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      Mapping human resources for eye health in 21 countries of sub-Saharan Africa: current progress towards VISION 2020


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          Development of human resources for eye health (HReH) is a major focus of the Global Action Plan 2014 to 2019 to reduce the prevalence of avoidable visual impairment by 25% by the year 2019. The eye health workforce is thought to be much smaller in sub-Saharan Africa than in other regions of the world but data to support this for policy-making is scarce. We collected HReH and cataract surgeries data from 21 countries in sub-Sahara to estimate progress towards key suggested population-based VISION 2020 HReH indicators and cataract surgery rates (CSR) in 2011.


          Routinely collected data on practitioner and surgery numbers in 2011 was requested from national eye care coordinators via electronic questionnaires. Telephone and e-mail discussions were used to determine data collection strategies that fit the national context and to verify reported data quality. Information was collected on six practitioner cadres: ophthalmologists, cataract surgeons, ophthalmic clinical officers, ophthalmic nurses, optometrists and ‘mid-level refractionists’ and combined with publicly available population data to calculate practitioner to population ratios and CSRs. Associations with development characteristics were conducted using Wilcoxon rank sum tests and Spearman rank correlations.


          HReH data was not easily available. A minority of countries had achieved the suggested VISION 2020 targets in 2011; five countries for ophthalmologists/cataract surgeons, four for ophthalmic nurses/clinical officers and two for CSR. All countries were below target for optometrists, even when other cadres who perform refractions as a primary duty were considered. The regional (sample) ratio for surgeons (ophthalmologists and cataract surgeons) was 2.9 per million population, 5.5 for ophthalmic clinical officers and nurses, 3.7 for optometrists and other refractionists, and 515 for CSR. A positive correlation between GDP and CSR as well as many practitioner ratios was observed (CSR P = 0.0042, ophthalmologists P = 0.0034, cataract surgeons, ophthalmic nurses and optometrists 0.1 >  P > 0.05).


          With only a minority of countries in our sample having reached suggested ophthalmic cadre targets and none having reached targets for refractionists in 2011, substantially more targeted investment in HReH may be needed for VISION 2020 aims to be achieved in sub-Saharan Africa.

          Translated abstract


          Les ressources humaines en santé oculaire semblent être moindres en Afrique subsaharienne que dans les autres régions du monde, mais peu de données sont disponibles. Nous avons collecté des données sur les ressources humaines et le taux de chirurgie de la cataracte dans 21 pays de l’Afrique subsaharienne afin d’estimer pour 2011 les progrès réalisés concernant les indicateurs suggérés de ressources humaines et de chirurgie de la cataracte de VISION 2020.


          Les données sur les six catégories de cadre de santé et les opérations de chirurgie régulièrement collectées en 2011 ont été demandées aux coordinateurs des programmes nationaux par questionnaire envoyé électroniquement. Des discussions par courrier électronique et téléphone ont permis de vérifier la qualité des données. Les associations avec les caractéristiques de développement ont été menées en utilisant le test de la somme des rangs de Wilcoxon et les coefficients de corrélation de Spearman.


          Une minorité de pays ont atteint les cibles suggérées de VISION 2020: cinq pays pour les ophtalmologistes et les opérateurs de cataracte, quatre pays pour les infirmiers en ophtalmologie et les techniciens supérieurs en ophtalmologie et deux pays pour les opérations de cataracte. Tous les pays n’ont pas assez d’optométristes. Le ratio régional (échantillon) pour les chirurgiens (ophtalmologistes et operateurs de cataracte) était de 2,9 par million de population, 5,5 pour les infirmiers en ophtalmologie et les techniciens supérieurs en ophtalmologie, 3,7 pour les optométristes et autres réfractionnistes, et 515 pour le taux de chirurgie de cataracte. Il existe une corrélation positive entre PNB et le taux de chirurgie de cataracte et le PNB et le nombre de la plupart des professionnels (opération de cataracte P = 0.0042, ophtalmologistes P = 0.0034, opérateurs de cataracte, infirmiers en ophtalmologie et optométristes 0.1 >  P > 0.05).


          Etant donné que seulement une minorité de pays d’Afrique subsaharienne dans notre échantillon ont atteint en 2011 les cibles suggérées VISION 2020 en termes de nombre de professionnels de la santé oculaire et qu’aucun pays n’a un nombre suffisant de réfractionnistes, il est nécessaire et urgent d’investir dans les ressources humaines de la santé afin de pouvoir atteindre les objectifs VISION 2020.

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          Most cited references23

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          The number of ophthalmologists in practice and training worldwide: a growing gap despite more than 200,000 practitioners.

          To assess the current number of ophthalmologists practicing worldwide in 2010 and to create a system for maintaining, collecting and improving the accuracy of data on ophthalmologists per population, ophthalmologists performing surgery, growth rate of the profession, and the number of residents in training. Between March 2010 and April 2010, the International Council of Ophthalmology emailed a standardised survey of 12 questions to 213 global ophthalmic societies. Missing data and additional information were gathered from direct correspondences with ophthalmologist contacts. The total number of ophthalmologists reported was 204,909. Data are presented for 193 countries. Information was obtained from 67 countries on the number of ophthalmologists doing surgery, entering practice, leaving practice, rate of growth and resident training. The survey results show that despite over 200,000 ophthalmologists worldwide, there is currently a significant shortfall of ophthalmologists in developing countries. Furthermore, although the number of practitioners is increasing in developed countries, the population aged 60+ is growing at twice the rate of the profession. To meet this widening gap between need and supply, it is necessary to aggressively train eye care teams now to alleviate the current and anticipated deficit of ophthalmologists worldwide.
            • Record: found
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            Global cost of correcting vision impairment from uncorrected refractive error

            OBJECTIVE: To estimate the global cost of establishing and operating the educational and refractive care facilities required to provide care to all individuals who currently have vision impairment resulting from uncorrected refractive error (URE). METHODS: The global cost of correcting URE was estimated using data on the population, the prevalence of URE and the number of existing refractive care practitioners in individual countries, the cost of establishing and operating educational programmes for practitioners and the cost of establishing and operating refractive care facilities. The assumptions made ensured that costs were not underestimated and an upper limit to the costs was derived using the most expensive extreme for each assumption. FINDINGS: There were an estimated 158 million cases of distance vision impairment and 544 million cases of near vision impairment caused by URE worldwide in 2007. Approximately 47 000 additional full-time functional clinical refractionists and 18 000 ophthalmic dispensers would be required to provide refractive care services for these individuals. The global cost of educating the additional personnel and of establishing, maintaining and operating the refractive care facilities needed was estimated to be around 20 000 million United States dollars (US$) and the upper-limit cost was US\(28 000 million. The estimated loss in global gross domestic product due to distance vision impairment caused by URE was US\) 202 000 million annually. CONCLUSION: The cost of establishing and operating the educational and refractive care facilities required to deal with vision impairment resulting from URE was a small proportion of the global loss in productivity associated with that vision impairment.
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              Salaries and incomes of health workers in sub-Saharan Africa.

              Public-sector health workers are vital to the functioning of health systems. We aimed to investigate pay structures for health workers in the public sector in sub-Saharan Africa; the adequacy of incomes for health workers; the management of public-sector pay; and the fiscal and macroeconomic factors that impinge on pay policy for the public sector. Because salary differentials affect staff migration and retention, we also discuss pay in the private sector. We surveyed historical trends in the pay of civil servants in Africa over the past 40 years. We used some empirical data, but found that accurate and complete data were scarce. The available data suggested that pay structures vary across countries, and are often structured in complex ways. Health workers also commonly use other sources of income to supplement their formal pay. The pay and income of health workers varies widely, whether between countries, by comparison with cost of living, or between the public and private sectors. To optimise the distribution and mix of health workers, policy interventions to address their pay and incomes are needed. Fiscal constraints to increased salaries might need to be overcome in many countries, and non-financial incentives improved.

                Author and article information

                Hum Resour Health
                Hum Resour Health
                Human Resources for Health
                BioMed Central
                15 August 2014
                : 12
                : 44
                [1 ]International Centre for Eye Health Clinical Research Department, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel St., London WC1B 7HT, UK
                [2 ]African Vision Research Institute, 172 Umbilo Road Umbilo, Durban 4001, South Africa
                [3 ]International Agency for the Prevention of Blindness (Africa Region), 172 Umbilo Road Umbilo, Durban 4001, South Africa
                Copyright © 2014 Palmer et al.; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.


                Health & Social care
                human resources,eye health,sub-saharan africa,cataract,low vision,blindness,ophthalmology,optometry,nursing,vision 2020


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