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

1. Extending eye care to rural Nigeria: The Vision2020 Eye Clinic Ukpor experience Sebastian N N Nwosu Cyriacus U Akudinobi Guinness Eye Center Onitsha Nigeria

2. Nnamdi Azikiwe University Awka

3. Guinness Eye Center Onitsha

4. Declaration • No financial interests

5. Introducton • Eye diseases and blindness are of public health importance in Nigeria

6. Political map of Nigeria

7. 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

8. Position of Anambra State in Nigeria

9. 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

10. Typical village gate

11. Typical rural house

12. 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

13. 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

14. Water source in rural areas

15. 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

16. 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

17. Previous efforts... • Outreach eye camps... • Poor follow-up • Not sustainable • Ownership taken by people • Seen as occasional patronage from enthusiastic urban dwellers

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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)

25. Bilaterally blind led by son

26. Bilateral cataract

27. Causes of low vision

28. Clinical diagnosis

29. 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

30. Comments...2 • Implementation of decisions delayed by • Government bureaucracy • Unstable council leadership (frequent transfers) • Industrial action by council & health workers

31. 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

32. 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

33. Sustainability...? • Our greatest worry & challenge

34. Sustainability...2 • A clinic revolving fund to be established • Sliding scale of fees charged to ensure that the poor benefits

35. Sustainability...3 • Continuing advocacy with the de facto leaders, including government and the local elite

36. 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

37. 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

38. Adjourn... • Thanks for listening