Addressing the severe shortage of eye care workers in Uganda…
The prevalence of blindness in Uganda is estimated at 1%, and 75% of this is avoidable. The most common cause is cataract (50%) followed by trachoma and other corneal scarring (30%), and glaucoma (10%). Infections, malnutrition, injuries and lack of eye care services in rural communities also give rise to a high proportion of blindness particularly in rural communities.
One of the main barriers to the uptake of eye care services is a severe shortage of eye care personnel. In Uganda, eye care services are provided by fewer than 50 Ophthalmologists and Cataract Surgeons, most of whom live in major towns and cities. The national ratio of Ophthalmologists is estimated to be one per 852,000 people, but it is as low as 1 per 3.7 million in the north of Uganda. The majority of Ophthalmologists continue to work in the major towns, with almost half of Uganda’s Ophthalmologists based in Kampala. Ophthalmic Clinical Officers (OCOs) generally work in the district hospitals and rural health centres, thus training and deploying eye care professionals, particularly mid-level paramedics and community based workers, is crucial to ensure the availability of quality eye care in rural areas.
To address the critical need for more mid-level eye care professionals across Uganda, Sightsavers has been working with the Jinja Training School in Uganda to support its Ophthalmic Training Programme. The Chalker Foundation agreed to fund the development of 15 Ophthalmic Clinical Officers in 2010.
The long term aim of the Ophthalmic Training Programme is to support the National Plan for the Prevention of Blindness in Uganda has at least one Ophthalmic Clinical Officer to screen, diagnose and treat many eye diseases and effectively manage local eye care services. Jinja Hospital, where the Jinja Training School is based, is one of 13 tertiary hospitals in Uganda. Each trainee spends one year here, having been carefully selected for the course according to the need and evidence of commitment to eye care by the district that they are based in and return to.
We decided to focus on these mid-level eye care workers so that eye care can be delivered to large numbers of people while at the same time allowing surgeons to concentrate on more complex cases. The OCOs also present a unique opportunity for expanding health services to rural populations by collaborating with other community-based workers to ensure that health promotion, prevention and primary eye care are integrated into primary health care at community level. For example, OCOs can be involved with community-based activities such as trachoma control, school screenings and community-directed distribution of Mectizan® (the drug to control river blindness), allowing them to bring their eye care services closer to people in rural communities. The OCOs also form a pool from which cataract surgeons, optical assistants, health educationalists or low vision specialists can be trained. There is a shortage of all of these eye care workers in Uganda, so it is important to build the capacity of professionals to work across these areas.
“I was working as a registered nurse in the eye department at the hospital since 1998, and had worked in different wards at the same hospital before then. I was interested in the course because I just wanted to help in preventing blindness where possible, and to educate people about how to prevent blindness “
– Justine Negas, OCO Trainee (January 70)