Department of Ophthalmology, College of Medicine, University of Nigeria, Enugu, Nigeria.
International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK.
BMC Health Serv Res. 2021 Dec 20;21(1):1360. doi: 10.1186/s12913-021-07359-3.
Over two-thirds of Africans have no access to eye care services. To increase access, the World Health Organization (WHO) recommends integrating eye care into primary health care, and the WHO Africa region recently developed a package for primary eye care. However, there are limited data on the capacities needed for delivery, to guide policymakers and implementers on the feasibility of integration. The overall purpose of this study was to assess the technical capacity of the health system at primary level to deliver the WHO primary eye care package. Findings with respect to service delivery, equipment and health management information systems (HMIS) are presented in this paper.
This was a mixed-methods, cross sectional feasibility study in Anambra State, Nigeria. Methods included a desk review of relevant Nigerian policies; a survey of 48 primary health facilities in six districts randomly selected using two stage sampling, and semi-structured interviews with six supervisors and nine purposively selected facility heads. Quantitative study tools included observational checklists and questionnaires. Survey data were analysed descriptively using STATA V.15.1 (Statcorp, Texas). Differences between health centres and health posts were analysed using the z-test statistic. Interview data were analysed using thematic analysis assisted by Open Code Software V.4.02.
There are enabling national health policies for eye care, but no policy specifically for primary eye care. 85% of facilities had no medication for eye conditions and one in eight had no vitamin A in stock. Eyecare was available in < 10% of the facilities. The services delivered focussed on maternal and child health, with low attendance by adults aged over 50 years with over 50% of facilities reporting ≤10 attendances per year per 1000 catchment population. No facility reported data on patients with eye conditions in their patient registers.
A policy for primary eye care is needed which aligns with existing eye health policies. There are currently substantial capacity gaps in service delivery, equipment and data management which will need to be addressed if eye care is to be successfully integrated into primary care in Nigeria.
超过三分之二的非洲人无法获得眼科保健服务。为了增加获得途径，世界卫生组织（WHO）建议将眼科保健纳入初级卫生保健，最近，WHO 非洲区域制定了初级眼科保健包。然而，对于提供服务所需的能力，数据有限，无法为决策者和执行者提供整合的可行性指导。本研究的总体目的是评估初级卫生保健层面的卫生系统提供世卫组织初级眼科保健包的技术能力。本文介绍了服务提供、设备和卫生管理信息系统（HMIS）方面的发现。
这是一项在尼日利亚阿南布拉州进行的混合方法、横断面可行性研究。方法包括对相关尼日利亚政策进行桌面审查；使用两阶段抽样法在六个区随机选择的 48 个初级保健机构进行调查，以及对六名主管和九名有针对性选择的机构负责人进行半结构访谈。定量研究工具包括观察检查表和问卷。使用 STATA V.15.1（Statcorp，德克萨斯州）对调查数据进行描述性分析。使用 z 检验统计量分析卫生中心和卫生所之间的差异。使用 Open Code Software V.4.02 辅助对访谈数据进行主题分析。
有支持眼科保健的国家卫生政策，但没有专门针对初级眼科保健的政策。85%的机构没有眼部疾病药物，每八个机构中就有一个没有库存的维生素 A。只有不到 10%的机构提供眼科服务。提供的服务侧重于母婴保健，只有不到 50%的机构报告每年每 1000 名服务人群中超过 50 岁的成年人就诊人数≤10 次。没有机构在患者登记簿中报告有眼部疾病的患者数据。
需要制定一项与现有眼健康政策相一致的初级眼保健政策。如果要成功将眼科保健纳入尼日利亚的初级保健，目前在服务提供、设备和数据管理方面存在重大能力差距，需要加以解决。
