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THE GAMBIA:IMPROVING CATARACT SURGICAL RATE

THE GAMBIA:IMPROVING CATARACT SURGICAL RATE. Presented at the Workshop on Best Practices for improving CSR & Trachoma Control in West Africa: 21-25 May 2007: NDiambour Hotel Dakar, Senegal by Ansumana Sillah- Program Manager. COUNTRY PROFILE. Population: 1364507- Rural =52%

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THE GAMBIA:IMPROVING CATARACT SURGICAL RATE

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  1. THE GAMBIA:IMPROVING CATARACT SURGICAL RATE Presented at the Workshop on Best Practices for improving CSR & Trachoma Control in West Africa: 21-25 May 2007: NDiambour Hotel Dakar, Senegal by Ansumana Sillah- Program Manager

  2. COUNTRY PROFILE • Population: 1364507- Rural =52% • Population density: 128 persons/sq. km • Male: 676,726 • Female: 687,781 • Households: 158,489 • Health Divisions=6

  3. Establishing Eye Care Services in The Gambia The Gambia established a National Eye Care Programme (NECP) following a Prevalence Survey of Blindness and Eye Diseases in 1986 : • The leading causes of blindness were Cataract47%, Trachoma 17%, and other corneal Opacities mainly associated with childhood measles or harmful traditional eye medicines 11%.

  4. NECP then set out specific objectives • reduction of avoidable blindness by at least 50% and to less than 0.5% blindness prevalence rate • Provision of eye Care to the entire population through integration into PHC

  5. With shortage of trained personnel NECP focused on the PHC approach • Every five years a plan of action is developed to meet the eye health needs of the Gambian population with emphasis on • Human Resource Development – Training Paramedics to handle cataracts, Community Ophthalmic Nurses, Village Health Workers and Traditional Birth Attendants to function at community level. • Appropriate Technology – construction and equipping secondary eye care centres, LPED • Cataract campaign

  6. Information,Education & Communication • Trachoma control activities- “SAFE” strategy is being fully implemented

  7. Program Design

  8. RVH Banjul Secondary Eye Units Extending eye care to the underserved/rural population in stages Satellite Clinics Community Ophth. Nurse

  9. Community based services & Operational Research enabled us identify some key barriers to service up take: • Time – travel time, domestic work (Women) • Cost – transport, surgery fees • Fear • Access – TPs, Couching in villages • Traditional belief : old age &blindness

  10. Resurvey A resurvey 10 years later in 1996 revealed 40 % reduction in the prevalence of blindness. • Cataract 46% - the leading cause of blindness, made the NECP improve on its PBL strategy through:

  11. Strategy ctd. • Intensifying cataract campaign, and conducting cataract camps to cater for the poor and clear the backlog of the cataract blind • Training & equipping VHWs, Nyateros ( “Firiends of the Eye”), CONs, Cataract Surgeons • careful case selection • provision of affordable aphakic glasses • conversion to ECCE with PC IOL (improved quality of visual outcome) • Collaboration with Traditional Practitioners • Urban Eye Health project with special focus on establishing PEC structures, and the marginalised urban poor • Increase Secondary Eye units & outreach surgery points

  12. RVTH Banjul Secondary Eye Units Good National Coverage NO more waiting list for cataract cases Community Ophthalmic Nurses

  13. Strategy ctd. • Program review with stakeholders • Divisional Health Office of NBDW

  14. Community based workers, Supervision, in-service training

  15. These achievements have been attained through • Government commitment, • Partnership with a committed NGO – Sight Savers International and • very importantly focus on Community based eye care services.

  16. Sustainability • Eye care is integrated into the general Health Services • Eye Care Secretariat within DoSH • Optical workshop for income generation • LPED • HRD in country

  17. Challenges • Co-opting Nurses from the general pool • Ophthalmologist • Understanding PC IOL not harmful • Cost recovery for IOLs • High cost of IEC • Attrition • Demand for new/ advanced techniques

  18. Inter country collaboration for discussion/consideration HFPI-PBL Review/planning; HFPI-PBL camps increased public awareness, exchange of professional skills & commitment of Political Leaders

  19. Obrigado Merci Thank you

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