From the Cradle... A journey into universal eye care service delivery!

The WHO defines universal health coverage-and hence Universal Eye Health – as “ensuring that all people have access to needed promotive, preventive, curative and rehabilitative health services, of sufficient quality to be effective, while also ensuring that people do not suffer financial hardship when paying for these services”.

Murphy G et al, refers to primary eye care as a combination of activities encompassing promotive, preventive, therapeutic and rehabilitation services delivered at the community level to avert serious sequels resulting in blindness.

When I started this journey, the objective was to fight blindness. It still remains our core believe, our ideology and the very purpose we exist. 

Blindness does not have a cure. Majority of the conditions that lead to blindness are usually preventable. According to WHO, over 80% curses of blindness can be prevented.

Managing blindness is very expensive. Principally therefore, primary level care aims to deliver affordable eye care services to all, irrespective of the socio-economic abilities of the individuals.

To effectively fight blindness, I adopted these 4 activities:

a) Promotive eye care service delivery

b) Preventive eye care service delivery

c) Curative eye care service delivery

d) Rehabilitative eye care service delivery

I came to Bonny Island on February 1st 2012 as a resident Optometrist. I was contacted by Dr Omila Alagoa, MD, to work for her in her hospital in Bonny Island. Her hospital, PAN-OJ Hospital, offers varieties of health care services including eye care services. I was deployed to head the eye care service unit. I stopped working in PAN-OJ Hospital in May 2015. I needed to pursue my career. I've being fraternizing with the concept of social medicine right from when I was a student in the university. The concept of social medicine fit into my passion to study Optometry in Abia state University.

 I used to remember how in our 5th year, we go for community eye care oureaches under the tutelage of Dr Emmanuel Nwaji et al. On every visit to a different community, the faces of those in need for our eye care outreaches, the abject poverty and the indigent nature of most patients struck a cord. How can I help these indigent persons with very little access to eye care services? How can I sustain my eye care service provision when these individuals cannot pay for the services? How can I get them to easily access eye care services without putting a huge burden of debt on my head? How can I provide consumables like eye glasses & eye drops to these indigent villagers when they cannot pay? How can I provide them with cataract surgery, trabeculectomy surgery and other ocular surgeries that are sight restorative when the cost is very high?  

 Unfortunately we are in Nigeria where over 90% of medical bills are paid out of the pocket. The cost of most Ophthalmology services are very high due to governmental policies and neglect. In a country with over 63% poverty rate as at 2018 (according to a Channels TV analysis), it is not surprising that the fight against blindness may not be won.

  In February 2nd 2016, I set up a primary eye centre to bridge the gap! As it has being the practice since WHO conceptualized primary eye care as an integral part of primary health care in Almaty, 1978, at the declaration of the International Conference on Primary Healthcare, we imbibed and entrenched the concept of primary health care delivery in every aspect of eye care service delivery. 

 Primary health care consists of:

 “…essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination”.

 My aim remains to fight blindness and the goal was to adopt a very cost effective method to achieve that objective while not compromising on the quality of our service delivery.
We have our target horned on two primary objectives of making essential eye care services available to all and to eliminate avoidable blindness in line with the WHO vision 2020. This was how Dr. Victor Ezebuiroh Specialist Eye Centre (Dr. VESEC) was born.

 Dr. VESEC is premised on the four fundamentals of efficient eye care service delivery by provision of promotive eye care services, preventive eye care services, curative/Therapeutic eye care services and rehabilitative eye care services. 
I will discuss each fundamental premise on its merit and  how we have tried to adopt those service delivery fundamentals in setting up Dr. VESEC.

a) Promotive Eye Care Service

 The concept of eye health promotion was first elaborated in 1986 in the OHAWA Charter. There are three areas of action:-

·        (i) Health education: Including use of mass media and face to face communication.

·        (iii) Reorientation (service improvement)

·        (iii) Advocacy.

One of the strengths of eye health education is it's ability to be a starting point for involving communities in addressing a wide range of health and social concerns.

For health promotion to be successful, it must be built on understanding of the health topic and the intended audience. Evaluation of health promotion programs provide information and feedback in a three way circle with the ultimate goal of improved eye health. Effective Eye Health promotion involves a combination of three components:-

a.  * Health education directed at behaviour changes to increase adoption of prevention behaviours and uptake of services. Dr. VESEC is in the fore-front of providing materials, documents and talks in Social media and other forums aimed at educating our host community about some practices that affects the integrity of the eyes. For instance, we use every opportunity to discuss the harmful practice of using breast milk or urine or local gin to treat conjunctivitis or any kind of red eyes. We also frown at people who visit quacks for couching (an outdated and harmful type of cataract surgery!) and practices like using onions to apply in the eyes for whatever reason. The effect and attendant behavioural changes have increased patient registrations and service uptake in various eye centres in Bonny Kingdom.

2. * Improvements in health services such as the strengthening of patient education and increased accessibility and acceptability. Dr. VESEC is poised to adopt contemporary technological improvements in the area of eye care services and equipment; improving our referral system (I will soon develop a compendium of secondary and tertiary eye care services centres and a correspondence to improve accessibility to eye care services) and we ensure that every individual in our host community accepts our eye care service delivery because we ensure that our services conform to internationally acceptable gold standard service delivery.

3.  * Advocacy for improved political support for blindness prevention policies. Human behaviour, community participation and advocacy to government for resources are paramount for successful eye health promotion.

Community participation is pivotal to successful implementation of primary health care (PHC) and hence primary eye care. 

The 1978 declaration of Alma-Ata identified community participation as:

“the process by which individuals & families assume responsibility for their own health and welfare and for those of the community, and develop the capacity to contribute to their community’s development." (WHO, 1978).

 National health policy of 1987 emphasizes on active community engagement in the provision of PHC. In our  'About us" of our eye centre, our responsibility to the host community is a major feature. It has led to the setting up of Finima Community Eye Centre, a subsidiary of Dr. VESEC, since September 2017. 

We have taken our eye care campaigns to political leaders of Bonny Kingdom. We have met with the legislative member of the Green Chamber representing Bonny/Degema constituencies on various occasions and have heard very productive discussions. One of such meetings led to the invitation of Lulu Briggs foundation sometime ago which provided free cataract surgery for over 100 individuals and provided glasses and eye drops for over 500 persons! Our advocacy led to the Finima community eye centre which was a product of our meetings with Finima community elders in 2017. Our advocacy also attracted Lions Club NLNG. We are not resting on our oars. We are planning to seek an audience with the King of Bonny Kingdom before the World Sight Day in the second week of October 2018.

To be continued...