Mapping human resources for eye health in 21 countries of sub-Saharan Africa: current progress towards VISION 2020

Human Resources for Health

Karl Blanchet¹  Daksha Patel¹  Ronnie Graham³  Kovin Naidoo²  Jyoti Jaggernath²  Samantha Fox¹  Devan Pillay²  Alice Gilbert¹  Farai Chinanayi²  Jennifer J Palmer¹ 

[1] International Centre for Eye Health Clinical Research Department, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel St., London WC1B 7HT, UK;African Vision Research Institute, 172 Umbilo Road Umbilo, Durban 4001, South Africa;International Agency for the Prevention of Blindness (Africa Region), 172 Umbilo Road Umbilo, Durban 4001, South Africa

关键词: Vision 2020;    Nursing;    Optometry;    Ophthalmology;    Blindness;    Low vision;    Cataract;    sub-Saharan Africa;    Eye health;    Human resources;   

Others  :  1161177
DOI  :  10.1186/1478-4491-12-44

 received in 2014-01-31, accepted in 2014-07-28,  发布年份 2014

【 摘 要 】

Background

Development of human resources for eye health (HReH) is a major focus of the Global Action Plan 2014 to 2019 to reduce the prevalence of avoidable visual impairment by 25% by the year 2019. The eye health workforce is thought to be much smaller in sub-Saharan Africa than in other regions of the world but data to support this for policy-making is scarce. We collected HReH and cataract surgeries data from 21 countries in sub-Sahara to estimate progress towards key suggested population-based VISION 2020 HReH indicators and cataract surgery rates (CSR) in 2011.

Methods

Routinely collected data on practitioner and surgery numbers in 2011 was requested from national eye care coordinators via electronic questionnaires. Telephone and e-mail discussions were used to determine data collection strategies that fit the national context and to verify reported data quality. Information was collected on six practitioner cadres: ophthalmologists, cataract surgeons, ophthalmic clinical officers, ophthalmic nurses, optometrists and ‘mid-level refractionists’ and combined with publicly available population data to calculate practitioner to population ratios and CSRs. Associations with development characteristics were conducted using Wilcoxon rank sum tests and Spearman rank correlations.

Results

HReH data was not easily available. A minority of countries had achieved the suggested VISION 2020 targets in 2011; five countries for ophthalmologists/cataract surgeons, four for ophthalmic nurses/clinical officers and two for CSR. All countries were below target for optometrists, even when other cadres who perform refractions as a primary duty were considered. The regional (sample) ratio for surgeons (ophthalmologists and cataract surgeons) was 2.9 per million population, 5.5 for ophthalmic clinical officers and nurses, 3.7 for optometrists and other refractionists, and 515 for CSR. A positive correlation between GDP and CSR as well as many practitioner ratios was observed (CSR P = 0.0042, ophthalmologists P = 0.0034, cataract surgeons, ophthalmic nurses and optometrists 0.1 > P > 0.05).

Conclusions

With only a minority of countries in our sample having reached suggested ophthalmic cadre targets and none having reached targets for refractionists in 2011, substantially more targeted investment in HReH may be needed for VISION 2020 aims to be achieved in sub-Saharan Africa.

【 授权许可】

   
2014 Palmer et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]V2020: Global Human Resource Development Assessment for Comprehensive Eye Care. Vision2020 Human Resources Development Working Group, Pakistan Institute of Community Ophthalmology; 2006. [http://www.iapb.org/sites/iapb.org/files/Global_HR_Development_Assessment.pdf webcite]
• [2]V2020: Global Initiative for the Elimination of Avoidable Blindness: Action Plan 2006 to 2011. WHO; 2007. [http://www.who.int/blindness/Vision2020_report.pdf webcite]
• [3]WHO: Universal Eye Health: A Global Action Plan 2014 -2019. World Health Organization; 2013. [http://www.who.int/blindness/actionplan/en/ webcite]
• [4]WHO: Global Initiative for the Elimination of Avoidable Blindness. World Health Organization; 1997. [http://whqlibdoc.who.int/hq/1997/WHO_PBL_97.61_Rev.1.pdf webcite]
• [5]WHA59: Prevention of Avoidable Blindness and Visual Impairment: Report by the Secretaria. World Health Assembly 59th session, provisional agenda 11.7; 2006. [http://apps.who.int/iris/handle/10665/21095 webcite]
• [6]WHO: The World Health Report 2006 - Working Together for Health. World Health Organization; 2006. [http://whqlibdoc.who.int/publications/2006/9241563176_eng.pdf webcite]
• [7]Resnikoff S, Felch W, Gauthier TM, Spivey B: The number of ophthalmologists in practice and training worldwide: a growing gap despite more than 200,000 practitioners. Br J Ophthalmol 2012, 96(6):783-787.
• [8]Odusote K: People deliver eye care: managing human resources. Community Eye Health J 2005, 18(56):117-119.
• [9]IAPB: Joint Report of the HReH Task Team & of the Africa Wide Workshop on HReH: Past, Present and Future. International Agency for the Prevention of Blindness; 2013.
• [10]Ackland P: Ten years to Vision 2020: how are we doing? Community Eye Health 2010, 23(74):54-55.
• [11]du Toit R, Brian G: Mid-level cadre providing eye care in the context of Vision 2020. N Z Med J 2009, 122(1291):77-88.
• [12]Stevens GA, White RA, Flaxman SR, Price H, Jonas JB, Keeffe J, Leasher J, Naidoo K, Pesudovs K, Resnikoff S, Taylor H, Bourne RR: Vision Loss Expert Group: Global prevalence of vision impairment and blindness: magnitude and temporal trends, 1990–2010. Ophthalmology 2013, 120(12):2377-2384.
• [13]WHO: Fact sheet number 282: visual impairment and blindness. 2013. [http://www.who.int/mediacentre/factsheets/fs282/en/ webcite]
• [14]Baltussen R, Sylla M, Mariotti SP: Cost-effectiveness analysis of cataract surgery: a global and regional analysis. Bull World Health Organ 2004, 82(5):338-345.
• [15]Foster A: Cataract - a global perspective: output, outcome and outlay. Eye (Lond) 1999, 13(Pt 3b):449-453.
• [16]V2020: A Manual for Vision 2020: The Right to Sight Workshops. The International Centre for Eye Health; 2005. [http://www.cehjournal.org/files/workshopmanual/V2020_Manual_2005.pdf webcite]
• [17]Lewallen S, Courtright P, Etya’ale D, Mathenge W, Schmidt E, Oye J, Clark A, Williams T: Cataract incidence in sub-Saharan Africa: what does mathematical modeling tell us about geographic variations and surgical needs? Ophthalmic Epidemiol 2013, 20(5):260-266.
• [18]Shah SP, Gilbert CE, Razavi H, Turner EL, Lindfield RJ, International Eye Research N: Preoperative visual acuity among cataract surgery patients and countries’ state of development: a global study. Bull World Health Organ 2011, 89(10):749-756.
• [19]Cook C, Qureshi M: VISION 2020 at the district level. Community Eye Health 2005, 18(54):85-89.
• [20]Raman U: Human resources for eye care: changing the way we think. Community Eye Health J 2009, 22(69):12.
• [21]Lewallen S, Etya’ale D, Kello AB, Courtright P: Non-physician cataract surgeons in sub-Saharan Africa: situation analysis. Tropical Medicine & International Health, TM & IH; 2012.
• [22]Hale I, Lewallen S, Courtright P: Task-Shifting: Ophthalmologist to non-Physician Cataract Surgeon: A Review of the Evidence. Kilimanjaro Centre for Community Ophthalmology (KCCO); 2013. [http://www.iapbafrica.co.za/resource/resourceitem/206/1 webcite]
• [23]Courtright P, Ndegwa L, Msosa J, Banzi J: Use of our existing eye care human resources: assessment of the productivity of cataract surgeons trained in eastern Africa. Arch Ophthalmol 2007, 125(5):684-687.
• [24]Habtamu E, Eshete Z, Burton MJ: Cataract surgery in Southern Ethiopia: distribution, rates and determinants of service provision. BMC Health Serv Res 2013, 13:480. BioMed Central Full Text
• [25]Eliah E, Lewallen S, Kalua K, Courtright P, Gichangi M, Bassett K: Task shifting for cataract surgery in eastern Africa: productivity and attrition of non-physician cataract surgeons in Kenya, Malawi and Tanzania. BMC Human Resources for Health 2014, 12(Suppl 1):S4. BioMed Central Full Text
• [26]Fricke TR, Holden BA, Wilson DA, Schlenther G, Naidoo KS, Resnikoff S, Frick KD: Global cost of correcting vision impairment from uncorrected refractive error. Bull World Health Organ 2012, 90(10):728-738.
• [27]Naidoo KS: Towards a new model in training and delivery of optometric education. Optom Educ 2000, 25(2):59-61.
• [28]IAPB: Vision Centres: Affordable & Accessible Community Level eye Care. International Agency for the Prevention of Blindness; 2010. [http://www.iapb.org/sites/iapb.org/files/Vision%20Centre%20Model%20BP_0.pdf webcite]
• [29]Naidoo KS, Wallace DB, Holden BA, Minto H, Faal HB, Dube P: The challenge of uncorrected refractive error: driving the agenda of the Durban Declaration on refractive error and service development. Clinical & Experimental Optom: J Aust Optometrical Assoc 2010, 93(3):131-136.
• [30]Eze BI, Maduka-Okafor FC: An assessment of the eye care workforce in Enugu State, south-eastern Nigeria. Hum Resour Health 2009, 7:38. BioMed Central Full Text
• [31]Molao C: Situation Analysis of Ophthalmic Nursing Services in Botswana. London School of Hygiene and Tropical Medicine; 2010.
• [32]Bozzani F, Griffiths U: Situation Analysis of Eye Health Care in Zambia. Sightsavers; 2011. [http://www.healthsystemassessment.com/wp-content/uploads/2012/06/Zambia-Country-Report.pdf webcite]
• [33]Lewallen S, Roberts H, Hall A, Onyange R, Temba M, Banzi J, Courtright P: Increasing cataract surgery to meet Vision 2020 targets; experience from two rural programmes in east Africa. Br J Ophthalmol 2005, 89(10):1237-1240.
• [34]Palmer JJ, Chinanayi F, Gilbert A, Pillay D, Fox S, Jaggernath J, Naidoo K, Graham R, Patel D, Blanchet K: Trends and Implications for achieving VISION 2020 human resources for eye health targets in 16 countries of sub-Saharan Africa by year 2020. Human Resources for Health; 2014.
• [35]Probabilistic population projections based on the 2010 revision of the world population prospects [http://esa.un.org/unpd/ppp/Data-Output/UN_PPP2010_output-data.htm webcite]
• [36]Sub-national population projections of Sudan and age-sex composition [http://www.cbs.gov.sd/en/files.php?id=7#&panel1-1 webcite]
• [37]On-line data: country profiles [http://esa.un.org/unpd/wup/unup/index_panel3.html webcite]
• [38]World economic outlook database [http://www.imf.org/external/pubs/ft/weo/2013/01/weodata/index.aspx webcite]
• [39]WHO global health observatory data repository [http://apps.who.int/gho/data/node.main.78?lang=en webcite]
• [40]Human development indicators and thematic tables [http://hdr.undp.org/en/data webcite]
• [41]United nations development programme in south Sudan [http://www.ss.undp.org/south_sudan/en/home.html webcite]
• [42]UNSTATS demographic yearbook [http://unstats.un.org/unsd/default.htm webcite]
• [43]UN workplan Sudan [https://docs.unocha.org/sites/dms/Sudan/Sudan_HWP_MYR_2012_Final.pdf webcite]
• [44]About South Sudan [http://ss.one.un.org/country-info.html webcite]
• [45]Lemiere C, Herbst C, Jahanshahi N, Smith E, Soucat A: Reducing geographical imbalances of health workers in sub-Saharan Africa: a labor market prospective on what works, what does not, and why. In. The World Bank: Washington, DC; 2010.
• [46]Gupta N, Maliqi B, Franca A, Nyonator F, Pate MA, Sanders D, Belhadj H, Daelmans B: Human resources for maternal, newborn and child health: from measurement and planning to performance for improved health outcomes. Hum Resour Health 2011, 9(1):16. BioMed Central Full Text
• [47]Ferrinho P, Siziya S, Goma F, Dussault G: The human resource for health situation in Zambia: deficit and maldistribution. Hum Resour Health 2011, 9(1):30. BioMed Central Full Text
• [48]Hernandez-Peña P, Poullier J, Van Mosseveld C, Van de Maele N, Cherilova V, Indikadahena C, Lie G, Tan-Torres T, Evans D: Health worker remuneration in WHO Member States. Bull World Health Organ 2013, 91:808-815.
• [49]McCoy D, Bennett S, Witter S, Pond B, Baker B, Gow J, Chand S, Ensor T, McPake B: Salaries and incomes of health workers in sub-Saharan Africa. Lancet 2008, 371:675-681.
• [50]McPake B, Maeda A, Araújo E, Lemiere C, El Maghraby A, Cometto G: Why do health labour market forces matter? Bull World Health Organ 2013, 91:841-846.
• [51]Soucat A, Scheffler R, Ghebreyesus T: The Labor Market for Health Workers in Africa: A New Look at the Crisis. Washington: The World Bank; 2013.
• [52]Lassi Z, Cometto G, Huichoc L, Bhuttaa Z: Quality of care provided by mid-level health workers: systematic review and meta-analysis. Bull World Health Organ 2013, 91:824-833.
• [53]Tjoa A, Kapihya M, Libetwa M, Schroder K, Scott C, Lee J, McCarthy E: Meeting human resources for health staffing goals by 2018: a quantitative analysis of policy options in Zambia. Hum Resour Health 2010, 8:15. BioMed Central Full Text
• [54]Buchan J, Couper I, Tangcharoensathien V, Thepannya K, Jaskiewicz W, Perfilieva G, Dolea C: Early implementation of WHO recommendations for the retention of health workers in remote and rural areas. Bull World Health Organ 2013, 91:808-815.
• [55]Scheffler RM, Liu JX, Kinfu Y, Dal Poz MR: Forecasting the global shortage of physicians: an economic- and needs-based approach. Bull World Health Organ 2008, 86(7):516-523B.
• [56]Riley P, Zuber A, Vindigni S, Gupta N, Verani A, Sunderland N, Friedman M, Zurn P, Okoro C, Patrick H, Campbell J: Information systems on human resources for health: a global review. Hum Resour Health 2012, 10:7. BioMed Central Full Text