IAPB Africa Promoting Eye Health, Preventing Blindness, Enhancing Life. Systems, Needs, Gaps & Priorities

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1 IAPB Africa Promoting Eye Health, Preventing Blindness, Enhancing Life Addressing the Challenge of Childhood Blindness in Africa Systems, Needs, Gaps & Priorities

2 What is needed? 1.Enough Paediatric Eye Centres, spread across the continent Adequately staffed & equipped, & fully functional 2.A well structured and sustainable system linking children with sight threatening conditions in the communities all the way to the Paediatric Centres A system that clearly identifies & empowers all those likely to play a facilitating role along the way

3 What is needed? 3. A dynamic partnership involving government, partner NGOs and other interested stakeholders, to ensure that enough support & resources are available for the work 4. A functional reporting and monitoring system to help track progress over time

4 What systems are in place? In terms of existing Paed. Eye Centres Country WHO recommendation One fully functional Paediatric Eye Unit per 10 millions population Number ofpediatric Eye Centres Population served by one Centre (million) Nigeria 7 22 Kenya 4 10 Tanzania 2 21 Uganda 3 12 South Africa 2 25 Malawi 1 16 Ghana 1 25 Sudan 1 45 DRC 1 72 Mali 1 14 Ethiopia 1 91

5 What systems are in place? In terms of geographic distribution

6 What systems are in place? In terms of linguistic distribution 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% ONLY 2 CENTRES OUT OF 24 ARE IN Percent FRANCOPHONE Pop Percent COUNTRIES! Ped C Anglophone Francophone Lusophone

7 What systems are in place? In terms of service delivery? A DISJOINTED SERVICE DELIVERY??

8 Most preventable causes of blindness in children come too late to the O Gist! Diseases Complicated Measles Ophtalmia neonatarum Vitaminose A Def./Xeropht Other infections Corn. & Trauma First level Access Pediatrics, G. Medecine. Health Centres Tradit. Healers communities. Health Centres Tradit. Healers communities. Tradit. Healers Commun. Work. Health Centres OCO? Prevention MCH, EPI, IMCI MCH TBA Midwifes MCH, EPI, IMCI, Comm. Distributors MCH IMCI Role of O gist/oco Late, Negligible Training++ Late, Negligible Training++ Late, Negligible Training++ Late, Training++

9 Main causes of death in children under years of age Pneumonia: the prime cause of death in children under five years of age Diarrhoeal diseases Malaria: One African child dies every 30 seconds from malaria. HIV: Over 90% of children infected through mother-to-child transmission, Malnutrition: About 20 million children <5yrs worldwide are severely malnouri-shed, more vulnerable to illness and early death

10 3 major Child Health initiatives of interest to Child Eye Health groups IMCI (Integrated Management of Childhood Illnesses): An integrated approach to child health that focuses on the well-being of the whole child. It includes both preventive and curative elements that are implemented by families and communities as well as by health facilities. MDG 4: Reduce the 1990 mortality rate among under 5 by 2/3 MDG 5: Reduce maternal morbidity and mortality School Health

11 The challenges of disjointed service delivery THE PAEDIATRIC CENTRE IS THE ONLY STRUCTURE CARRYING THE BURDEN OF CHILDHOOD BLINDNESS Paediatric Center FOLLOW UP OF CHILDREN IS VERY DIFFICULT Province E. Unit District H. Unit THE ROLE OF DISTRICT & PROVINCE LEVELS IS UNCLEAR OR COUNTER PRODUCTIVE Community Children MANY CHILDREN IN NEED NEVER REACH THE PAEDIATRIC CENTRE

12 What is needed: A functional & responsive system A GOOD AND WELL STRUCTURED REFERRAL SYSTEM WITH CLEAR ROLES ASSIGNED TO EACH LEVEL A GOOD AND WELL STRUCTURED COUNTER REFERRAL SYSTEM

13 Needed: A fully integrated system Community District Province Paediatric Center

14 The varying situation of Child Eye Health Development in SSA Group of countries Countries with >10mil pop Countries with <10mil pop (70mil) Large Countries (42% Total Pop) Total With Ped Eye Unit Shortfall ?? (4) Nigeria (155mil) 7 8 Ethiopia (90mil) 1 8 D R Congo(71mil) 1 6 South Africa (49mil) 2? 4?? NOT ONE BUT MANY STRATEGIES/APPROACHES WILL NEED TO BE CONSIDERED & DEVELOPED

15 UNRESOLVED ISSUES AND CHALLENGES WHO 1/10million Current Strategy: How realistic/feasible? Role of Paediatric Eye Units Pediatric Eye Health Development across SSA Development of National & District Plans for P. Eye Health Strategy may make sense in theory, but difficult to implement in practice, esp. in countries with low population density Issues of adequate geographic coverage, uptake and follow up by Paed. Units Should they be the only ones responsible for Ped. Eye Health development and delivery in the country? Some suggested key roles: Specialised services, Training of other Personnel (ophthalmic & Non Ophthalmic), Development of Nat. Guidelines Need for some geographic & linguistic equity Specific strategies to further develop existing P. Units What strategy where there is no single P. Eye Unit? What strategy for the <10mil pop countries? What process to use? What steps to follow? Whom to involve? What roles for the province and the district?

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