addressing ophthalmologists training in francophone west africa

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  1. 1. ADDRESSING OPHTHALMOLOGISTS TRAINING IN FRANCOPHONE WEST AFRICA Adidja AMANI, MD, MPH HR PROGRAMME MANAGER , SIGHTSAVERS Skills have become the global currency of the 21st century. Without proper investment in skills, progress does not translate into economic growth
  2. 2. Outline Overview The Analysis of the situation The Regional Strategic Plan
  3. 3. Overview of the Problem
  4. 4. How did we get there? Nigel Crisp, the inspirer Caroline Harper, CEO Ronnie Graham, HRH D 10-Year Strategy to respond to the HReH Crisis in Africa Objective 4:Meeting the specific health workforce challenges in Francophone and Lusophone Africa
  5. 5. Francophone West Africa at a Glance 16 countries - 8 francophone Area=3, 455, 984 km2 Population of 99, 599, 066 (CIA fact book, 2012) Average life expectancy = 53 years % of Urban Population = 37% (17-50%) the population aged over 50 years will double during the next 20 years (UNFPA) greater number of people with visual loss and blindness from cataract that will need eye services Health budgets =5.84%
  6. 6. The CSR in Francophone Africa remains>>> unnecessary losses in productivity How best can we support FWAC to meet their needs /the vision 2020 targets?
  7. 8. July 2012- The situational analysis: the process Goal: generate evidence to deepen the appreciation of the challenges and the opportunities of in the region 8 Countries
  8. 9. 360 degree stakeholders consultation Benin, Dean and Chief of department Senegal, Dean Cheik Anta Diop Residents in ophthalmology CBM D.O Cote dIvoire OCO, ON and Chief of department Patients at USE Niger with HR Director, NEEC Burkina Faso, Medical council
  9. 10. Findings: The Gap Country Training program Population Ophtalomologists Current Required Gap BENIN YES 9598787 26 38 18 BURKINA F NO 17275115 27 68 41 COTE DIVOIRE YES 21952053 82 84 2 GUINEE YES 9300000 24 37 13 MALI YES 14533511 34 57 23 NIGER NO 17078839 14 68 54 SENEGAL YES 12969606 54 51 +3 TOGO YES 6191155 18 24 6 Total 279 427 167
  10. 11. Who perform eye surgery in FWAC? Ophthalmologists who reported to perform surgery vs Medical ophthalmologist Source: Adapted from WAHO data, 2010 Cataract surgeons are not really present nor accepted as a cadre.#IOTA TSO= conflicts of competences Various eye camps by INGOs Not welcomed : Mercy Ships, Nadi El Bassar, Islamic relief, etc= Neither integrated nor sustainable, they are a strong disruptor of health system The regions has the lowest % of surgically-active ogists (Resnikoff and al., 2012) Medical ophtalmolog ists 44% Ophthalmolo gistwho reported to perform surgery 56%
  11. 12. . The number of Ogists in FWAC range from 14 in Niger to a maximum of 60 in Senegal
  12. 13. Findings: Shortage, quality, equipment U. of Lome- TOGO 12% UCAD- SENEGAL 14% DESSO- GUINNEE 16%U of Bamako- MALI 17% U. Abomey Calavi- BENIN 19% U of Coccody- COTE DIVOIRE 22% 53% of the Residents in ophthalmology do not perform surgery at all 53% Training centres for ophtalomologists Faculty Cataract surgery /10 N. of functional wet lab Max per batch Current batch Facult des Sciences de la Sant of the University of Abomey Calavi -Benin 5 3 0 N/A 5 Units de Formation et de Recherche of the University of Cocody Cote dIvoire 16 1 0 10 3 Faculty of Medicine, Pharmacy and Odontostomatology of the University Cheickh Anta Diop in Dakar -Senegal 8 5 1 6 4 Faculty of Medecin and Pharmacy of the University of Lome-Togo 3 4 0 4 2
  13. 14. 18 in 2013 28 34 in 2015 23 28 in 2017 36 in 2018 1 2 3 4 5 6 N. of graduates Projection of the N. of graduates in ophthalmology in the region /year Evolution of the number of post graduates in ophthalmology in the Francophone West Africa for the last 40 years 50% are more than 55 years Retirement rate is up, the production is not enough and the quality of graduates do not meet the population needs 74 74 75 84 68 70 72 74 76 78 80 82 84 86
  14. 15. Priorities are crosscutting: Strengthen surgical skills and Equipping Country Priority n1 Priority n 2 Benin Upgrade surgical skills for trainees & ogists Start to train TSOs Burkina Faso Start training ogists upgrade surgical skills for Ogists Equip health centers Cote dIvoire Upgrade surgical skills for trainees and ogists Equip the training institution and health centers Niger Start training ogists Equip Sngal Upgrade surgical skills for trainees Equip the training institution Togo Upgrade surgical skills for trainees Equip training institution Mali Training of trainers Equip health centers
  15. 16. The Regional Strategic Plan The Need To Rethink Approaches To Training Is Not New, But Is Becoming URGENT
  16. 17. Training institutions: Dean, Chief of Department of ophthalmology MoH: Human Resources Directors, NECC of 8 countries INGOS: Nadi El Bassar, CBM, HKI,OPC WHO, WAHO, Independent consultant NOV 2012 OPEN & INCLUSIVE consultation with 52 stakeholders
  17. 18. The strategic plan The goal: produce surgically skilled ophtalomologists well equipped to address eye health challenges 1. Increase the number of surgically skilled ophthalmologists at the regional level( Residency program, medical ogist CPD) 2. upgrade and scale up the infrastructures of the training institutions 3. Upgrade the equipment and training materials for all the training institutions and for their university teaching hospital 4. mobilize resources and coordinate the implementation of the regional strategic plan
  18. 19. Erasing red dividing line between training and Needs Accreditation of non-academic high volume surgery centres for internships of residents Post trainees in high volume centers like Dabou, IOTA ,Bopp,Gl, CADESSO CPD for medical ophtalomologists upgrade the infrastructures of training institutions and Upgrade the equipment and training materials for all the training institutions and the university teaching hospitals Train domestically (Niger and Burkina Faso) Equip residents improve the productivity and retention Regionalize areas of sub specialization (Paediatric ophthalmology) according to the relative endowment of individual institutions
  19. 20. Better Skills, Better Lives COUNTRIES COSTS GUINEE 76,984 CROSS CUTTING ACTIVITIES 291,005 MALI 506,613 BENIN 507,275 SENEGAL 515,211 COTE D'IVOIRE 836,068 TOGO 1,012,566 NIGER 1,136,243 BURKINA FASO 4,412,698 TOTAL 9, 294, 663 There is a need, and the potential to do things differently Do more with less by integrating useful skills Avoid costly medical evacuations However, the successful delivery of these interventions will require broad-based partnerships
  20. 21. Massive scaling up = Massive funding On trainees 9% On trainers 14% CPD for medical ophtalmologist 4% Equipment and Upgrading 63% Construction and extension 7% Advocacy, M&E,etc 3%Other 10% Where will the money go? NIGER 12% COTE D'IVOIRE 9% SENEGAL 6% TOGO 11% BENIN 6% BURKINA FASO 49% MALI 6% GUINEE 1% Budget By Country
  21. 22. Half full Half empty
  22. 23. The elimination of avoidable in blindness in FWAC is within our grasp. When it is achieved, it will be a major public health triumph. What is stopping us?