primary eye care workshop for west africa
Bilingual Primary Eye Care Workshop for West Africa
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Table of Contents
PageExecutive Summary / 1
Agenda / 4
Review of Current Concepts in PEC / 9
PEC/PHC in The Gambia / 11
Examples of PEC/PHC in Africa / 12
Integration / 12
Way Forward / 14
Barriers to Integration / 14
Evidence and Advocacy / 16
Indicators for Monitoring and Evaluation / 17
Development of PEC training and IEC materials / 18
Critical Issues / 19
Recommendations / 19
Appendix 1: Site Visits / 20
Appendix 2: Participant list / 21
Primary Eye Care Workshop for west africa
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Primary Eye Care Workshop for west africa
Executive Summary
A
bilingual Primary Eye Care workshop for West Africa was hosted by the Ministry of Health and Social Services of the Gambia. The workshop was officially opened by the Minister of health for the Gambia but to show how supportive the Government of the Gambia is to this agenda, 5 other ministers accompanied the Minister of Health for this function. They are:
a. Minister of Justice
b. Minister of Local Government & Lands
c. Minister of Youth and Sports
d. Minister of Tourism & Culture
e. Minister of Trade, Industry and Employment
The aim of the workshop was to get West African Countries to consider integrating Primary Eye Care (PEC) into their existing Primary Health Care (PHC) activities and health care systems.
Objectives of the workshop:
1. To review the current concepts of PEC.
2. To identify constraints to the development of PEC in West Africa.
3. To learn from best practices in various countries.
4. To identify priority actions and follow up required to integrate blindness prevention and eye care services into existing PHC programs.
Participants to the workshop
There were 51 participants representing the following countries: Togo, Benin, Niger, Mali, Nigeria, Cote d’Ivoire, Guinea Conakry, Guinea Bissau, Senegal, Ghana, Gambia, Liberia and Sierra Leone. There were three guest countries represented namely Cameroon, Zanzibar and Kenya. However, Cape Verde and Burkina Faso were unable to attend. To facilitate integration of PEC into the PHC system, both the National PHC director and the National Eye Care Coordinator from each country were invited to attend and majority of the countries were able to be so represented.
Partnerships between public and private institutions are so important to support PEC and international NGOs in Blindness Prevention were represented at this workshop: Sight Savers International, The Fred Hollows Foundation, Swiss Red Cross, International Trachoma Initiative, Concern Universal and Operation Eyesight Universal. Helen Keller International sent in their apologies.
Further, support for this initiative was shown by the attendance of representatives of the World Health Organization (WHO), International Agency for the prevention of Blindness (IAPB), and West African Health Organization (WAHO) who sent in their apologies.
The workshop was officially closed by the WHO Country Representative for the Gambia who pledged his support and promised to disseminate the message to all his colleagues in the West African sub – region, which is already the beginning of advocacy for this cause.
This workshop was jointly funded by Sight Savers International and Operation Eyesight Universal.
Workshop content
The following concepts were discussed and agreed upon during the workshop:
1. Definition of PEC. The definition conceptualized in Zanzibar in November 2006, which was the topic of discussion in Sri Lanka in 2007 generated further constructive discussions during this workshop. These ideas will be submitted to the PEC discussion group for further discussion.
2. Integration. There are a range of activities, traditional and orthodox, household, community and facility based which can be used to deliver PEC. Criteria and possible steps for integration were identified. The development and strengthening of comprehensive PEC programs and integration with PHC is of utmost importance if the aims of Vision 2020 are to be achieved.
3. Partnerships Partnerships, public and private, with other health related initiatives and departments are vital to ensure integration and sustainability of PEC programs.
4. Community ownership and partnership Community participation is an essential ingredient to the success of PEC programs and this is clearly demonstrated in the PEC programs in the Gambia and in onchocerciasis control programs.
5. Advocacy and tools for Advocacy. Almost all countries noted advocacy as essential to raise awareness of the importance of the integration of PEC into PHC as an immediate action required on their return. Support for PEC and the development of tools, models of PEC and evidence for advocacy generated by operational research and evaluation should be a priority.
6. Human Resource and their Development. To ensure the provision of safe, effective PEC there is need to develop appropriate training programs: to review the curricula of all training programs; pre, in- service and refresher to make them task oriented and evidence based. In-service PEC courses should be integrated into other health care training programs. The development of appropriate IEC materials to match all training, which can be adapted for different areas are further priorities.
Conclusions:
A. Concrete actions required for the integration of PEC into PHC.
§ advocate with WHO and Ministries of Health of various countries
§ harmonise minimum activity packages to be integrated by the creation of a ‘PEC Tool box’
§ ensure coordination between PEC training curricula and required actual practice.
B. Advocacy by various different people and within a framework for implementation of action plans in various countries is required to:
§ mobilize resources, both internal and external
§ raise awareness of PHC and the possibilities of full integration of PEC
§ plan for PEC based on the population need i.e. establish the denominator in districts or regions depending on the country
§ generate and adopt a range of solutions, since these will be context dependant. “Africas” solutions will not be singular, but rather based on different needs.
C. Country Action Plans for PEC integration
§ Countries decided on strategies to assist them in the process of integrating PEC into PHC. Three strategies were to be achievable within the next six months
BILINGUAL PRIMARY EYE CARE WORKSHOP FOR WEST AFRICA
BANJUL 18-20 MARCH 2008
OBJECTIVES :
§ TO REVIEW THE CURRENT CONCEPTS PRIMARY EYE CARE
§ TO IDENTIFY CONSTRAINTS TO THE DEVELOPMENT OF PRIMARY EYE CARE IN WEST AFRICA
§ LEARN FROM BEST PRACTICES
§ TO IDENTIFY PRIORITY ACTIONS FOR INTEGRATION OF BLINDNESS PREVENTION INTO EXISTING PHC PROGRAMS IN WEST AFRICA.
OUTPUTS: Workshop Report
A PEC strategy for West Africa
VENUE: BANJUL, THE GAMBIA.
AGENDA Sun. 16-Mon 17: Participants Arrive
Mon. 17th: Workshop Planning Group/Participants arrive
Tues. 18 th: Workshop: REVIEW OF CURRENT CONCEPTS
Wed. 19th: PEC Visits
Thurs. 20th: Workshop: Establishing Way Forward
Fri. 21st: Participants depart
WORKSHOP PLANNING GROUP: , S. Bush, Hannah Faal, J. Oye, Jerrell Sanyang, B. Wiafe
LOGISTICS COMMITTEE: . Gambia Team
DETAILED AGENDA
TUESDAY 18TH MARCH 2008
REVIEW OF CURRENT CONCEPTS IN PRIMARY EYE CARE
Chair: DIRECTOR OF HEALTH SERVICES - GAMBIA
08.00 Gambia Country Office Arrival and Registration
08.30 Dr Jerreh Sanyang Welcome and Introductions
Purpose and Objectives
08.40 Dr. B. Wiafe IAPB and PEC Discussion Group
08.45 Dr. Hannah Faal Vision 2020 and the MDGs
09.00 Dr. Daniel Etya’ale (WHO ) Primary Health Care
09.15 Drs. Diallo and Aboe Community Directed Interventions
09.30 Dr. Daniel Etya’ale (WHO) Overview of PEC in Africa
09.45 Dr. Maria Hagan Trachoma, PEC and PHC
10.00 Dr. Bo Wiafe CBR, PHC and PEC
10.15 MOH Senegal Community Based Approach in
Senegal
10.30 Presenters Plenary Discussion (Q and A)
10.45 Coffee/Tea
11.00 Mr. R. Graham (SSI) PHC and PEC in ECSA
11.15 Dr. Roberts Experience of community-based
Health Planning and Services (CHPS) in Ghana
11.30 Mr. K. Manneh Participatory Rural Appraisal(PRA)
Participatory Learning Action (PLA)
11.45 Presenters Plenary Discussion (Q and A)
12.00 MINISTER OF HEALTH OFFICIAL OPENING
12.40 PHOTO SESSION
13.00 Lunch
Successful Examples of PEC in Africa
Chair: Dr. Maria Hagan (IAPB Co - Chair for West Africa)
14.00 MOH Nigeria PHC/PEC in Nigeria
14.15 MOH Gambia PHC/PEC in the Gambia
14.30 MOH Zanzibar PHC/PEC in Zanzibar
14.45 R. du Toit PHC/PEC in Zambia
15.00 MOH Cameroon PHC/PEC in Cameroon
15.15 MOH Mali PHC/ PEC in Mali
15.30 Tea/Coffee
15.45 MOH KENYA PHC / PEC in Kenya
16.00 PRESENTERS Plenary Session (Q and A)
16.30 MOH Gambia Introduction to Visit to the SITES of
the PHC
17.00 END OF DAY 1
WEDNESDAY MARCH 19TH 2008: VISITS TO PEC SITES
08.15 Assemble at PARADISE Hotel
08.45 Depart on visits in SEVEN groups, led by a member of Gambia Eye
Department
Each group will visit ONE example of PEC in the Gambia
12.30 Return to Banjul
13.00 Lunch
Chair: Dr. Andreas Mueller (The Fred Hollows Foundation)
14.00 Group rapporteurs Feedback from PEC Visits (10 mins/group)
15.00 Mr. Ronnie Graham PHC and PEC IN ECSA
15.15 MOH KENYA PHC/PEC IN KENYA
15.30 Coffee/Tea
15.45 Dr. Bo Wiafe Successful Examples of Advocacy
16:15 MOH CAMEROON PHC/PEC IN CAMEROON
16.30 MOH NIGERIA PHC/PEC IN NIGERIA
16.45 Dr. Joseph Oye Principles of Monitoring and Evaluation
17.00 MOH MALI PHC/PEC MALI
17.15 MOH GAMBIA PHC/PEC IN GAMBIA
17.30 R. du Toit Training in PEC
17.45 Dr. Kola The Refractive Error/ Presbyopia Challenge:
Role of PHC/PEC
18.00 Dr. Bo Wiafe Introduction to Group Work
Group / Discussion topic1. / What are the barriers to integrating PEC into PHC? How can we strengthen PEC in West Africa?
2. / What evidence do we need to support a PEC strategy? How can we advocate for PEC in our countries?
3. / Can we draft some Indicators for M and E for PEC in West Africa? How do we integrate PEC indicators into the HMIS system.?
4. / How can we develop training and IEC materials for West Africa?
Chair: Dr. NOUHOU KOUNKOURE DIALLO – National Coordinator for Oncho/ Eye Care Guinea
08.30 Dr. Jerreh Sanyang Housekeeping Announcements
08.45 Ms. Jennifer Bohl Recap of Days 1 – 2
09.00 Facilitators Discussion on Recap
09.30 Group Group work
10.30 Coffee/ Tea
11.00 Groups Report Back and Discussion (10 mins. per
group)
Discussion after each report – 5 mins
12.00 Dr. B. Wiafe Introduction of Afternoon Session
12.30 Lunch
THE WAY FORWARD
Chair: MR BENEDICT HOEFNAGELS – SSI WARO
13.30pm Countries The Way Forward - Based on what has been
discussed countries will meet to look at own
situations and strategize
14.30pm Countries Report Back - 5 mins per country
15.45pm Coffee/Tea
16.00pm Dr. Daniel Etya’ale Wrap UP
16.30pm Official Closing WHO WR for the Gambia
1. Review of Current Concepts in PEC
Attention to wake up to reality was drawn to the participants when during the presentation it was made clear that we have barely 11 years and not 20! The sense that 2020 is a long way away but we are already 8 years into this initiative.
A call to “Act and not just keep planning”. We should remember the WHA 2006 consensus to integrate eye care into Primary Health Care activities.
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Presentations:
- Introduction to IAPB and PEC Discussion Group
- Vision 2020 and the MDGs
- History and definition of PHC
- Overview of PEC in Africa
- Community directed interventions – Examples from Ghana,
Guinea, Zambia, Senegal
Key Issues:
1. The majority of eye care needs in Africa are at the primary and secondary level, yet eye care structures at this level tend to be dysfunctional or non-existent; PHC systems, however, are functioning in most African countries, though to different levels.
2. PEC needs to be integrated into existing PHC structures and practices – resources are insufficient to build adequate parallel systems which deal with eye care only. PHC is the cornerstone of all national health care policies.
3. Defining PEC:
§ Primary Eye Care is defined as the integrated, participatory approach to the eye health component of Primary Health Care.
§ Primary Eye Care consists of Eye Health Promotion, Prevention, and Curative and Rehabilitation services.
§ It is anchored in community and is delivered by the health work force and community members up to and including the front line health facilities
§ Primary Eye Care comprises those aspects of eye care that can be delivered at the level of first contact with the health system.
This definition was conceptualized in Zanzibar in November 2006 and was the topic of discussion in Sri Lanka in 2007. It generated further constructive discussions here in Banjul and these points have been captured and will be submitted to the PEC discussion group for further refinement.
4. Integration: Integrated, participatory approach of the eye health component of PHC.
5. Eye health promotion, prevention, cure and rehabilitation services
6. Anchored in the community and delivered by the health work force and community members - up to and including front-line health facilities
7. V2020 – a global initiative which integrates very well with all of the Millennium Development Goals – most of which can be addressed at the primary level.
8. Need to move from the “dance floor to the balcony” – to gain perspective on how we can integrate eye care into the broader health and development picture.
9. Good leadership means looking for the most appropriate partner for a specific task – often these are non-specialists at the community level.
10. Be careful not to develop primary level too aggressively – unless secondary structures are in place to deal with increased demand.
11. Need to look at multi-sectoral approach and integration with other interventions.
The workshop was officially opened by the Secretary of State for Health for the Gambia.
2. PEC/PHC in the Gambia: Site Visits
The delegates were divided into four groups and visited four sites. These visits were to communities (Nyateros), schools, primary level health centres and secondary level hospital.
Lessons Learned from the Gambia experience:
· Community-centred approach – Start by asking what is most convenient for the population. The population’s needs should drive decision-making.