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Extending eye care to rural Nigeria: The Vision2020 Eye Clinic Ukpor experience. 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 .

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extending eye care to rural nigeria the vision2020 eye clinic ukpor experience

Extending eye care to rural Nigeria: The Vision2020 Eye Clinic Ukpor experience

Sebastian N N Nwosu

Cyriacus U Akudinobi

Guinness Eye Center

Onitsha Nigeria

declaration
Declaration
  • No financial interests
introducton
Introducton
  • Eye diseases and blindness are of public health importance in Nigeria
introduction 2
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
introduction 3
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
introduction 21
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 31
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
eye care in anambra state
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
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
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
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
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
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
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
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
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
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)
comments
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
Comments...2
  • Implementation of decisions delayed by
    • Government bureaucracy
    • Unstable council leadership (frequent transfers)
    • Industrial action by council & health workers
comments 3
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
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
Sustainability...?
  • Our greatest worry

&

challenge

sustainability 2
Sustainability...2
  • A clinic revolving fund to be established
  • Sliding scale of fees charged to ensure that the poor benefits
sustainability 3
Sustainability...3
  • Continuing advocacy with the de facto leaders, including government and the local elite
future
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
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
Adjourn...
  • Thanks for listening