Refractive Errors in Africa Current status

1
Refractive Errors in AfricaCurrent status
Challenges

• Daniel Etya'ale MDVision 2020 Coordinator for
  Africa

2
Refractive errors in Africa

• The Main challenges
• Data on Refractive Errors still very limited
• Human Resources largely inadequate and
  opportunities and places to train more remain
  limited
• Infrastructure to support and sustain refractive
  service still in its infancy in many countries
  and still poorly distributed
• Access to technology and spectacles remain
  limited, especially to the poor and needy.

3
Difficulties with Current Data

• Non-uniform definitions across studies
• Non-representative study populations (convenience
  rather than population-based)
• Dissimilar demographics of study population (age
  and sex)
• Different Refraction procedures used in different
  studies (with/without cycloplegia etc)

4
Refractive errors in Africa

• 3 very distinct linguistic groupings that often
  supersede ethnic geographic groupings
• Ex 1 Ghana more in common with Nigeria than
  Togo or C. d'Ivoire
• Ex 2 MadagascarEx 3 Cameroon PHC

Ghana
Nigeria

• French Speaking

• English Speaking

• Lusophones

5
Refractive errors in Africa

• Personnel available for Refractive services
  Nigeria, Ghana, Tanzania, South Africa and the
  rest!
• Availability of services - Largely inadequate
  overall- Essentially Private Sector and big
  Cities- Still run more as a business model than
  a service delivery- Still largely excluding the
  poor

6
Refractive errors in Africa

• Few countries with well structured nation-wide,
  rural and urban refractive services
• Little coordination between training deployment
  of personnel, infrastructure technology
  development, procurement and availability of high
  quality and affordable spectacles

7
What is currently neededin Africa
8
Eye Care Personnel Needed in Africa To succeed
in Vision 2020
9
What Personnel is needed To succeed in VISION
2020 in AFRO

• THE WHOLE RANGE OF TECHNICAL PERSONNEL

• Ophthalmologists
• Ophthalmic Medical Assistants
• Optométrists/Refractionists
• Low Vision Technicians
• Community workers
• Other non ophthalmic personnel

Still largely missing
See "Personnel Available for Eye care" for more
details
10
What is needed in Africa

• Training more optometrists/refractive urgently
  needed but not sufficient
• Countries should move away from disjointed RE
  activities
• More urgently needed coherent and effective
  "system" to deliver refractive services to the
  community at large. Such a system could
  include- policies for training, recruitment and
  deployment of staff throughout the country- a
  sustainable system for the procurement and
  distribution of affordable spectacles- targeting
  high priority groups, e.g., school children,
  "professional presbyopes (nurses, teachers, etc)