Vision First - Universal Eye Health for Universal Health Coverage in Nigeria

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The value of vision in our daily living is tremendous. However, many of us tend to take our eyesight for granted, until we develop vision problems. Vision loss has a detrimental impact on the lives of those affected, as well as on their families, friends, and society. Whether sudden or gradual, loss of sight can be overwhelming, and affects one’s quality of life, independence, economic productivity and mobility.

Globally, it is estimated that 1.3 billion people live with vision loss. The Nigeria national blindness and visual impairment survey (2007) estimated that 4.25 million adults aged 40 years and above are vision impaired or blind and 3.1 million adults in the same age-group are moderately or severely vision impaired. Uncorrected refractive errors, cataract and glaucoma are the leading avoidable causes of vision loss.

Image credit: Nigeria Health Watch

There are many other non-blinding but important eye conditions such as stye, bacterial and allergic conjunctivitis, dry-eye, to name a few; and these are among the most common reasons for hospital visits. These also cause significant discomfort, misery and loss of productivity.

Founded in 1969, the Ophthalmological Society of Nigeria (OSN) provides an annual forum for the study and discussion of issues related to Ophthalmology, eye health and vision rehabilitation in Nigeria. In September, 400 ophthalmologists, corporate citizens, researchers, academics and scientists convened in the beautiful city of Calabar for the 44th Annual General Meeting and Scientific Conference. The Conference, themed “Universal Eye Health: Leveraging on Integration, Linkages and Collaborations,” also marked celebrations for the Society’s 50th anniversary.

Pre-conference workshops provided opportunities for delegates to learn from seasoned facilitators. The first ever Uveitis Course in Nigeria was facilitated by Manfred Zierhut, Professor of Ophthalmology, University Clinic of Tuebingen, Germany and Derrick Smith, Associate Professor Stellenbosch University, South Africa. Other courses included Medical Retina, Research for Universal Eye Health, and Medical Contact Lens Handling.

Professor Ivara Esu, Deputy Governor, Cross River State, Etubom (Dr) Eyoita, Professor Eka Braide, Dr. Ekpo Bassey, Chairman, CRS House of Assembly Committee on Health, Dr Ogundipe, President OSN and others at the Society’s 44th Annual General Meeting and Scientific Conference. Photo source: OSN

The Need for Universal Eye Health (UEH) in Nigeria

Matthew Burton, Professor of International Eye Health and Wellcome Trust Senior Research Fellow delivered the President’s lecture titled Universal Eye Health: From Dream to Reality. He defined UEH as, “All people obtaining the eye health services they need, of sufficient quality to be effective, without suffering financial hardship when paying for them.” He discussed the linkage between eye health and all 17 sustainable development goals, “If you want to transform eye health in Nigeria, policymakers need to acknowledge the broad relevance of eye health to development in Nigeria”.

OSN is constantly leveraging on integration, linkages and collaborations to improve eye health in Nigeria. As a result, ophthalmic practice has recorded several laudable successes over the years. One of such is the updated Strategic Plan of the OSN, currently at a 45% implementation level. Also, in February 2018, OSN inaugurated the National Cataract Project, a joint project with the Federal Ministry of Health. Its aim is to restore vision to 10,000 Nigerians with blinding cataracts. Currently, the project has attained 80% successful completion in 30 States and the FCT while the remaining 6 states are at various stages of completion. Other successes include, for the first time, inclusion of eye health in the 2nd National Strategic Health Development Plan 2018; and the resolutions of the 62nd National Council on Health to implement the National Eye Health Policy and the Treatment Guideline for Child Eye Health. Nigeria has also been an active collaborator with the Commonwealth Eye Health Consortium, which has created and developed remarkable young leaders and subspecialists in eye health.

Leveraging Technology for UEH

On leveraging technology to achieve UEH, speakers reiterated the crucial role of technological innovations in improving eye care delivery. For example, the PEEK school eye health system enables early diagnosis and treatment, thus preventing the negative effects of poor vision on children’s education and social interactions; Simulation surgical training which enhances surgeons’ surgical skills through sophisticated simulation technology; and Fluid Intelligence by RETINA-AI that detects retinal and systemic diseases from images of the retina.

Dr Stephen Odaibo, CEO and founder of RETINA-AI Health Inc., spoke on Innovations in Eye Care: Artificial Intelligence, Telemedicine and Robotics. His organisation developed RETINA -AI, the world’s first mobile AI app for eye care providers. “AI based diabetic retinopathy screening should start immediately in Nigeria. The technology is available, and we can use it to overcome the problems of inequity,” he said.

Dr Ayobade Ogundipe, President OSN, commended OSN’s founders for setting a solid foundation for ophthalmic practice in Nigeria. This year also marks the 50th anniversary of the establishment of the National Postgraduate Medical College of Nigeria; “We celebrate these two great bodies that have nurtured and produced most of our ophthalmologists, and other medical specialists and educators in the country,” he said.

Dr Ogundipe, President of the Ophthalmological Society of Nigeria noted that the meeting is unique as it coincides with the 50th anniversary inauguration of the society and the 50th anniversary of the establishment of the National Postgraduate Medical College of Nigeria. Photo source: OSN

Professor Ivara Esu, Deputy Governor, Cross River State, who represented Governor Benedict Ayade, commended the OSN for their commitment in ensuring that eye health policies are made and implemented. He urged deliberate actions, saying “It is only when the lessons learned have been practiced that it can be said that you have had a successful conference”.

In collaboration with Sightsavers, SEE International, Alcon and UNHCR, the OSN did an outreach to the Refugee Camp in Ogoja, where people displaced by the current crises in Cameroon reside. This entailed 200 sight-restoring cataract surgeries at the Ogoja General Hospital and treatment of other eye conditions for the refugees and the community.

The conference theme reveals the urgent need to bridge the gaps in eye care service delivery in Nigeria. Identified gaps include inequity in eye care delivery, massive physician shortage, the dearth of personnel to properly detect and treat sight-threatening eye conditions, and the increasing number of people in Nigeria at risk of vision loss. Ophthalmology has been exemplary in collaborating with other stakeholders in the health sector but there is the need to further consolidate those linkages and collaborations to achieve UHC. UEH is a crucial component towards achieving the global goal of UHC. Equitable access, quality care, and financial protection make up its core. The Nigerian health system needs to be prepared to ensure access to services and OSN should be commended for leveraging innovations and partnerships to deliver quality eye care to Nigerians.

As we join the rest of the world to celebrate World Sight Day 2019 with the theme, ‘Vision First”, we suggest that more focus be put on primary eye care as it is an integral part of comprehensive eye care; we also push for increased public and private partnerships to deliver the solutions necessary to ensure that everyone, especially vulnerable populations, receive effective, affordable, safe and equitable eye care, “leaving no-one behind.”

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