancet 2011, 378:1139-1165.
• [17]Herbst CH, Vledder M, Campbell K, Sjoblom M, Soucat A: The human resources for health crisis in Zambia–An outcome of health worker entry, exit, and performance within the national health labor market. In World Bank working paper no. 214. Washington, D.C: World Bank; 2011.
• [18]World Health Organization: World health report 2006–working together for health. Geneva: WHO; 2006.
• [19]Clemens M, Pettersson G: A New Database of Health Professional Emigration from Africa. Washington, D.C: Center for Global Development; 2006.
• [20]International Labour Organization (ILO): Inclusion of People with Disabilities in Zambia. [http://www.ilo.org/wcmsp5/groups/public/@ed_emp/@ifp_skills/documents/publication/wcms_115100.pdf webcite ]
• [21]Central Statistical Office: Living conditions monitoring survey 2006 & 2012. Lusaka: CSO; 2012.
• [22]Lindfield R, Griffiths U, Bozzani F, Mumba M, Munsanje J: A rapid assessment of avoidable blindness in southern Zambia. PLoS One 2012, 7:e38483.
• [23]University of Zambia and Ministry of Health: Equity Watch. Harare: EQUINET, UCT HEU; 2011.
• [24]Government of the Republic of Zambia: User fee removal: tracking policy. Lusaka: GRZ; 2006.
• [25]Masiye F, Chitah BM, Chanda P, Simeo F: Removal of user fees at primary health care facilities in Zambia: a study of the effects on utilisation and quality of care. In discussion paper series 57. Harare: EQUINET, UCT HEU; 2008.
• [26]Ministry of Health: HMIS procedure manual (Primary Health Care): Version 1.4. Lusaka: Ministry of Health; 2008.
• [27]Central Statistical Office, Ministry of Health, Tropical Disease Research Centre, University of Zambia, Macro International Inc: Zambia Demographic and Health Survey 2007. Calverton, Maryland: CSO and Marco International Inc; 2009.
• [28]World Health Organization: Annual Report 2008–Zambia Country Office. Lusaka: WHO; 2008.
• [29]Solomon AW, Akudubillah J, Abugri P, Hagan M, Foster A, Bailey RL, Mabey DCW: Pilot study of the use of community volunteers to distribute azithromycin for trachoma control in Ghana. Bull World Health Organ 2001, 79:8-14.
• [30]Smeeth LL, Iliffe S: Community screening for visual impairment in the elderly. Cochrane Database Syst Rev 2006., 19(3)
• [31]Pizcazo O, Kagulura S: The state of human resources for health in Zambia: Findings from the Public Expenditure Tracking and Quality of Service Delivery Survey (PET/QSDS), 2005/06. [http://www.hrhresourcecenter.org/node/1384 webcite]
• [32]Ferrinho P, Siziya S, Goma F, Dussault G: The human resource for health situation in Zambia: deficit and maldistribution. Hum Resour Health 2011., 9
• [33]Ramke J, du Toit R, Brian G: An assessment of recycled spectacles donated to a developing country. Clin Exp Ophthalmol 2006, 34:671-676.
• [34]Ackland P: The accomplishments of the global initiative VISION 2020: the right to sight and the focus for the next 8 years of the campaign. Indian J Ophthalmol 2012, 60:380-386.
• [35]Mounier-Jack S, Griffiths UK, Closser S, Burchett HD, Marchal B: Measuring the health systems impact of disease control programmes: a critical reflection on the WHO building blocks framework. BMC Public HealthIn press
• [36]Hoffman SJ, Røttingen JA, Bennet S, Lavis JN, Frenk J: Background paper on conceptual issues related to health systems research to inform a WHO global strategy on health systems research, in Health Systems Alliance. Geneva: WHO; 2012.