optometry is discussed here, eye diseases and disabilities are highlighted and management of such ocular conditions enumerated.
Wednesday, 7 October 2015
optometry.naija: The perspective of the Nigerian Optometrist.
optometry.naija: The perspective of the Nigerian Optometrist.: realblazzer 27 June 2012 at 23:10 I don't think you have critically addressed the role of optometrist in Nigeria under this blog. R...
The perspective of the Nigerian Optometrist.
realblazzer27 June 2012 at 23:10
I don't think you have critically addressed the role of optometrist in Nigeria under this blog.
ReplyDeleteSaturday, 6 June 2015
The Nigerian Optometrist as Primary Eye Care Provider; a reality or a hoax.
While the Optometrist is defined as an independent primary eye care provider who examine,
diagnose, treat and manage diseases and disorders of the visual system,
the eye and associated structures; as well as diagnose related systemic
conditions. {1}
World Council of Optometry went further to define Optometry as a healthcare profession that is autonomous, educated, and regulated (licensed/registered), and optometrists are the primary healthcare practitioners of the eye and visual system who provide comprehensive eye and vision care, which includes refraction and dispensing, detection/diagnosis and management of disease in the eye, and the rehabilitation of conditions of the visual system.
But the Act establishing Optometrists and Dispensing Opticians Board of Nigeria (Chap 09. Part VI, Section 29 [interpretation]) defined optometry thus:
And that worrying inclusion of the clause in the Dr Joe Owie led "Political Action Committee" setup by the current President of Nigerian Optometric Board, Dr Damien Echendu. To wit,
Then the question, is Optometry a primary eye healthcare profession? Why is it not captured thus in the ODORBN Act? And the issue of gazetting the Nigerian Optometrist as a primary eye care professional, it befuddles me that nothing has been done to question the reason why it is taking eternity to gazette us as primary eye care specialists. If the Nigerian Optometrist is not designated as primary eye care provider, then who is a primary eye care provider in Nigeria?
What is Primary Health care?
The concept of primary health care emerged in the 20th century as a strategy to provide access to comprehensive, effective health services for populations. Many forces and historic events shaped the evolution of primary health care.
Historically, China provided the first broad experiences of primary health care beginning in the 1930’s, this was expanded into the concept of the “barefoot doctor” on a national scale and subsequently the largest experience has been and continues to be on the Indian sub-continent.{4}
Primary Health Care Service was first introduced in Nigeria in 1975 by Yakubu Gowon, Nigeria’s leader announced the Basic Health Service Scheme (BHSS) as part of the Third National Development Plan (1975-80). The objectives of the scheme were to increase the proportion of the population receiving health care from 25 to 60 percent, correct the imbalances in the location and distribution of health institutions and provide the infrastructures for all preventive health programmes such as control of communicable diseases, family health, environmental health, nutrition and others and establish a health care system best adapted to the local conditions and to the level of health technology. {5}
Optometry practice in Nigeria is mainly a private health care initiative with little or no practical solution to the lacunae orchestrated by the burden of blindness in our society today. The burden of blindness in Nigeria, in Africa, is a result of poverty and ineptitude by the authorities in the health sector.
Primary health care in Nigeria revolves round maternal (pregnancy) and child (0-5 years) care. Chronic disease conditions like Diabetes, Hypertension, Osteoarthritis etc other health care issues like Glaucoma, Cataract prevention and management, refractive errors in children and in presbyopic adults, congenital and inherited ocular disease conditions that could be easily accessed in the primary health care level are not only left to fate, quacks end up preying on that lacunae created by the dearth of such health services at that level.
It is not in doubt that we practice a selective kind of Primary health care system in the country, but it is ominous that even the legislative framework that brought about Optometry as a health care practice in Nigeria neither recognizes the Nigerian Optometrist as primary eye care professionals nor does it empower us as the first port of call for eye care disease conditions and until this and other measures are taken to ameliorate this contending issues, the burden of blindness will forever weigh us down to a breaking point. It is rather unfortunate that our primary health care policy is so out of sync with the realities of universal health determinants and little wonder our elites troop out in droves on medical tourism to other developed countries and leaving the rest of us subjected to a life expectancy of less than 55 years!
What needs to be done? I will elaborate this in my next blog as I discuss extensively on the core principles outlined by Alma-Ata declaration of 1978 on Primary Health care.
to Be continued...
World Council of Optometry went further to define Optometry as a healthcare profession that is autonomous, educated, and regulated (licensed/registered), and optometrists are the primary healthcare practitioners of the eye and visual system who provide comprehensive eye and vision care, which includes refraction and dispensing, detection/diagnosis and management of disease in the eye, and the rehabilitation of conditions of the visual system.
But the Act establishing Optometrists and Dispensing Opticians Board of Nigeria (Chap 09. Part VI, Section 29 [interpretation]) defined optometry thus:
"Optometry” means a health-care profession specializing in the art and science of
vision care and whose scope of practice includes—
(a) eye examinations to determine refractive errors and other departures
from the optimally healthy and visually efficient eye;
(b) correction of refractive errors using spectacles, contact lenses, low
vision aids and other devices;
(c) correction of errors of binocularity by means of vision training
(orthoptics);
(d) diagnosis and management of minor occular infections which do not
pose a threat to the integrity of the occular or visual system; and
(e) occular first aid;
And that worrying inclusion of the clause in the Dr Joe Owie led "Political Action Committee" setup by the current President of Nigerian Optometric Board, Dr Damien Echendu. To wit,
" To ensure that Optometry is designated as a Primary Care Profession by the Ministry of Health in all enabling health Act."
Then the question, is Optometry a primary eye healthcare profession? Why is it not captured thus in the ODORBN Act? And the issue of gazetting the Nigerian Optometrist as a primary eye care professional, it befuddles me that nothing has been done to question the reason why it is taking eternity to gazette us as primary eye care specialists. If the Nigerian Optometrist is not designated as primary eye care provider, then who is a primary eye care provider in Nigeria?
What is Primary Health care?
Essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community… It forms an integral part of the country’s health system…and of the social and economic development of the community…bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process.” {2}
The primary health care system is a grassroots approach meant to address the main health problems in the community by providing preventive, curative and rehabilitative services. {3}
The concept of primary health care emerged in the 20th century as a strategy to provide access to comprehensive, effective health services for populations. Many forces and historic events shaped the evolution of primary health care.
Historically, China provided the first broad experiences of primary health care beginning in the 1930’s, this was expanded into the concept of the “barefoot doctor” on a national scale and subsequently the largest experience has been and continues to be on the Indian sub-continent.{4}
Mable and Marriott (2002) state that
Primary Health Care (PHC) “recognizes the broader determinants of health and includes coordinating,
integrating, and expanding systems and services to provide more population
health, sickness prevention, and health promotion, not necessarily just by
doctors. It encourages the best use of all health providers to maximize the
potential of all health resources.”
The Alma-Ata declaration of 1978 on Primary health care summarizes five (5) core principles on which Primary health care should be built on:
(1) active public participation,
(2)
accessibility;
(3) health promotion and chronic disease prevention and
management,
(4) the use of appropriate technology and innovation (including
knowledge, skills and information),
(5) inter-sectoral cooperation and
collaboration.
Primary Health Care Service was first introduced in Nigeria in 1975 by Yakubu Gowon, Nigeria’s leader announced the Basic Health Service Scheme (BHSS) as part of the Third National Development Plan (1975-80). The objectives of the scheme were to increase the proportion of the population receiving health care from 25 to 60 percent, correct the imbalances in the location and distribution of health institutions and provide the infrastructures for all preventive health programmes such as control of communicable diseases, family health, environmental health, nutrition and others and establish a health care system best adapted to the local conditions and to the level of health technology. {5}
Optometry practice in Nigeria is mainly a private health care initiative with little or no practical solution to the lacunae orchestrated by the burden of blindness in our society today. The burden of blindness in Nigeria, in Africa, is a result of poverty and ineptitude by the authorities in the health sector.
Primary health care in Nigeria revolves round maternal (pregnancy) and child (0-5 years) care. Chronic disease conditions like Diabetes, Hypertension, Osteoarthritis etc other health care issues like Glaucoma, Cataract prevention and management, refractive errors in children and in presbyopic adults, congenital and inherited ocular disease conditions that could be easily accessed in the primary health care level are not only left to fate, quacks end up preying on that lacunae created by the dearth of such health services at that level.
It is not in doubt that we practice a selective kind of Primary health care system in the country, but it is ominous that even the legislative framework that brought about Optometry as a health care practice in Nigeria neither recognizes the Nigerian Optometrist as primary eye care professionals nor does it empower us as the first port of call for eye care disease conditions and until this and other measures are taken to ameliorate this contending issues, the burden of blindness will forever weigh us down to a breaking point. It is rather unfortunate that our primary health care policy is so out of sync with the realities of universal health determinants and little wonder our elites troop out in droves on medical tourism to other developed countries and leaving the rest of us subjected to a life expectancy of less than 55 years!
What needs to be done? I will elaborate this in my next blog as I discuss extensively on the core principles outlined by Alma-Ata declaration of 1978 on Primary Health care.
to Be continued...
Saturday, 30 May 2015
optometry.naija: National Health Insurance Scheme (NHIS), Universal...
optometry.naija: National Health Insurance Scheme (NHIS), Universal...: The National Health Bill 2014 referred to a: "health care personnel" as health care providers and health workers; "hea...
National Health Insurance Scheme (NHIS), Universal health coverage and the Nigerian Optometrist. Part 4.
The National Health Bill 2014 referred to a:
Laws of the Federation (1989) Chap. 09, No. 34 established the regulatory framework of the Optometrists in Nigeria, the ODORBN (Optometrist and Dispensing Opticians Board of Nigeria). This Act of Law automatically qualifies the Optometrist as a "health care provider" as posited above.
It is therefore important to note the inclusiveness of the Optometrist in the Health system of Nigeria.
In Part 2 of this blog, I pointed out this:
Basic health is defined as
The National Health Insurance Scheme is funded under the National Health Bill 2014 for:
The " Technical Committee" means the committee formed by section 6;[Section 64]
The Technical Committee shall comprise - (Amongst others)
ODORBN is the statutory health regulatory body of the Nigerian Optometrists by law and is automatically a member of the Technical Committee based on the provision of Section 6(2)(h). It therefore behoves of us to consolidate our view points and stress our agendas using this channel.
ODORBN, with the blessing of the NOA, is expected and literally compelled to assume the responsibility of proper representation of the profession in relevant health issues like the NHIS, national health policy etc.
It is a good head-start by Dr Damien Echendu's NOA (Nigerian Optometric Association) presidency to have inaugurated the Political Action Committee (PAC) with an instruction to explore NHIS and other relevant issues. I hope the recommendations they (PAC) came up with will be appropriately looked into with the view of forming opinions to be discussed at the Technical Committee meetings. Another laudable and bold step is the town-hall meeting that was organized recently in Owerri, first of its kind since 1968! This type of town-hall meeting should be held in all 36 states of the country and in Abuja periodically to hear our version of the Optometry story and act as a melting pot in our quest for growth and development!
Finally, on the 24th of December, Dr.Anene Chukwuemeka, the secretary of the PAC, released some recommendations by the committee. I will only highlight one of those recommendations, to wit,
I will add that we should seek legislative interpretations of the relevant laws guiding the operation of NHIS in Nigeria with a view to appreciating the role of the Nigerian Optometrist as an Eye care service provider, nay, as an independent primary eyecare provider.
It will be laudable and appreciated if the newly appointed ODORBN registrar, Prof. Mrs Uzodike, and The NOA President, Dr Damien Echendu, will become allies for the common good of the profession especially as it pertains to National Health Insurance Scheme in Nigeria. For starters, we need to have eye clinics that meet the minimum requirements on the NHIS operational guidelines for Optometry (See Section 2.7.9. of the 2012 NHIS Operational Guidelines) and become registered as a Primary care Provider under the NHIS.
This is the first line to "... open up channels of communication..." between the Optometrists, the Health Maintenance Organizations (HMO) and the citizenry.
The ODORBN should be responsible for "advising" The National Council of Health in Nigeria. They should play that role, as well as their traditional "dues" collecting role and other responsibilities as contained in the Act of Law that brought it to existence. On the other hand, the NOA should play the advocacy role, it should even lobby to ensure that ODORBN is heard at the technical committee meetings! NOA should seek the invocation of existing legislative premises that support our collective aspirations and even encourage review of our existing "scope" of participation in health care practice in Nigeria in a bid to align with the goals of the NHIS.
With the burden of blindness and visual handicap astronomical among the poor, the NHIS will surely ameliorate the sufferings of the masses and help in facilitating the objectives of vision 2020.
Long Live Optometry in Nigeria.
Long Live the Federal Republic of Nigeria.
[Section 64(c)]"health care personnel" as health care providers and health workers;
"health care provider" as a person providing health services under Act of Law;
Laws of the Federation (1989) Chap. 09, No. 34 established the regulatory framework of the Optometrists in Nigeria, the ODORBN (Optometrist and Dispensing Opticians Board of Nigeria). This Act of Law automatically qualifies the Optometrist as a "health care provider" as posited above.
It is therefore important to note the inclusiveness of the Optometrist in the Health system of Nigeria.
In Part 2 of this blog, I pointed out this:
The National Health Insurance Scheme Operational Guidelines (2012) identifies the Optometrist thus:In pursuant to a proper representation and inclusiveness of Optometry in the health system of Nigeria it is very important to identify with these:
2.2.13.1 Possession of Doctor of Optometry degree, or equivalent qualification recognized by optometrist and dispensing optician registration board of Nigeria (ODORBN)
2.2.13.2 Registration with ODORBN
2.2.13.3 Possession of current license to practice issued by ODORBN.
(4) The National Council shall have powers to regulate its proceedings.[ National Health Bill 2014]
(5)(1) The National Council which shall be the highest policy making body in Nigeria on matters relating to health, shall-
(c) ensure the delivery of basic health services to the people of Nigeria and prioritize other health services that may be provided within available resources;
Basic health is defined as
"basic minimum package" which means the set of health services as may be prescribed from time to time by the Minister after consultation with the National Council on Health; [Section 64]
The National Health Insurance Scheme is funded under the National Health Bill 2014 for:
"provision of basic minimum package of health services to citizens, in eligible primary/or secondary health care facilities" [Section 11(3)(a)]And,
(5)(3) The National Council shall be advised by the Technical Committee established in terms of this Bill.
The " Technical Committee" means the committee formed by section 6;[Section 64]
The Technical Committee shall comprise - (Amongst others)
one representative each of all statutory health regulatory agencies or councils;
[Section 6(2)(h)]
ODORBN is the statutory health regulatory body of the Nigerian Optometrists by law and is automatically a member of the Technical Committee based on the provision of Section 6(2)(h). It therefore behoves of us to consolidate our view points and stress our agendas using this channel.
ODORBN, with the blessing of the NOA, is expected and literally compelled to assume the responsibility of proper representation of the profession in relevant health issues like the NHIS, national health policy etc.
It is a good head-start by Dr Damien Echendu's NOA (Nigerian Optometric Association) presidency to have inaugurated the Political Action Committee (PAC) with an instruction to explore NHIS and other relevant issues. I hope the recommendations they (PAC) came up with will be appropriately looked into with the view of forming opinions to be discussed at the Technical Committee meetings. Another laudable and bold step is the town-hall meeting that was organized recently in Owerri, first of its kind since 1968! This type of town-hall meeting should be held in all 36 states of the country and in Abuja periodically to hear our version of the Optometry story and act as a melting pot in our quest for growth and development!
Finally, on the 24th of December, Dr.Anene Chukwuemeka, the secretary of the PAC, released some recommendations by the committee. I will only highlight one of those recommendations, to wit,
"We also recommend that a letter be written to all relevant parastatals and agencies associated with health and more especially ocular health such as National health insurance scheme, National primary health care development agency etc. This is necessary and will open up channels of communication between the association and these agencies which will be utilized when the need arises."
I will add that we should seek legislative interpretations of the relevant laws guiding the operation of NHIS in Nigeria with a view to appreciating the role of the Nigerian Optometrist as an Eye care service provider, nay, as an independent primary eyecare provider.
It will be laudable and appreciated if the newly appointed ODORBN registrar, Prof. Mrs Uzodike, and The NOA President, Dr Damien Echendu, will become allies for the common good of the profession especially as it pertains to National Health Insurance Scheme in Nigeria. For starters, we need to have eye clinics that meet the minimum requirements on the NHIS operational guidelines for Optometry (See Section 2.7.9. of the 2012 NHIS Operational Guidelines) and become registered as a Primary care Provider under the NHIS.
This is the first line to "... open up channels of communication..." between the Optometrists, the Health Maintenance Organizations (HMO) and the citizenry.
The ODORBN should be responsible for "advising" The National Council of Health in Nigeria. They should play that role, as well as their traditional "dues" collecting role and other responsibilities as contained in the Act of Law that brought it to existence. On the other hand, the NOA should play the advocacy role, it should even lobby to ensure that ODORBN is heard at the technical committee meetings! NOA should seek the invocation of existing legislative premises that support our collective aspirations and even encourage review of our existing "scope" of participation in health care practice in Nigeria in a bid to align with the goals of the NHIS.
With the burden of blindness and visual handicap astronomical among the poor, the NHIS will surely ameliorate the sufferings of the masses and help in facilitating the objectives of vision 2020.
Long Live Optometry in Nigeria.
Long Live the Federal Republic of Nigeria.
Friday, 22 May 2015
National Health Insurance Scheme (NHIS), Universal health coverage and the Nigerian Optometrist Part 3.
To achieve the goals of Universal Health Coverage, WHO posited the following as prerequisite requirements. I will discuss them in the light of existing legislation and our contemporary premise in health care service delivery in Nigeria.
1) A strong, efficient, well-run health system.
Roemer (1991) defined a health system as“the combination of resources, organization,financing and management that culminate in the delivery of health services to the population.”{1}
An efficient health system should be able to provide comprehensive health services to its recipients including primary health care services on a properly "balanced":
2) A system for financing health services: Financing of health care services is known to influence efficiency in health service provision. Health services are financed either through government budgetary allocations, through taxation, through payroll contributions, through voluntary contributions to have a pool of health fund. Health services can be financed by "fee-for-service" (or out-of-pocket) method.
The goal of universal health coverage is to remove "out-of-pocket" method as a form of financing health services.
Health care funding systems have various effects on cost of running health care services, equity and access to health care services and patient’s choice and power. World Health Organization (WHO) 2000 report on ranking of national health system performance done in 1997 put Nigeria in 187th position out of 191 member countries. Nigeria needs a health care funding system that can sustain and improve health care service delivery to the whole population irrespective of patients’ financial status. {2}
The 2014 National Health Bill captures the Nigerian method of financing health service thus:
The Nigerian health care funding system is still evolving despite the numerous challenges facing the system. Amongst the challenges are shortage of manpower, poor implementation of good programs, poor funding and lack of political will on the part of government (Kumar, 2007).
3) Access to essential medicines and technologies: Access to essential medications involves the production, distribution and consumption of "medicines" prescribed by a healthcare expert for either curative and/or diagnostic purposes without hitches. The success of universal health coverage is predicated on how easy prescribed "medicines" can reach an ill individual for consumption. NHB (National Health Bill 2014) captures the importance of access to essential "medicine" thus:
Technological advancement has helped in improving diagnosis and saving lives in the health care system. For an efficient health coverage, access to new live-saving technologies should be a norm. Health technology is defined as the application of organized knowledge and skills in the form of devices, medicines, vaccines, procedures and systems developed to solve a health problem and improve quality of life (WHO).
4) A sufficient capacity of well-trained, motivated health workers:
As diseases keep evolving, new ways to tackle them are accessed by training of health personnel periodically. Well trained health care capacity improves medical science and health care delivery. Motivation in the area of their remunerations, allowances and promotion as at when due will not only foster diligence in service deliver by health care personnel, it improves productivity and efficiency.
The National Health Bill 2014 provides for "Human Resources" development in Section 3 (d) :
The National Council is obligated to:
Section 43 (a-h) of the National Health Bill 2014 further throws more light on the need to have a well trained staff and on motivation of health workers in Nigeria.
What is the way forward then? How would we remain relevant in realization of our objectives in providing comprehensive eye care examination, provision of necessary medications, glasses, treatments and surgery, necessary ocular rehabilitation for those with severe visual handicap through the National Health Insurance Scheme?
It is my opinion that Optometry in Nigeria should evolve away from the shadow of mediocrity in the Nigerian Health care sector and grow some teeth by pursuing autonomy of our profession.
By the way, Nigerian Optometric Association (NOA) defined the Nigerian Optometrist thus:
The emphasis here is on "independence". I have the hunch that the future of our dear profession lies in our independence and our ability to curve out for ourselves a niche and truly bring eye care to the people that really need it.
The last part of this elaborate discussion will be deliberated on subsequently...
To be continued!
1) A strong, efficient, well-run health system.
Roemer (1991) defined a health system as“the combination of resources, organization,financing and management that culminate in the delivery of health services to the population.”{1}
An efficient health system should be able to provide comprehensive health services to its recipients including primary health care services on a properly "balanced":
a) Resources: These include hospital equipments, consumables, personnel, hospital buildings, and other hardware used in the hospitals etc.
b) Financing: The cost of hospital resources, cost of health care providers, cost of training health personnel, salaries, allowances, cost of oversight, and other financial transactions in the organization and management of the health system etc.
c) Organization: Policy making, regulations, gate-keeping healthcare finance, distribution and maintenance of hospital resources, Health care providers, Health management Organizations, Ministry of health etc
d) Management: Managing hospital resources, managing information, managing organization etc
2) A system for financing health services: Financing of health care services is known to influence efficiency in health service provision. Health services are financed either through government budgetary allocations, through taxation, through payroll contributions, through voluntary contributions to have a pool of health fund. Health services can be financed by "fee-for-service" (or out-of-pocket) method.
The goal of universal health coverage is to remove "out-of-pocket" method as a form of financing health services.
Health care funding systems have various effects on cost of running health care services, equity and access to health care services and patient’s choice and power. World Health Organization (WHO) 2000 report on ranking of national health system performance done in 1997 put Nigeria in 187th position out of 191 member countries. Nigeria needs a health care funding system that can sustain and improve health care service delivery to the whole population irrespective of patients’ financial status. {2}
The 2014 National Health Bill captures the Nigerian method of financing health service thus:
[Section 11. Establishment of Basic Health Care Provision Fund.].
(1) There is hereby created a Fund to be known as Basic Health Care Provision Fund.
(2) The Basic Health Care Provision Fund shall be financed from-
(a) Federal Government Annual Grant of not less than one per cent of its Consolidated Revenue Fund.
(b) grants by international donor partners; and
(c) funds from any other source.
The Nigerian health care funding system is still evolving despite the numerous challenges facing the system. Amongst the challenges are shortage of manpower, poor implementation of good programs, poor funding and lack of political will on the part of government (Kumar, 2007).
3) Access to essential medicines and technologies: Access to essential medications involves the production, distribution and consumption of "medicines" prescribed by a healthcare expert for either curative and/or diagnostic purposes without hitches. The success of universal health coverage is predicated on how easy prescribed "medicines" can reach an ill individual for consumption. NHB (National Health Bill 2014) captures the importance of access to essential "medicine" thus:
[Section 11. (3)]
(b) 20 percent of the fund shall be used to provide essential drugs, vaccines and consumables for eligible primary health care facilities.
Section 39. Part IV [National Drugs Formulary and Essential Drugs List and Safety of Drugs and Food Supply].(1) There shall be a compendium of drugs approved for use in health facilities throughout the Federation- (in this Bill referred to as the "Essential Drugs List") which shall be under the periodic review of the National Drugs Formulary, and Essential Drugs List Review Committee.
(2) Indigenous and local manufacture and production of as many items in the formulary as practicable shall be encouraged.
Section 2.[Functions of the Federal Ministry of Health]
(1)The Federal Ministry of Health shall-
(I) promote availability of good quality, safe and affordable essential drugs, medical commodities, hygienic food and water; and
(m) issue guidelines and ensure the continuous monitoring, analysis and good use of drugs and poisons including medicines and medical devices.
Technological advancement has helped in improving diagnosis and saving lives in the health care system. For an efficient health coverage, access to new live-saving technologies should be a norm. Health technology is defined as the application of organized knowledge and skills in the form of devices, medicines, vaccines, procedures and systems developed to solve a health problem and improve quality of life (WHO).
4) A sufficient capacity of well-trained, motivated health workers:
As diseases keep evolving, new ways to tackle them are accessed by training of health personnel periodically. Well trained health care capacity improves medical science and health care delivery. Motivation in the area of their remunerations, allowances and promotion as at when due will not only foster diligence in service deliver by health care personnel, it improves productivity and efficiency.
The National Health Bill 2014 provides for "Human Resources" development in Section 3 (d) :
10 per cent of the fund shall be used for the development of Human Resources for Primary Health Care;
The National Council is obligated to:
the provision of appropriately trained staff at all levels of the national health system to meet the population's health care needs; {3}
Section 43 (a-h) of the National Health Bill 2014 further throws more light on the need to have a well trained staff and on motivation of health workers in Nigeria.
Section 2. (1) The Federal Ministry of Health shall-
(d) promote adherence to norms and standards for the training of human resources for health;
What is the way forward then? How would we remain relevant in realization of our objectives in providing comprehensive eye care examination, provision of necessary medications, glasses, treatments and surgery, necessary ocular rehabilitation for those with severe visual handicap through the National Health Insurance Scheme?
It is my opinion that Optometry in Nigeria should evolve away from the shadow of mediocrity in the Nigerian Health care sector and grow some teeth by pursuing autonomy of our profession.
By the way, Nigerian Optometric Association (NOA) defined the Nigerian Optometrist thus:
Optometrists are independent primary eye care providers who examine, diagnose, treat and manage diseases and disorders of the visual system, the eye and associated structures; as well as diagnose related systemic conditions.
The emphasis here is on "independence". I have the hunch that the future of our dear profession lies in our independence and our ability to curve out for ourselves a niche and truly bring eye care to the people that really need it.
The last part of this elaborate discussion will be deliberated on subsequently...
To be continued!
Friday, 8 May 2015
National Health Insurance Scheme (NHIS), Universal health coverage and the Nigerian Optometrist Part 2.
On the 31st of August 2014, a Political Action Committee (PAC) was inaugurated by the NOA President Dr Damien Echendu. The chairman of the committee, Dr. Joe Owie, was to perform the following functions, among other things:
COST in health care- eye care inclusive- is the much needed impetus driving Optometry to explore the National Health Insurance Scheme (NHIS) option. In a sequel blog, I rhetorically raised the following questions:
1) How does eye health care service benefit from NHIS scheme in Nigeria?
The Nigerian NHIS established in 1999 by act 35 of the Federal Government of Nigeria has the overall goal of enhancing access to quality and affordable health care to all Nigerian citizens. The eye care system, a microcosm of health care service, would actualize the goal of quality and affordability service in it's practice by keying into the NHIS till.
2) Of what effect is the National Health Bill of 2014 to the rising cost of eye care services in Nigeria today? How will NHIS affect the direct and indirect cost of visual impairment and blindness in the country?
To ameliorate the sufferings of the average Nigerian citizen on the burden of astronomical rise in cost of health care services, the Basic Health Care Provision Fund was introduced into the Nigerian Health care system. (National Health Bill[ Section 11 (1). 2014]).
The purpose of this fund is elaborated in subsection (3) and summarized such:
3) Legislatively, can the eye care business be said to have a good representation in the National Health Insurance Scheme?
The National Health Insurance Scheme Operational Guidelines (2012) identifies the Optometrist thus:
Remember this? [laws of the Federation (1989) Chap. 09, No. 34. Part VI. {29}]
NHIS Operational Guidelines (2012) [Section 1.1.3.1.x] highlights our Primary health Care functions thus:
NHIS Operational Guidelines (2012) [Section 1.1.3.2.xvi.] highlights our Secondary Health Care functions thus:
NHIS Operational Guidelines (2012) [Section 1.1.3.3.vi.] highlights our Tertiary Health Care functions thus:
To be continued...
Ensure that optometrists are included in National health insurance scheme (NHIS)
Ensure that National Health Insurance Scheme (NHIS) Act is amended to include optometry as Primary Care Provider (PCP).
COST in health care- eye care inclusive- is the much needed impetus driving Optometry to explore the National Health Insurance Scheme (NHIS) option. In a sequel blog, I rhetorically raised the following questions:
1) How does eye health care service benefit from NHIS scheme in Nigeria?
The Nigerian NHIS established in 1999 by act 35 of the Federal Government of Nigeria has the overall goal of enhancing access to quality and affordable health care to all Nigerian citizens. The eye care system, a microcosm of health care service, would actualize the goal of quality and affordability service in it's practice by keying into the NHIS till.
2) Of what effect is the National Health Bill of 2014 to the rising cost of eye care services in Nigeria today? How will NHIS affect the direct and indirect cost of visual impairment and blindness in the country?
To ameliorate the sufferings of the average Nigerian citizen on the burden of astronomical rise in cost of health care services, the Basic Health Care Provision Fund was introduced into the Nigerian Health care system. (National Health Bill[ Section 11 (1). 2014]).
The purpose of this fund is elaborated in subsection (3) and summarized such:
(a) 50% of the fund will be used to provide basic minimum package of health services to eligible citizens.
(b) 20% of the fund will be used to provide essential drugs, vaccines and consumables for eligible primary health care facilities.
(c) 15% of the fund goes for maintenance of facilities, equipments and transportation for primary health care facilities.
(d) 10% of the fund goes for Human Resources development.
(e) 5% of the fund will go to Emergency Medical Treatment.
3) Legislatively, can the eye care business be said to have a good representation in the National Health Insurance Scheme?
The National Health Insurance Scheme Operational Guidelines (2012) identifies the Optometrist thus:
2.2.13.1 Possession of Doctor of Optometry degree, or equivalent qualification recognized by optometrist and dispensing optician registration board of Nigeria (ODORBN)
2.2.13.2 Registration with ODORBN
2.2.13.3 Possession of current license to practice issued by ODORBN.
Remember this? [laws of the Federation (1989) Chap. 09, No. 34. Part VI. {29}]
“Optometry” means a health-care profession specializing in the art and science of
vision care and whose scope of practice includes—
(a) eye examinations to determine refractive errors and other departures
from the optimally healthy and visually efficient eye;
(b) correction of refractive errors using spectacles, contact lenses, low
vision aids and other devices;
(c) correction of errors of binocularity by means of vision training
(orthoptics);
(d) diagnosis and management of minor ocular infections which do not
pose a threat to the integrity of the ocular or visual system; and
(e) ocular first aid;
NHIS Operational Guidelines (2012) [Section 1.1.3.1.x] highlights our Primary health Care functions thus:
Treatment of minor eye ailments including:* Conjunctivitis.* Simple contusion, abrasions, foreign bodies etc.* Other illnesses as may be listed from time to time by the NHIS.
NHIS Operational Guidelines (2012) [Section 1.1.3.2.xvi.] highlights our Secondary Health Care functions thus:
* Refraction, including provision of low priced spectacles and excluding contact lenses,
*All Ophthalmological cases that cannot be handled at the primary level except those requiring tertiary care or on the exclusion list.
NHIS Operational Guidelines (2012) [Section 1.1.3.3.vi.] highlights our Tertiary Health Care functions thus:
*All Ophthalmological cases that cannot be handled at the primary and secondary levels of care except those on the exclusion list.It is obvious that Optometry is not only represented in the operational guidelines of the National Health Insurance Scheme (NHIS), clauses in the guidelines predicate the legislative nuances that we (Nigerian Optometrists) fail to explore. I always remain of the opinion that we should focus on the real substance than to shadowbox mirages or ask irrelevant questions.
For instance, is it more important to request that frames are put on the exclusion list of NHIS than to explore areas our profession appropriately fits into the Nigerian version of universal health coverage?
To be continued...
Saturday, 2 May 2015
National Health Insurance Scheme (NHIS), Universal health coverage and the Nigerian Optometrist Part 1.
The world health organization (WHO) define Health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
Health care is known as one of man's fundamental needs. The cost of health care has been on the rise for decades now owing to increasing population, increased life expectancy, rise in cost of hospital equipments amongst other things. Skyrocketing cost of healthcare, the effect it has on families and communities brought about the concept of universal health care.
Eye care, a microcosm of the health care concept, comprises the primary eye care, the secondary eye care and tertiary eye care systems. The eye health care concept is fundamental to a healthy eye and by extension to a healthy body.
The direct and indirect cost of visual impairments and blindness to the society and especially to the individual runs into hundreds of million dollars. The direct cost is measurable via cost of performing eye surgery, cost of having a comprehensive eye examination, the dearth of eye care professionals and eye care structures etc. Indirect cost is measurable by measuring the activity of daily living quotient.
Universal health care, sometimes referred to as universal health coverage, universal coverage, or universal care, is a health care system which provides health care and financial protection to all its citizens. universal health care system incorporates the primary health care system that focuses mainly on prevention, early detection and planned management of diseases or illnesses.
The concept of secondary health care, which includes active use of medication to manage diseases, illness and or injuries, the use of surgery to remove, replace or amend tissues or organs. And tertiary health care system, this health care system is focused on rehabilitative care e.g. low vision care etc.
Historically, Germany is credited as the first country to start up a universal health coverage for its citizens as early as 1883! As at 2009, we had about 58 countries with one form of Universal health care or another. {1}
Nigeria is eager to achieve Universal Healthcare Care. Since its launch in 1999, the National Health Insurance Scheme (NHIS) has been the major initiative to expand health insurance in Nigeria. However, as of mid-2012, NHIS still covered only about 3 percent of the population (5 million individuals). {2}
There are four models of health care systems as put forward by Physicians for a National Health Program (PNHP), Chicago (2010). {3}
I will discuss them briefly:
a) The Beveridge Model: In this system, health care is provided and financed by the government through tax revenues of the government. This is known as the single payer model of health care system. This means that the government determines what type of health care services is been provided for the individual, what the doctors will charge and the individual is not expected to pay for his health care services! The government acts as both the regulator of funds and regulator of health services provided. This model is named after the author, William Beveridge.
Countries practicing such model include Britain, Cuba, Spain, most of Scandinavia, New Zealand and Hong-Kong.
b) The Bismarck Model: This model of health care system is regulated by government, financed through payroll deductions from employees and employers of labour known as health insurance fund. It is often a no-profit insurance scheme and it is aimed at providing health care coverage for everyone. This is a multi-payer system of health system and named after the Prussian Chancellor Otto Von Bismarck, who invented the welfare state as part of the unification of Germany in the 19th century. Countries that practice this model include Germany, France, Belgium, Japan, Netherlands, the USA( though it practices a variant kind!) and to an extent Latin America.
c) National Health Insurance (NHI) Model: This model adopts the Beveridge and Bismarck systems of health care provision. Government-run insurance scheme are paid into by the citizens and the government on its own provides fund via taxation to fund the NHI model. Government regulations control how the health fund is used both in private and public health care facilities. Countries that practice this system include Taiwan, Canada and Nigeria.
d) Out-of-Pocket Model: This model requires payment from the pocket when the patient goes to see a doctor. This is common in many rural areas in Africa, Asia etc were health care facilities are either moribund or health care facilities are not readily in place.
Majority of Nigerians and Africans practices the out-of-pocket model till date, the remaining minority especially those working in state, federal civil services and those working in banks, multinational companies etc are covered under the NHI Model and/or the Bismarck Model of health care!
No doubt that health insurance scheme is cost effective, but enormous challenges abound as to the effective implementation of this scheme in the country partly as a result of inadequate legislation, corruption and outright distrust of the portfolio handlers, the government. These are some hitches that frustrate the effective take-off of the scheme in Nigeria since it was made law in 1990 . The 2014 National Health Bill passed by President Goodluck Jonathan last year can be said to have put to rest a lot of the challenges raised above. We are looking forward to a more participatory health insurance scheme in the country when the policies in the bill are implemented from the second quarter of 2015.
How does eye health care service benefit from NHIS scheme in Nigeria? Of what effect is the National Health Bill of 2014 to the rising cost of eye care services in Nigeria today? How will NHIS bill affect the direct and indirect cost of visual impairment and to blindness in the country? How do the eye care professionals key into National health insurance scheme? Legislatively, can the eye care business be said to have a better representation in the 2014 National Health Bill 2014? I will discuss the questions raised above above in a subsequent blog while analyzing them in the light of WHO's requirements for achieving Universal health care goals, they include:
1) A strong, efficient, well-run health system.
2) A system for financing health services.
3) Access to essential medicines and technologies.
4) A sufficient capacity of well-trained, motivated health workers.
To be continued...
Health care is known as one of man's fundamental needs. The cost of health care has been on the rise for decades now owing to increasing population, increased life expectancy, rise in cost of hospital equipments amongst other things. Skyrocketing cost of healthcare, the effect it has on families and communities brought about the concept of universal health care.
Eye care, a microcosm of the health care concept, comprises the primary eye care, the secondary eye care and tertiary eye care systems. The eye health care concept is fundamental to a healthy eye and by extension to a healthy body.
WHO (2012) estimates there are approximately 314 million people around the world whose vision is impaired, due either to eye diseases or uncorrected refractive errors. Of this number, 45 million people are blind and over 110 million in need of low vision aid.
The direct and indirect cost of visual impairments and blindness to the society and especially to the individual runs into hundreds of million dollars. The direct cost is measurable via cost of performing eye surgery, cost of having a comprehensive eye examination, the dearth of eye care professionals and eye care structures etc. Indirect cost is measurable by measuring the activity of daily living quotient.
Universal health care, sometimes referred to as universal health coverage, universal coverage, or universal care, is a health care system which provides health care and financial protection to all its citizens. universal health care system incorporates the primary health care system that focuses mainly on prevention, early detection and planned management of diseases or illnesses.
The concept of secondary health care, which includes active use of medication to manage diseases, illness and or injuries, the use of surgery to remove, replace or amend tissues or organs. And tertiary health care system, this health care system is focused on rehabilitative care e.g. low vision care etc.
Historically, Germany is credited as the first country to start up a universal health coverage for its citizens as early as 1883! As at 2009, we had about 58 countries with one form of Universal health care or another. {1}
Nigeria is eager to achieve Universal Healthcare Care. Since its launch in 1999, the National Health Insurance Scheme (NHIS) has been the major initiative to expand health insurance in Nigeria. However, as of mid-2012, NHIS still covered only about 3 percent of the population (5 million individuals). {2}
There are four models of health care systems as put forward by Physicians for a National Health Program (PNHP), Chicago (2010). {3}
I will discuss them briefly:
a) The Beveridge Model: In this system, health care is provided and financed by the government through tax revenues of the government. This is known as the single payer model of health care system. This means that the government determines what type of health care services is been provided for the individual, what the doctors will charge and the individual is not expected to pay for his health care services! The government acts as both the regulator of funds and regulator of health services provided. This model is named after the author, William Beveridge.
Countries practicing such model include Britain, Cuba, Spain, most of Scandinavia, New Zealand and Hong-Kong.
b) The Bismarck Model: This model of health care system is regulated by government, financed through payroll deductions from employees and employers of labour known as health insurance fund. It is often a no-profit insurance scheme and it is aimed at providing health care coverage for everyone. This is a multi-payer system of health system and named after the Prussian Chancellor Otto Von Bismarck, who invented the welfare state as part of the unification of Germany in the 19th century. Countries that practice this model include Germany, France, Belgium, Japan, Netherlands, the USA( though it practices a variant kind!) and to an extent Latin America.
c) National Health Insurance (NHI) Model: This model adopts the Beveridge and Bismarck systems of health care provision. Government-run insurance scheme are paid into by the citizens and the government on its own provides fund via taxation to fund the NHI model. Government regulations control how the health fund is used both in private and public health care facilities. Countries that practice this system include Taiwan, Canada and Nigeria.
d) Out-of-Pocket Model: This model requires payment from the pocket when the patient goes to see a doctor. This is common in many rural areas in Africa, Asia etc were health care facilities are either moribund or health care facilities are not readily in place.
Majority of Nigerians and Africans practices the out-of-pocket model till date, the remaining minority especially those working in state, federal civil services and those working in banks, multinational companies etc are covered under the NHI Model and/or the Bismarck Model of health care!
No doubt that health insurance scheme is cost effective, but enormous challenges abound as to the effective implementation of this scheme in the country partly as a result of inadequate legislation, corruption and outright distrust of the portfolio handlers, the government. These are some hitches that frustrate the effective take-off of the scheme in Nigeria since it was made law in 1990 . The 2014 National Health Bill passed by President Goodluck Jonathan last year can be said to have put to rest a lot of the challenges raised above. We are looking forward to a more participatory health insurance scheme in the country when the policies in the bill are implemented from the second quarter of 2015.
How does eye health care service benefit from NHIS scheme in Nigeria? Of what effect is the National Health Bill of 2014 to the rising cost of eye care services in Nigeria today? How will NHIS bill affect the direct and indirect cost of visual impairment and to blindness in the country? How do the eye care professionals key into National health insurance scheme? Legislatively, can the eye care business be said to have a better representation in the 2014 National Health Bill 2014? I will discuss the questions raised above above in a subsequent blog while analyzing them in the light of WHO's requirements for achieving Universal health care goals, they include:
1) A strong, efficient, well-run health system.
2) A system for financing health services.
3) Access to essential medicines and technologies.
4) A sufficient capacity of well-trained, motivated health workers.
To be continued...
Subscribe to:
Posts (Atom)