Transcript Sebastian Nwosu_Extending eye care services into rural Nigeria

Sebastian N N Nwosu
Cyriacus U Akudinobi
Guinness Eye Center
Onitsha Nigeria
Nnamdi Azikiwe University Awka
Guinness Eye Center Onitsha
Declaration
 No financial interests
Introducton
 Eye diseases and blindness are of public health
importance in Nigeria
Political map of Nigeria
Introduction...2
Estimated blindness rate in
Nigeria
Blindness prevalence in
Nigeria
 The national blindness & low
vision survey reported in
2008 that 46 out of every 1000
adults aged even 40 years and
above were blind
Position of Anambra State in
Nigeria
Introduction...3
 In Anambra State the
prevalence of blindness
is even higher
 The rural-urban
migration
notwithstanding,
majority of the populace
still reside in rural areas
Typical village gate
Typical rural house
Introduction...2
 Anambra State is one of the 36 states in Nigeria
 Divided into 21 local government councils, it has the
Ministry of Health that regulates and oversees health
care delivery especially at secondary care level
throughout the state
 The local governments are in-charge of primary
health care activities
Introduction...3
 Health care services are provided by both the
government and the private entrepreneurs
 However the latter tend to concentrate in urban areas
 Generally the rural areas are poorly served
Water source in rural areas
Eye care in Anambra State
 There is only one publicly-owned eye hospital in
Anambra State – the Guinness Eye Center Onitsha
 Two other sparsely staffed eye units exist in
government run hospitals
 Private eye care facilities exist but these are located in
the urban cities
Anambra Strategic Health Plan
 To ensure optimal health
for the people the
government drew up the
2010-2015 strategic
health development plan
 But this 74-page
document has nothing
on eye care
Previous efforts...
 Outreach eye camps...
 Poor follow-up
 Not sustainable
 Ownership taken by
people
 Seen as occasional
patronage from
enthusiastic urban
dwellers
Static eye care facility sought
 Dissatisfaction with intermittent eye camp programme
led to a shift in approach viz:
 Possibility of establishing static eye care facilities in
rural areas:

churches, town unions, influential persons, government
officials were contacted
Collaboration for eye care
 In order to bring quality eye care to the rural dwellers
in the state the Nnamdi Azikiwe University
collaborated with Nnewi-South Local Government
Council to establish the Vision2020 eye clinic at Ukpor
 This paper reports the experience in the first year of
services in the clinic
Memorandum of Understanding
 Idea of establishing the clinic
originated from the
Ophthalmology Dept
Nnamdi Azikiwe University
 A memorandum of
understanding (agreement)
between
 Nnewi-South Local
Government Council
 Nnamdi Azikiwe University
offically ensured the
establishment of the clinic
Stake holders’ responsibilities
 Council: To provide infrastructure & equip the clinic
 University: To provide ophthalmologists; provide
technical support; train primary eye care workers;
provide clinical services and conduct research
 Community: To provide land & security
 All: maintain advocacy for the eye clinic
Developmental phases
 Community awareness of the clinic’s existence
 Clinical services
 School eye health
 Eye health promotion & education in the community
 Self-sustaining services
 Replication of the model in other communities
Results
 We trained 3 primary health care workers nominated
by council in primary eye care
 Publicity about the clinic existence mounted through
de facto leaders in churches, marketplaces, women
fora, town union, village meetings, etc
 Clinical services commenced June 2011
 Surgical services became available a year later
Results...2
 166 new patients – seen; M:F = 1:1.6
 Age range: 1-88; mean- 48.8±15.2
 Blindness rate: 10.4% (7 male; 7 female)
 Visual impairment: 17.7%(11 male; 18 female)
Bilaterally blind led by son
Bilateral cataract
Causes of low vision
Cause
Blindness (%)
Visual impairment(%)
Refractive error
-
13(44.8)
Cataract
10 (71.4)
11(37.9)
Glaucoma
4(28.6)
5(17.3)
Total
14(100.0)
29(100.0)
Clinical diagnosis
Diagnosis
No.
%
Refractive error / presbyopia
61
36.8
Cataract
39
23.5
Irritative/allergic conjunctivitis
35
21.1
Glaucoma
21
12.7
Pterygium
13
7.8
Uveitis
7
4.2
Corneal ulcer
5
3.0
Purulent conjunctivitis
4
2.4
Corneal foreign body
2
1.2
Optic atrophy
2
1.2
ARMD
Diabetic retinopathy
2
2
1.2
1.2
Traumatic hyphaema
2
1.2
Migraine
2
1.2
Retinal detachment
1
0.6
Orbital tumour
1
0.6
Comments
 The establishment of the clinic took more than 5 years
of planning & advocacy
 At initial stage patronage was low
 Patronage improved when the local elite was satisfied
with the services - esp. optical services
Comments...2
 Implementation of decisions delayed by
 Government bureaucracy
 Unstable council leadership (frequent transfers)
 Industrial action by council & health workers
Comments...3
 Low vision rate, though clinic-based, is high
 Causes of low vision - largely avoidable
 Most of the blind require cataract surgery
 Patients blind from glaucoma presented late
Comments...4
 Steady, dependable clinical services as well as
community health education will expectedly
encourage patients to present early
 The quality of cataract surgery should not be
compromised – better visual outcome ensures better
uptake
Sustainability...?
 Our greatest worry
&
challenge
Sustainability...2
 A clinic revolving fund to be established
 Sliding scale of fees charged to ensure that the poor
benefits
Sustainability...3
 Continuing advocacy
with the de facto leaders,
including government
and the local elite
Future...
 Establish such clinics in other local government
councils
 Draw 5 year strategic plan for eye care
 Hopefully this will form the nucleus of Anambra State
eye care plan
Acknowlegdement...
 Mr E Nwabuagha, Former Head of Service, Nnewi-South




Local Government Council, Ukpor, Anambra State, Nigeria
Mr Dubem Obaze, Former Commissioner for Local
Government and Chieftaincy Matters, Anambra State,
Nigeria
Prof B Egboka, Vice Chancellor Nnamdi Azikiwe
University, Awka, Nigeria
Dr Kunle Hassan, Eye Foundation Hospital, Lagos, Nigeria
– for some surgical consummables
Deseret International Inc. Utah USA – for providing
surgical consummables & cataract surgery instruments
Adjourn...
 Thanks for listening