Improving availability of Eye Health Workers in Rural and Remote Areas of West Africa- Role of Retention Strategies

Health Systems Development, 9th General Assembly, International Agency for the Prevention of Blindness,

Hyderabad, India, 17 – 20 Sept. 2012.

<|> Prof. Kayode ODUSOTE

Vision 2020: StrategyVision 2020: Strategy

Coordination:Coordination: International and NationalInternational and National

ResourceResource MobilisationMobilisation

AdvocacyAdvocacy

The 3 Pillars The 3 Pillars of Vision of Vision

20202020

Infrast Infrast & & Eqpt DevptEqpt Devpt

Hum. Hum. ResRes. . DevptDevpt

Disease Disease ControlControl

The Vision The Vision 2020 2020

TriangleTriangle

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HREH in WA - Role of Retention Intervention Strategies3

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Ophthalmologists 1: 250,000

Cataract Surgeons (1:250,000) Ophthalmic Assistants/ON 1:100,000 Optometrists/Refractionists 1:50,000 Community/PEC Workers 1:5,000 Ophthalmic Equip. Technicians ?? Managers & Administrative Personnel

100% of 3o and 50% of 2o

PERSONNEL IN EYE CARE by 2020

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Progress in Numbers of EHWs

No. Category of EHWs 1994 2008 1994 2008 1994 2008 1994 2008

1Ophthalmic Nurse/Ophthalmic Medical Assistant

18 33 102 239 310 946 38 25

2 Cataract Surgeon 3 13 1 1 NA NA - 73 Ophthalmologist 2 3 24 48 157 400 5 34 Optometrist 3 1 25 63 100* 1,475 - 0

5Optometrist Assistant

4 9 3 1 10 - 6 11

6 LPED Technicians - 2 9 ? 5 22 6 47 Low Vision Workers ? 1 ? ? ? 12 ? 4

* - Probably an underestimation + - Effect of Civil War

CHANGE IN AVAILABILITY OF EYE HEALTH WORKERS

Gambia Ghana Nigeria Sierra Leone+

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Characteristics of HRH Crisis in West Africa

Inadequate number of all categories of health professionals.

Mal-distribution of available staff. Inappropriate mix of health workers. Poor performance associated with poor motivation.

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IN-EQUITABLE

DISTRIBUTION

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Attraction and

Retention

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Living conditions◦ Housing◦ Infrastructure – roads, water, electricity,

telephone◦ School for children, work for spouse

Opportunities for Career Progression Work Environment

◦ In Eye Health – lack of facilities for specialized care.

Professional Development and isolation Opportunity Cost.

Major factors against Retention

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Financial incentives – rural allowance, etc◦ main issue is sustainability

Enhanced career progression – ◦ reduced length of service for promotion to next

grade

Hire Purchase facilities for car purchase◦ less effective with high cost of new vehicles and

lower cost of imported used cars.

Interventions that have worked in general HRH in West Africa

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Compulsory rural service ◦ effect is only short-term and does not make for

sustained retention Bonding for sponsored training

◦ Difficult to police sometimes, effect is short-term and requires other packages for long-term retention.

Priority for further training or overseas trips◦ dependent on volume of available sponsorships.

Decentralized recruitment◦ works in a situation of adequate supply and no

vacancies in the major cities/

Interventions that have worked in general HRH in West Africa - 2

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TRAINING

Intervention

Potential for Effectivenes

s

Students from rural backgrounds Pos

Health Professional schools outside major cities Prb

Clinical rotations in rural areas during studies Prb

Curricula that reflect rural health issues NL

Continuous professional development for rural health workers Pos (if)

WHO recommended interventions – potential for effectives in HREH/WA

Key: Def – Definite Pos – Possible Prb – Probable NL – Not likely

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REGULATION

Intervention

Potential for Effectivenes

s

Enhance scope of Practice Pos

Different types of health workers Def

Compulsory service Def

Subsidized education for return of service

Def

WHO recommended interventions – potential for effectives in HREH/WA 2

Key: Def – Definite Pos – Possible Prb – Probable NL – Not likely

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FINANCIAL INCENTIVES

Intervention

Potential for Effectivenes

s

Appropriate financial incentives Def (but)

WHO recommended interventions – potential for effectives in HREH/WA 3

Key: Def – Definite Pos – Possible Prb – Probable NL – Not likely

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PROFESSIONAL AND PERSONAL SUPPORT

Intervention

Potential for Effectivenes

s

Better living conditions Pos

Safe and supportive working conditions

Prb

Outreach support Prb

Career development programmes Pos (if)

Professional Networks NL

Public recognition measures Prb

WHO recommended interventions – potential for effectives in HREH/WA 4

Key: Def – Definite Pos – Possible Prb – Probable NL – Not likely

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By 2020 – Every person, everywhere, should have access to a well-trained and well-motivated specialized eye health worker within 50 km and a well-trained and well-motivated primary eye care worker within 5 km of where he/she lives.

Proposed new HRD Goal

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We need retention strategies to achieve the new goal, but◦ No single intervention works for all situations and for all

categories.◦ Package of financial and non-financial incentives have

better chances of success. Eye Health remains low in priority of governments

in WA and so is Human Resources for Eye Health. We appreciate the support of the IAPB family and

would continue to depend on this support for the development of HREH in WA at least until 2015 and possibly beyond.

Conclusion

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