South Africa - National Refractive Error Program

The Challenge

Study in school children revealed that of those children requiring glasses only 20% had them.

South Africa is in the unique position of technically having enough optometrists to meet the needs of the population; however there are enormous inequities in the provision of health care services throughout the country. The Department of Health estimates that 85 percent of the population relies on public health care, yet only 2 percent of optometrists are employed in the public sector - effectively leaving 25 optometrists to meet the needs of 38 million people.

Estimates are that at least 10 percent of those South Africans ages 15 to 42 have some refractive error, with the elderly, women and children disproportionately affected. A recent Refractive Error Study in school going children, 5 to15 years of age, revealed that of those children requiring glasses, only 20 percent had them. The remaining 80 percent will struggle with learning and have reduced opportunities for the future as a result of poor vision. In addition, data indicates that women in South Africa bear a much higher burden of blindness - up to 40 percent higher - often due to cultural and economic reasons.

The challenge with the provision of quality eye care in South Africa is to attain an equitable distribution of services in the short-term, while developing a self-sustaining national program via capacity building for the long term.

The Optometry Giving Sight Answer

Optometry Giving Sight will target its funding for the National Refractive Error Program (NREP), a plan developed by the International Centre for Eyecare Education (ICEE) in Africa that facilitates private-public sector collaboration between the Department of Health and private optometrists that would quickly increase the access to eye care in the public sector in South Africa.

With this plan, private optometrists are recruited to provide part-time services in public hospital clinics. This would be done on a formal, structured basis with remuneration for optometrists built into the project. The eye exam would be free to patients. The NREP provides the management, monitoring, evaluation and program development expertise, working with the districts and hospitals to ensure that screening and referral sites are in place, and that affordable glasses are made available to the patients.

It is estimated that each NREP clinic will be able to see 5,000 patients a year. This program is currently being implemented in KwaZulu-Natal, and the Eastern Cape has already requested that the project be implemented in their province. An additional 23 other sites around the country have been identified for implementation, ensuring that nearly 100,000 additional people will have access to services when funding is available and these sites are fully operational. For the longer term, the program would achieve sustainability by focusing on capacity building through training of primary eye care personnel (general nurses), establishment of in-hospital and outreach clinics as well as the development of eye care delivery systems and the distribution and sale of affordable glasses.

Partners:

International Centre for Eyecare Education (ICEE) in Africa
Provincial Departments of Health
South African Optometric Association
Private South African Optometrists