Trends and implications for achieving VISION 2020 human resources for eye health targets in 16 countries of sub-Saharan Africa by the year 2020

Human Resources for Health

Karl Blanchet²  Daksha Patel²  Ronnie Graham³  Kovin Naidoo¹  Jyoti Jaggernath¹  Samantha Fox²  Devan Pillay¹  Alice Gilbert²  Farai Chinanayi¹  Jennifer J Palmer² 

[1] African Vision Research Institute, 172 Umbilo Road, Umbilo, Durban 4001, South Africa;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;International Agency for the Prevention of Blindness (Africa Region), 172 Umbilo Road, Umbilo, Durban 4001, South Africa

关键词: Task-shifting;    Nursing Vision 2020;    Optometry;    Ophthalmology;    Cataract;    Sub-Saharan Africa;    Eye health;    Human resources;   

Others  :  1161176
DOI  :  10.1186/1478-4491-12-45

 received in 2014-02-26, accepted in 2014-06-19,  发布年份 2014

【 摘 要 】

Background

Development of human resources for eye health (HReH) is a major global eye health strategy to reduce the prevalence of avoidable visual impairment by the year 2020. Building on our previous analysis of current progress towards key HReH indicators and cataract surgery rates (CSRs), we predicted future indicator achievement among 16 countries of sub-Saharan Africa by 2020.

Methods

Surgical and HReH data were collected from national eye care programme coordinators on six practitioner cadres: ophthalmologists, cataract surgeons, ophthalmic clinical officers, ophthalmic nurses, optometrists and ‘mid-level refractionists’ and combined them with publicly available population data to calculate practitioner-to-population ratios and CSRs. Data on workforce entry and exit (2008 to 2010) was used to project practitioner population and CSR growth between 2011 and 2020 in relation to projected growth in the general population. Associations between indicator progress and the presence of a non-physician cataract surgeon cadre were also explored using Wilcoxon rank sum tests and Spearman rank correlations.

Results

In our 16-country sample, practitioner per million population ratios are predicted to increase slightly for surgeons (ophthalmologists/cataract surgeons, from 3.1 in 2011 to 3.4 in 2020) and ophthalmic nurses/clinical officers (5.8 to 6.8) but remain low for refractionists (including optometrists, at 3.6 in 2011 and 2020). Among countries that have not already achieved target indicators, however, practitioner growth will be insufficient for any additional countries to reach the surgeon and refractionist targets by year 2020. Without further strategy change and investment, even after 2020, surgeon growth is only expected to sufficiently outpace general population growth to reach the target in one country. For nurses, two additional countries will achieve the target while one will fall below it. In 2011, high surgeon practitioner ratios were associated with high CSR, regardless of the type of surgeon employed. The cataract surgeon workforce is growing proportionately faster than the ophthalmologist.

Conclusions

The HReH workforce is not growing fast enough to achieve global eye health targets in most of the sub-Saharan countries we surveyed by 2020. Countries seeking to make rapid progress to improve CSR could prioritise investment in training new cataract surgeons over ophthalmologists and improving surgical output efficiency.

【 授权许可】

   
2014 Palmer et al.; licensee BioMed Central Ltd.

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