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”
Outline
Overview
The Analysis
of the situation
The Regional Strategic Plan
Overview of the Problem
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
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%
The CSR in Francophone Africa remains<500
CSR AFRO , 2003 CSR AFRO, 2004
SOURCE: Prevention of Blindness and Visual Impairment WHO-AFRO
CSR Global, 2004
What is the problem?
The Escalating Number of avoidable blindness
Heavy non operated cataract burden in FWAC --
------ >>>> unnecessary losses in productivity
How best can we support FWAC to meet their needs
/the vision 2020 targets?
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
360 degree stakeholder’s consultation…
Benin, Dean and Chief
of department Senegal, Dean
Cheik Anta Diop
Residents in
ophthalmology CBM D.O
Cote d’Ivoire
OCO, ON and Chief of
department
Patients at USE Niger with
HR Director, NEEC Burkina Faso,
Medical council
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
D’IVOIRE
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
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 o’gists (Resnikoff and al., 2012)
Medical ophtalmolog
ists
44%
Ophthalmolo
gistwho reported to
perform surgery
56%
.
The number of O’gists in FWAC range from 14 in
Niger to a maximum of 60 in Senegal
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 D’IVOIRE
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
Faculté des Sciences de la
Santé of the University of
Abomey Calavi -Benin 5 3 0 N/A 5
Unités de Formation et de
Recherche of the University
of Cocody – Cote d’Ivoire 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
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
Priorities are crosscutting:
Strengthen surgical skills and Equipping
Country Priority n°1 Priority n° 2
Benin Upgrade surgical skills for trainees &
o’gists
Start to train TSO’s
Burkina Faso Start training og’ists
upgrade surgical skills for O’gists
Equip health centers
Cote d’Ivoire Upgrade surgical skills for trainees and
o’gists
Equip the training institution and
health centers
Niger Start training og’ists Equip
Sénégal 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
The Regional Strategic Plan
The Need To Rethink Approaches To Training Is
Not New, But Is Becoming URGENT
• 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
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 o’gist 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
“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,Gléï, 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
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
“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
Half full
Half
empty
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?
