Nigeria

Lead Agency
Sight Savers International

Name of Project
Kwara State Comprehensive Eye Care Programme

Name of Partner/ Implementing Organisation
Kwara State Ministry of Health

Location
Kwara State

BRIEF DESCRIPTION

The Kwara State Eye Care Programme (KwSECP) is a comprehensive eye care programme that aims to contribute to the social and economic development of Kwara State through the elimination of avoidable blindness by the year 2020.

By the end of 2007, the project aims to cover the population of the poorest and most marginalized 50% of Kwara State. This can be achieved by ensuring the target population has the knowledge to prevent avoidable blindness and the ability to access the eye care services it requires, regardless of socio-economic status. It will be attained by raising awareness on the issues of blindness and eye-care, strengthening community-based systems for identification and referral, providing eye care services, improving infrastructure and human resources, reinforcing programme management, and initiating services for irreversibly blind adults and children (with cross-referral between the different services).

BACKGROUND

Kwara State (KW), one of the 36 states of the Nigerian Federation, is located in the western part of the middle belt of Nigeria and is a partner to Sight Savers International (SSI) in the Mectizan® distribution programme (MDP) for onchocerciasis. The state has three senatorial districts, which are the main political divisions and very roughly have a geographic distribution.

The Kwara State Eye Care programme was designed at a stakeholders meeting held in November 2001. It was conceived as a programme to expand SSI successful MDP achievements into eye care. The partners are the KW Ministry of Health and the University of Ilorin Teaching Hospital.

The programme is designed to implement comprehensive eye care in the state over a five year period, running from 2003 - 2007. By working together with our partners, SSI will support studies to determine the pattern of blinding diseases in the community, support the establishment of quality eye care services by equipping eye clinics in the three senatorial districts, improve human resource development to deliver modern intraocular microsurgery, support service delivery targeted at the underserved portion of the population, and develop a management system to run and sustain the programme beyond the project period.

The KW MDP was visualised as performing a major role by incorporating community based screening for visual disability into its activities. The project began in June 2003 with training of personnel, infrastructure and technology development. The state Ophthalmologist was trained in intra ocular lens implantation.

An eye care consultant was recruited by SSI to support implementation of the programme, with service delivery commencing in February 2004. The other partner, University of Ilorin Teaching Hospital, also commenced surgery at the outreach centre in 2004.

PROGRESS

Human Resource Development:
Two Diploma doctors are on the Diploma in ophthalmology training programme.
The KS Ophthalmologist attended a training programme in planning for VISION 2020 at the International Centre for Eye Health in London.

Four nurses have already commencing the training programme. Work is underway to get new nurses nominated as candidates for the training programme, and to obtain admission in other training institutions for the next academic session.

Retraining of ophthalmic nurses to improve diagnostic abilities and clinical acumen has been a significant part of the outreaches workload. Though not planned, it has been necessary in order to carry out clinical work. 19 Nurses have been retrained in this manner.

With only two surgeons carrying out most of the surgical work, it has been necessary to share some of the workload in the eye camps and outreaches by training nurses to carry out the anaesthesia. Five nurses were trained to carry out ophthalmic anaesthesia.
Community health extension workers (CHEWs) have been trained as primary eye care workers, with 21 CHEWs selected from local government areas.

Training of 199 schoolteachers exceeded the target of training 100 teachers.
Training of three refractionists has been completed exceeding the planned training of two. This is because the demand for refractive services is potentially much higher than for surgical services, making it important to have enough personnel trained before the optical workshop is ready.

Training of an equipment maintenance technician was undertaken to provide maintenance of surgical equipment and instruments.

Training of an optical technician was completed.

Infrastructure and technology

• Equipment for two secondary facilities was ordered and delivered.
• Intraocular lenses, sutures and viscoelastic sufficient for 1000 surgeries was ordered and delivered.
• Renovation and equipment of two secondary facilities was carried out.
• One Land Rover vehicle for service delivery was ordered and delivered.

Service Delivery

• 18 outreach services to the secondary centres were carried out.
• Four eye camps carried out.
• Sight Savers supported the constitution and inauguration of the Kwara State VISION 2020 committee as part of the World Sight Day activities. This committee could play a vital role in advocacy.
• 150 radio jingles to increase awareness of the Kwara eye care programme and public eye health were aired.
• The partners attended a ‘cataract surgical rate’ workshop to identify barriers to uptake of service and develop strategies to address the barriers.

Training at Secondary Level

• Two doctors commenced training in Diploma in Ophthalmology, with two others due to start in 2005. On completion of training, the ophthalmologists will support the current surgeons in service delivery and help meet agreed targets.
   
• The state ophthalmologist has been trained in intra ocular lens surgery to enable him to provide high quality modern surgery.
   
• Four nurses commenced the post-basic ophthalmic nursing training programme. New training candidates are being sought who will be pre-screened by the project and assisted in obtaining admission in other training institutions for the next academic session.
   
• Two nurses were trained in ophthalmic theatre microsurgery. The nurses will support the surgeons in cataract operations.
   
• One optical technician has been trained. The technician will provide optical services to the needy and support the programme’s optical workshop, which aims to raise enough income to sustain the programme.
   
• Three refractionists have been trained to provide refractive services to the population. They will also provide support to the optical workshop.

Infrastructure and Equipment

• Three eye units in Ilorin, Offa, and Esie, have been equipped to function as eye units for service delivery to the catchment areas.
   
• Three outreach centres in Okuta, Share Pategi and Omu-Aran, have been developed to provide eye care services to the catchment areas.

Service Delivery
Community eye health sensitisation activities have been carried out in all the 16 local governments, to create awareness on eye health and improve service uptake. 199 teachers have been trained in school eye health to screen and recruit pupils requiring services.

The integration of Vitamin A strategies into Onchocerciasis control commenced, to protect and prevent childhood blindness.

The number of cataract surgeries has gone up by 400% as a result of the programme.

Development of comprehensive eye care services
Identification of potential rehabilitation partners and stakeholders has been done and a feasibility study on community-based rehabilitation is planned for early 2005.

Logistics and programme support
Establishment of a management system, equipping the programme office with two computers, printers, a photocopier and the provision of vehicles, has enabled staff to meet management and administrative needs.

Programme management
The state ophthalmologist was trained in planning for VISION2020. A data manager was trained in the use of statistics analytical software packages, and an accountant and an administrative assistant were employed to support the programme office and eye care consultant, in order to free up the ophthalmologists time for service delivery.

The state VISION 2020 committee was established and inaugurated with SSI support. This committee will play an important role in the development of eye care in the state and help ensure that targets are met.

SITUATION

Financial sustainability
The programme has introduced a "sustainability" fee of N2000 (£8 ) for surgery. We are encouraging local government authorities to assist these individuals who cannot afford this small amount of money.

To ensure sustainability, the project will devolve the procurement of consumables and intraocular lenses to the Ministry of Health.

Sustainability of services
Capacity is being built in the secondary centres so that more services can be provided. Once diploma ophthalmologists and ophthalmic nurses have completed training, the centres are fully functional, and other cadres of clinical personnel are retrained, service delivery rates will increase.

The advocacy visits to KW by SSI and the National Programme for Prevention of Blindness, along with discussions with the Eye Foundation should improve services and promote a holistic approach to implementation of the programme.

Other activities that will affect the sustainability of the programme include;

• Project monitoring systems.
• Events, developments or circumstances (e.g. change in personnel or funding situation etc.) within the organisation(s) implementing this project.
• Division of roles, responsibilities and inputs between SSI and the project partner.
• External Factors, Risks and Assumptions.
• Benefits from or contributions to other projects (SSI or other) in the project area.
• Significant changes in the project environment (e.g. area covered, beneficiary population, other providers etc.

Key Activities:

A. Programme Management
· Establish a management structure
· Obtain baseline information through a formal survey and monitoring
· Provide management support and activities
· Conduct monitoring and evaluation of programme implementation

B. Human Resource Development
· Provide community training and develop community eye care workers
· Provide Integrated Worker Training
· Provide specialist training at secondary & tertiary level

C. Infrastructure and Technology
· Build and refurbish eye care facilities in Kwara State
· Equip and renovate facilities and outreach system
· Provide logistical and programme support functions

D. Service Delivery
· Provide service to poor and underserved communities at community, primary,
secondary and tertiary levels

E. Development of CES
· Carry out feasibility study and develop projects on Community Based
Rehabilitation (CBR) and services to blind and sick children

TIMESCALE

Programme timescale: July 2003 to June 2007
Standard Chartered funding: January 2004 to December 2006

APPROXIMATE COST (Year 1, 2, 3 & Total)*

Forecast 2004-06: US$940,000

• Year 1 US$306,000
• Year 2 US$328,000
• Year 3 US$306,000 (estimated as current forecast not yet available)

*Note: All stated costs are provisional figures.

ESTIMATED NUMBER OF TOTAL BENEFICIARIES

2004-2006
· 4,000 sight restoring cataract operations
· 60,000 people accessing eye screening services

Kwara State Programme - Nigeria

9 May - 13 May 2005

Last week, I had the privilege of visiting the Sight Savers International (SSI) Comprehensive Eye Care Programme for Kwara State, Nigeria. I was together with Andrew Peel and Peter Renew of SSI.

As you know, Nigeria is one of the flagship countries for Seeing is Believing.

We visited primary, secondary, as well as the State Hospitals that are part of the programme. Whilst much has been done - thanks to Dr. Kola Ogundimu and Dr. Elizabeth Elhassan, so much still needs to be done.

The programmes that I have visited (Ilorin, Offa and Essie) are very much in their infancy stages - particularly when compared to the India and Bangladesh projects that we've visited earlier. The conditions are rudimentary at best. Whilst the equipment and instruments funded by the programme have already reached the sites, there still is a long way to go in terms of training (health professionals as well as beneficiaries) and mobilization of the community network to ensure a steady flow of patients.

The ophthalmologists (2 of them) are currently very stretched. They are very much looking forward to October when 2 more doctors will join them after finishing their diploma in ophthalmology training (which is being funded by Seeing is Believing). Nurses and health workers are likewise being trained either through a six-week programme or a full-blown course in ophthalmic nursing.

Perhaps the most daunting task is getting the local population to accept cataract and glaucoma procedures. Local healers as well as poor results of previous programmes contribute to the scepticism of the local population. Also, the general poverty level has contributed to the limited number of patient flow. We are trying to address these issues through a broad range of activities including but not limited to pamphlet distribution, radio advertisement as well as tie up with community based and faith based organizations. There has also been significant breakthrough with the relationship of the various stakeholders (University of Ilorin Training Hospital and Kwara State government) in bringing down the fees related to the procedures.

The training hospital is also critical in providing the much needed resources (in the form of resident doctors and staff) in the near term. Much time was spent in building this specific relationship.

As I said, much still needs to be done.

Your support and prayers are much appreciated.

Jerry

» View photos (PDF, 906Kb)

Information compiled on 20/6/05 by Peter Renew and Katy Dore at SSI, for publication on FundraiseOnline.

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