Human resource and governance challenges in the delivery of primary eye care: a mixed methods feasibility study in Nigeria

BMC Health Services Research

Clare Gilbert¹  Ada Aghaji²  Ngozi Oguego³  Helen E. D. Burchett⁴  Shaffa Hameed⁵ 

[1] Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK;Department of Ophthalmology, College of Medicine, Enugu, Nigeria;Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK;Department of Ophthalmology, University of Nigeria Teaching Hospital, Enugu, Nigeria;Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK;International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, GB, UK;

关键词: Primary eye care;    Health workforce;    Governance;    Feasibility;    Nigeria;    Word count 5383.;   

DOI  :  10.1186/s12913-021-07362-8

来源: Springer

【 摘 要 】

BackgroundTo increase access to eye care, the World Health Organization’s Africa Region recently launched a primary eye care (PEC) package for sub-Saharan Africa. To determine the technical feasibility of implementing this package, the capacity of health systems at primary level needs to be assessed, to identify capacity gaps that would need to be addressed to deliver effective and sustainable PEC. This study reports on the human resource and governance challenges for delivering PEC in Anambra State, Nigeria.MethodsDesign: This was a mixed methods feasibility study. A desk review of relevant Nigerian national health policy documents on both eye health and primary health care was conducted, and 48 primary health care facilities in Anambra state were surveyed. Data on human resource and governance in primary health facilities were collected using structured questionnaires and through observation with checklists. In-depth interviews were conducted with district supervisors and selected heads of facilities to explore the opportunities and challenges for the delivery of PEC in their facilities/districts. Data were analysed using the World Health Organization’s health system framework.ResultsA clear policy for PEC is lacking. Supervision was conducted at least quarterly in 54% of facilities and 56% of facilities did not use the standard clinical management guidelines. There were critical shortages of health workers with 82% of facilities working with less than 20% of the number recommended. Many facilities used volunteers and/or ad hoc workers to mitigate staff shortages.ConclusionOur study highlights the policy, governance and health workforce gaps that will need to be addressed to deliver PEC in Nigeria. Developing and implementing a specific policy for PEC is recommended. Implementation of existing national health policies may help address health workforce shortages at the primary health care level.

【 授权许可】

CC BY