Integration of Eye Health into Primary Care Services in Tanzania: A Qualitative Investigation of Experiences in Two Districts.

Journal article


Jolley, E, Mafwiri, M, Hunter, J and Schmidt, E (2017). Integration of Eye Health into Primary Care Services in Tanzania: A Qualitative Investigation of Experiences in Two Districts. BMC Health Services Research. 17 (823), pp. 1-12.
AuthorsJolley, E, Mafwiri, M, Hunter, J and Schmidt, E
Abstract

Background: Visual impairment is a public health problem in sub-Saharan Africa, affecting nearly 5% of the population. Efforts to combat avoidable causes have been hampered by weak health systems and little evidence exists to suggest what interventions may be effective to improve the situation. Despite this, there are calls to promote some specific interventions, one of which being the closer integration of eye health services into health systems, often focusing on training primary health workers to deliver basic eye health services. This study seeks to understand how eye health services are delivered by primary health workers who have received training and what constraints remain to effective service provision. Methods: This was a qualitative investigation into the experiences of 20 primary health workers trained in primary eye care and eight key informants working within specialist eye health services or regional and district health management positions in two districts in Tanzania. Results: Despite feeling confident in their own eye care skills, most primary health workers felt constrained in the services they could provide to their communities by insufficient resources needed for diagnosis and treatment, and by lack of systematic supportive supervision to their work. Specialist ophthalmic staff were aware of this issue, although for the most part they felt it was not within their capacity to remedy and that it fell within the remit of general health managers. Many participants discussed the low support to eye health from the national government, evidenced through the lack of dedicated funding to the area and traditional reliance on outside funds including international charities. Conclusions: Although training of primary health workers is useful, it is recognised that is not sufficient to address the burden of eye health disease present in rural communities in Tanzania. It is likely that broader engagement with the general health system, and most likely with the private sector, will be necessary to improve the coverage of eye health care to remote and poor communities such as those in Morogoro. Further investment is needed to develop innovative approaches to delivering eye health services, including preventative, curative and rehabilitative services.

KeywordsPrimary eye care; Primary health workers; Health systems; Integration
Year2017
JournalBMC Health Services Research
Journal citation17 (823), pp. 1-12
PublisherBioMed Central
ISSN1472-6963
Digital Object Identifier (DOI)doi:10.1186/s12913-017-2787-x
Publication dates
Print13 Dec 2017
Publication process dates
Deposited15 Jan 2018
Accepted07 Dec 2017
Accepted author manuscript
License
CC BY 4.0
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https://openresearch.lsbu.ac.uk/item/86w7v

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