Transcript Slide 1

Current State of Blindness
in Ghana and SiB
Boateng Wiafe,
Regional Director for Africa
Oscar Debrah
Head, Eye Care Unit, Ghana Health Service
KATH
KUMASI
FEBRUARY 2014
Causes of Blindness
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Cataract
Glaucoma
Trachoma
Onchocerciasis
Childhood Blindness
Refractive Errors
& Low Vision
Others
45 – 50%
15 – 20%
5%
5%
5 -10%
5%
10 – 15%
Human Resource
Development
 Ophthalmologists – Trained by Ghana
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Postgraduate College
Optometrists – Doctors in Optometry (OD).
Trained in Kumasi and Cape Coast
Ophthalmic Nurses – Trained at Ophthalmic
Nursing School in Korle Bu
Optical Technicians – Trained at Oyoko
Human Resource
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Ophthalmologists
74
Optometrists
150
Ophthalmic Nurses
420
Low Vision Specialist
1
Distribution of personnel (especially
ophthalmologists and optometrists) skewed
towards Accra and Kumasi.
No ophthalmologist in Upper West Region. One
each in Volta, BA and Upper East Regions
HR in Eye Health in Ghana
 Skewed
Distribution of Eye
Health workforce
Disease Control
 Cataract
 Trachoma Control Programme
 Childhood Blindness
 Refractive Error & Low Vision Services
Cataract Services
 Provided at both static and outreach centres
 Cataract surgery covered under the National
Health insurance Scheme (NHIS) which started
in 2005
 CSR in 2012 was 819
 Total cataract surgeries in 2012 = 19860
5-Year CSR Trend
1000
900
800
700
600
500
400
300
200
100
0
2008
2009
2010
2011
2012
2012 CSR
Target
Target
National
National
Western
Western
Volta
Volta
Upper
UpperWest
West
Upper
UpperEast
East
Northern
Northern
Greater
GreaterAccra
Accra
Eastern
Eastern
Central
Central
Brong
BrongAhafo
Ahafo
Ashanti
Ashanti
00
500
500
1000
1000
1500
1500
2000
2000
2500
2500
Trachoma Control
Programme
 Trachoma was endemic in two regions,
Northern and Upper West
 Using ‘SAFE’ strategy for control, which
started in 2000
 Targeted 2010 for the elimination of
blinding trachoma
Trachoma Control
Programme
 Trachoma was endemic in two regions,
Northern and Upper West
 Using ‘SAFE’ strategy for control, which
started in 2000
 Targeted 2010 for the elimination of
blinding trachoma
Prevalence of Active Trachoma (Baseline
& After Intervention)
Wa
16.1
Tolon/Kunbumgu
12.4
West Gonja
11.7
11.5
Sissala
Savelugu/Nanton
9.7
Bole
8.2
West Mamp
6.8
Zab/Tat
6.7
Tamale
5.7
J/Lambussie
5
Gushiegu K
4.4
Nanumba
3.8
3.7
E Gonja
Nadowli
3.6
3.5
Yendi
Sab Cherep
3.2
E Mamprusi
2.8
2.8
Lawra
0
2
4
6
8
10
Prevalence (%)
12
14
16
18
Trachoma Control
Programme
 3rd year of Trachoma Surveillance in the 2
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Regions.
Epidemiological Prevalence Survey to be
conducted next year, which will lead to applying
for declaration of Ghana being free from Blinding
Trachoma
Childhood Blindness
Prevention
 Paediatric Ophthalmology Units in Korle Bu and
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Komfo Anokye Teaching Hospitals
Trained ophthalmic nurses in Childhood
Blindness prevention
Lions Club International/WHO supporting Korle
Bu Paediatric Unit to set up a satellite centre at
Weija
Refractive Error & Low
Vision Services
 Refractive Error Services mostly in the private
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sectors. Teaching and some Regional Hospitals
also render service
2 Low Vision Centres set up in 2 regions
(Greater Accra and Eastern).
National Low Vision Coordinator in the office of
Eye Care Unit. Used to be supported by CBM
but support ended in 2010
Challenges
 No National Prevalence of Blindness Survey
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done
Integration of PEC into Regional and District
Health Service delivery
Inadequate and inequity in distribution of eye
care personnel especially ophthalmologists
and optometrists
Sub-specialty for ophthalmologists
Low National Cataract Surgical Rate (CSR)
Inadequate resource for eye health activities
Data collection
No National Prevalence
Survey done
 Data we use are extrapolated
 A RAAB conducted in the Eastern Region in
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2009 funded by Sightsavers revealed a
prevalence of blindness of 0.7
The Faculty of Public Health, Swiss Red Cross
and OE are planning on a National Survey but
the funds are not adequate so we will sample
from each of the 3 ecological zones and have a
snap shot of the prevalence and causes of
blindness in Ghana
LOW CSR
 From this
presentation we
can observe that
we need to
operate at least
50,000 cataract
surgeries per
annum if we want
to deal with the
backlog
Target
National
Western
Volta
Upper West
Upper East
Northern
Greater Accra
Eastern
Central
Brong Ahafo
Ashanti
0
500
1000
1500
2000
2500
OUR APPROACH
In Partnership with the Standard Chartered
Bank, Seeing is Believing we decided to
REMOVE BARRIERS TO QUALITY EYE
CARE IN GHANA BY
a)
b)
Strengthening the district level eye care,
making it robust enough to take referrals from
the community
Empower the frontline health workers and
volunteers through capacity building
Strengthening the District
Level Eye Services
 Infrastructure Development –
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Constructed and Renovated Eye Clinics
 Equipment provision –
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Equipped 24 District Hospitals with Diagnostic
Equipment to make them functional
Provision of 7 Surgical Sets to 7 regions Operating Microscopes, Biometry Equipment,
Surgical Instruments
 Capacity Building •
Retraining of the Ophthalmic Nurses on how to use
the equipment provided
 Capacity building –
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Training of instruments technicians and
equipping them with tool kits
Training the Ophthalmic Nurses to be trainers
of others
 Service Delivery enhancement:
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SiB offered consumables for cataract services
for as many surgeries as would be required for
the first year and then decline as the year goes
by , an attempt to assist in sustainability
Outcome of the intervention
 Infrastructure Development:
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2 new eye clinics were constructed - Bibiani and
Weija
3 Eye Clinics refurbished – Takoradi Government
Hospital, Worawora district Hospital and Tokurano
Clinic
 Human Resource Development
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42 Ophthalmic Nurses
10 Optometrists
12 Equipment Technicians
1361 PEC workers trained
Service Delivery
1. 240,664 patients screened and treated
2. Community Awareness program through the
3.
mass media
Surgeries – low productivity (27%)
a)
b)
c)
Only 31% of the 10,969 cataract surgeries have
been delivered
Only 11% of the 4388 major surgeries have been
delivered
Only 40% of the 6581 minor surgeries have been
delivered
Discussion
 Several of the partners have never delivered
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any surgery at all
Those who do something are grossly
underperforming
Only about 7 or so partners are delivering
There is surgical instruments available,
consumables are available, patients are
available
The blind patients are not converted to seeing
Recommendations
 Districts should be adopted by Ophthalmic
Teams from the teaching hospitals
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Surgical Visits should be once a month and if a
regular visit is made and a target is set at not
less than 20 cases per day in a year we can
reach at least 200 – 250 cases.
If it becomes busy, then the frequency can be
increased.
We should not treat this as a part time work
outside our normal duties, activities done over
the weekends.
Recommendations
 Districts that have been equipped and not
generating any surgeries may have to
surrender their equipment to district
hospitals that are prepared to deliver.
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It is unethical to tell someone that he has a
problem and not do anything about it.
Any suggestions?
1. …….
2. …….
3. ……….
Partners in Eye Care
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Sightsavers
CBM
SRC
OEU
HCP
GEF
 Rotary Club
 Lions Club
 Standard
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Chartered Bank
(“Seeing is
Believing”)
Orbis
Thank you