Improving availability of Eye Health Workers in Rural and Remote Areas of West Africa
description
Transcript of Improving availability of Eye Health Workers in Rural and Remote Areas of West Africa
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
Supp
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Supp
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Act
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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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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