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 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 Cause Blindness (%) Visual impairment(%)
Refractive error -
13(44.8)
Cataract
10 (71.4)
11(37.9)
Glaucoma
4(28.6)
5(17.3)
Total
14(100.0)
29(100.0)

28. Clinical diagnosis Diagnosis No. % Refractive error / presbyopia 61
36.8
Cataract 39
23.5
Irritative/allergic conjunctivitis 35
21.1
Glaucoma 21
12.7
Pterygium 13
7.8
Uveitis 7
4.2
Corneal ulcer 5
3.0
Purulent conjunctivitis 4
2.4
Corneal foreign body 2
1.2
Optic atrophy
ARMD
Diabetic retinopathy
Traumatic hyphaema
Migraine
Retinal detachment 1
0.6
Orbital tumour

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