Sightsavers, Yaoundé, Cameroon Country Office.
Sightsavers, Freetown, Sierra Leone Country Office.
J Glob Health. 2021 Mar 10;11:07001. doi: 10.7189/jogh.11.07001.
Preventing visual impairment due to avoidable causes has been a long-standing global priority. Of all blindness in Sierra Leone, 91.5% is estimated to be avoidable and 58.2% treatable, however there are only 6 ophthalmologists for the whole country. Task-shifting has been suggested as a strategy to address this issue and a training intervention was developed to create a cadre of community-based staff known as Ophthalmic Community Health Officers (OCHOs). This qualitative study aimed to explore the experiences of OCHOs, their relationship with other eye health workers, and how they interact with the wider health system, in order to provide recommendations for the design and delivery of future task shifting strategies.
Between April and May 2018, we conducted semi-structured interviews with 42 participants including: OCHOs (n = 13), traditional ophthalmic staff (n = 17) and other stakeholders from the districts (n = 6), training institution staff (n = 4) and MOH headquarters (n = 2). We identified participants using purposive sampling. Interviews were audio-recorded, transcribed, and thematically analysed. We draw largely on in-depth interviews but complement the analysis with evidence from a document review.
In Sierra Leone, the roll-out of the OCHO programme presented a mixed picture. OCHOs participating in the study expressed a strong commitment to their new role. However, policy changes proposed to clearly demarcate roles and responsibilities and institutionalise the cadre in the civil service were not implemented, resulting in the posting of some staff at an inappropriate level, dissatisfaction with the OCHO certification, and lack of opportunities for advancement and training. These challenges reflect structural weaknesses in the health system that undermine a cohesive implementation of eye health initiatives at the primary health care level in Sierra Leone.
Task-shifting has the potential to improve provision in under-resourced specialities such as eye health. However, the success of this approach will be contingent upon the development of a robust and supportive health policy environment.
预防可避免原因导致的视力损害一直是全球长期以来的重点。在塞拉利昂的所有失明病例中，91.5%估计是可避免的，58.2%是可治疗的，但全国仅有 6 名眼科医生。任务转移已被提议作为解决这一问题的策略，并且已经开发了一项培训干预措施来创建一个名为眼保健社区卫生官员（OCHOs）的社区为基础的工作人员队伍。这项定性研究旨在探索 OCHOs 的经验、他们与其他眼保健工作者的关系，以及他们与更广泛的卫生系统的互动方式，以便为未来的任务转移策略的设计和实施提供建议。
2018 年 4 月至 5 月期间，我们对 42 名参与者进行了半结构式访谈，包括：OCHOs（n=13）、传统眼科工作人员（n=17）和来自各区的其他利益攸关方（n=6）、培训机构工作人员（n=4）和卫生部总部（n=2）。我们通过有针对性的抽样选择参与者。访谈进行了录音、转录和主题分析。我们主要借鉴了深入访谈，但也从文件审查中补充了分析证据。
在塞拉利昂，OCHO 计划的推出情况喜忧参半。参与研究的 OCHOs 表达了对其新角色的坚定承诺。然而，提议的政策变化旨在明确划分角色和责任，并将干部纳入公务员制度，但并未实施，导致一些工作人员被派往不适当的级别，对 OCHO 认证不满意，以及缺乏晋升和培训机会。这些挑战反映了卫生系统的结构性弱点，破坏了塞拉利昂初级卫生保健一级眼保健举措的协调实施。
任务转移有可能改善资源匮乏的专业领域的服务提供，例如眼保健。然而，这种方法的成功将取决于一个强大和支持性的卫生政策环境的发展。
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