Current State of Blindness in Ghana and SiB Boateng Wiafe, Regional Director for Africa Oscar Debrah Head, Eye Care Unit, Ghana Health Service KATH KUMASI FEBRUARY 2014

Causes of Blindness  Cataract45 – 50%  Glaucoma15 – 20%  Trachoma5%  Onchocerciasis5%  Childhood Blindness5 -10%  Refractive Errors  & Low Vision5%  Others10 – 15%

Human Resource Development  Ophthalmologists – Trained by Ghana Postgraduate College  Optometrists – Doctors in Optometry (OD). Trained in Kumasi and Cape Coast  Ophthalmic Nurses – Trained at Ophthalmic Nursing School in Korle Bu  Optical Technicians – Trained at Oyoko

Human Resource  Ophthalmologists74  Optometrists150  Ophthalmic Nurses420  Low Vision Specialist1 Distribution of personnel (especially ophthalmologists and optometrists) skewed towards Accra and Kumasi. No ophthalmologist in Upper West Region. One each in Volta, BA and Upper East Regions

HR in Eye Health in Ghana  Skewed Distribution of Eye Health workforce

Disease Control  Cataract  Trachoma Control Programme  Childhood Blindness  Refractive Error & Low Vision Services

Cataract Services  Provided at both static and outreach centres  Cataract surgery covered under the National Health insurance Scheme (NHIS) which started in 2005  CSR in 2012 was 819  Total cataract surgeries in 2012 = 19860

5-Year CSR Trend

2012 CSR

Trachoma Control Programme  Trachoma was endemic in two regions, Northern and Upper West  Using ‘SAFE’ strategy for control, which started in 2000  Targeted 2010 for the elimination of blinding trachoma

Trachoma Control Programme  Trachoma was endemic in two regions, Northern and Upper West  Using ‘SAFE’ strategy for control, which started in 2000  Targeted 2010 for the elimination of blinding trachoma

Prevalence of Active Trachoma (Baseline & After Intervention)

Trachoma Control Programme  3 rd year of Trachoma Surveillance in the 2 Regions.  Epidemiological Prevalence Survey to be conducted next year, which will lead to applying for declaration of Ghana being free from Blinding Trachoma

Childhood Blindness Prevention  Paediatric Ophthalmology Units in Korle Bu and Komfo Anokye Teaching Hospitals  Trained ophthalmic nurses in Childhood Blindness prevention  Lions Club International/WHO supporting Korle Bu Paediatric Unit to set up a satellite centre at Weija

Refractive Error & Low Vision Services  Refractive Error Services mostly in the private sectors. Teaching and some Regional Hospitals also render service  2 Low Vision Centres set up in 2 regions (Greater Accra and Eastern).  National Low Vision Coordinator in the office of Eye Care Unit. Used to be supported by CBM but support ended in 2010

Challenges  No National Prevalence of Blindness Survey done  Integration of PEC into Regional and District Health Service delivery  Inadequate and inequity in distribution of eye care personnel especially ophthalmologists and optometrists  Sub-specialty for ophthalmologists  Low National Cataract Surgical Rate (CSR)  Inadequate resource for eye health activities  Data collection

No National Prevalence Survey done  Data we use are extrapolated  A RAAB conducted in the Eastern Region in 2009 funded by Sightsavers revealed a prevalence of blindness of 0.7  The Faculty of Public Health, Swiss Red Cross and OE are planning on a National Survey but the funds are not adequate so we will sample from each of the 3 ecological zones and have a snap shot of the prevalence and causes of blindness in Ghana

LOW CSR  From this presentation we can observe that we need to operate at least 50,000 cataract surgeries per annum if we want to deal with the backlog

OUR APPROACH In Partnership with the Standard Chartered Bank, Seeing is Believing we decided to REMOVE BARRIERS TO QUALITY EYE CARE IN GHANA BY a) Strengthening the district level eye care, making it robust enough to take referrals from the community b) Empower the frontline health workers and volunteers through capacity building

Strengthening the District Level Eye Services  Infrastructure Development – Constructed and Renovated Eye Clinics  Equipment provision – Equipped 24 District Hospitals with Diagnostic Equipment to make them functional Provision of 7 Surgical Sets to 7 regions - Operating Microscopes, Biometry Equipment, Surgical Instruments  Capacity Building - Retraining of the Ophthalmic Nurses on how to use the equipment provided

 Capacity building – Training of instruments technicians and equipping them with tool kits Training the Ophthalmic Nurses to be trainers of others  Service Delivery enhancement: SiB offered consumables for cataract services for as many surgeries as would be required for the first year and then decline as the year goes by, an attempt to assist in sustainability

Outcome of the intervention  Infrastructure Development: 2 new eye clinics were constructed - Bibiani and Weija 3 Eye Clinics refurbished – Takoradi Government Hospital, Worawora district Hospital and Tokurano Clinic  Human Resource Development 42 Ophthalmic Nurses 10 Optometrists 12 Equipment Technicians 1361 PEC workers trained

Service Delivery ,664 patients screened and treated 2. Community Awareness program through the mass media 3. Surgeries – low productivity (27%) a) Only 31% of the 10,969 cataract surgeries have been delivered b) Only 11% of the 4388 major surgeries have been delivered c) Only 40% of the 6581 minor surgeries have been delivered

Discussion  Several of the partners have never delivered any surgery at all  Those who do something are grossly underperforming  Only about 7 or so partners are delivering  There is surgical instruments available, consumables are available, patients are available  The blind patients are not converted to seeing

Recommendations  Districts should be adopted by Ophthalmic Teams from the teaching hospitals Surgical Visits should be once a month and if a regular visit is made and a target is set at not less than 20 cases per day in a year we can reach at least 200 – 250 cases. If it becomes busy, then the frequency can be increased. We should not treat this as a part time work outside our normal duties, activities done over the weekends.

Recommendations  Districts that have been equipped and not generating any surgeries may have to surrender their equipment to district hospitals that are prepared to deliver. It is unethical to tell someone that he has a problem and not do anything about it.

Any suggestions? 1. ……. 2. ……. 3. ……….

Partners in Eye Care  Sightsavers  CBM  SRC  OEU  HCP  GEF  Rotary Club  Lions Club  Standard Chartered Bank (“Seeing is Believing”)  Orbis

 Thank you