Africa works towards Universal Eye Health
The major causes of visual impairment in Africa are cataract, glaucoma, trachoma, childhood blindness, onchocerciasis and refractive error. In recent years there has been enormous progress with the coordinated control of onchocerciasis and trachoma through the African Programme for Onchocerchiasis Control and the Alliance for the Global Elimination of Trachoma by 2020 (GET 2020) programmes. Recently, efforts to eliminate trachoma have advanced with The Global Trachoma Mapping Project.
Many governments in the region are taking strident steps towards universal eye health . Ghana’s National Health Insurance System now covers most ocular diseases, and almost every district has an ophthalmic nurse . In several African countries, nurses and medical assistants have been trained to diagnose and to make referrals.
However, challenges remain, the shortage of health workers at all levels in Africa is alarming and without additional ophthalmologists, optometrists and nurses, the targets in the Global Action Plan will not be met . Workforce problems are most pronounced in Francophone and Lusophone countries. Across the region, political leaders, donors and other decision-makers need to increase their investments in eye health.
Rwanda: Striding Towards Universal Eye Health
In 2012 Rwanda’s Ministry of Health and its partners developed the Third Health Sector Strategic Plan. With the motto, Universal Coverage, the plan provides for greater integration and collaboration across the health system. Rwanda allocated 18.8% of its budget in 2011 to the health sector and community-based poverty programmes (including savings and credit) for the rural poor. An improving economy means more Rwandans are capable of contributing premiums to the community-based health insurance scheme, which allows individuals to access comprehensive, subsidised, preventative care. The Minimum Package of Activities (MPA) covers all services provided at the health centres and the Complementary Package of Activities (CPA) covers a limited number of services at the district hospitals, including cataract surgery and all diseases afflicting children under five.
Many development initiatives impact on eye health. Access to drinking water increased from 77% of the population in 2005 to 87% in 2011, and this has contributed to Rwanda being the only country in the region without trachoma. The incidence of childhood blindness has also fallen dramatically, with greater coverage of Vitamin A supplementation (92%) and measles vaccination (82%).
The review of health care ‘packages’ for different levels was a great milestone and saw the development of eye care treatment protocols, adoption of eye indicators in the Health Management Information System and more eye health consumables added to the national procurement system. A central eye fund was established and workforce issues were also reviewed to support the health system.
The importance of free healthcare for the poorest
User fees in public health facilities are a barrier to access, and a major obstacle to achieving universal health coverage. Many countries, such as Burkina Faso, South Africa, Mali, Niger and Ghana have introduced exemption policies, targeting specific population groups (e.g. children under five years) or specialised services (e.g. caesareans). In Burkina Faso, 80% of poor households go into debt or sell assets to pay healthcare costs. The introduction of user fee exemption has had a very noticeable impact: the number of children under five consultations in health facilities increased six-fold. By increasing access and utilisation of health care, it is estimated that free healthcare can save the lives of around 20,000 children every year in Burkina Faso. In a recent national study, it was found that universal health coverage through free healthcare will cost only £3 per child per year.
(Excerpt from the WSD13 report on Universal Eye Health)