ABSTRACT
Introduction: Service provision for tackling cataract blindness is a key priority and remains a challenge for eye care programs in Nigeria. At the moment, paucity of data on these services makes evaluation and effective planning difficult. Objective: To evaluate the infrastructure, equipment, and human resources for cataract surgical services, and determine the cataract surgical output in Kwara State, Nigeria. Materials and Method: A descriptive cross-sectional study of all cataract service institutions in Kwara state was conducted in May-July 2008 using pre-tested questionnaire and on-site review. Output data for 2003-2007 was collected and channels of yearly reporting of cataract surgical output for 2008-2009 established. Descriptive and analytical statistics were performed. For all comparisons, statistical significance was indicated by p<0.05. Results: There were 14 cataract surgical centres (9 Base Hospitals and 5 Surgical Outreach Centres); all the Base Hospitals were located in the urban centres with over two third cited in Ilorin, the state capital. The state had adequate equipment and infrastructures; however they are mal-distributed in favour of urban areas. A total of 157 eye care workers comprising 12(7.6%) ophthalmologists (consultants=8, Diplomates=4), 16(10.2%) trainee ophthalmologists, 94(59.9%) mid-level ophthalmic personnel and 35(22.3%) support staff serve the state’s 2.37million people. Eighty per cent of the eye care workers reside in the state capital where less than 30% of the population lives. Cataract surgical output increased from 218 in 2,003 to 1020 in 2009. Conclusion: There is adequacy of infrastructure, equipment and human resources with improving cataract surgical output. To attain vision 2020 target, mal-distribution of infrastructures, equipment and human resources and poor staff mix need to be addressed. There is urgent need for establishing state- and nation-wide systems for reporting cataract surgical output.
ABSTRACT
Understanding Health systems have now become the priority focus of researchers and policy makers, who have progressively moved away from a project-centred perspectives. The new tendency is to facilitate a convergence between health system developers and disease-specific programme managers in terms of both thinking and action, and to reconcile both approaches: one focusing on integrated health systems and improving the health status of the population and the other aiming at improving access to health care. Eye care interventions particularly in developing countries have generally been vertically implemented (e.g. trachoma, cataract surgeries) often with parallel organizational structures or specialised disease specific services. With the emergence of health system strengthening in health strategies and in the service delivery of interventions there is a need to clarify and examine inputs in terms governance, financing and management. This present paper aims to clarify key concepts in health system strengthening and describe the various components of the framework as applied in eye care interventions.