KENYA:Uneven distribution of eye specialists aggravates Kenya’s blindness plight

October 2016 BusinessDaily; More than a half of eye specialists (ophthalmologists) in Kenya are based in Nairobi as counties struggle with rising cases of blindness.

Data from the Health ministry shows that Kenya has 115 ophthalmologists, of which 60 are Nairobi-based.

This translates to one specialist for every 450,000 Kenyans living outside Nairobi county, a ratio far below the World Health Organisation’s (WHO) recommendation of 1:250,000 patients.

“Out of the 115 ophthalmologists, about 60 are in Nairobi translating to a ratio of 1:70,000 patients,” said Michael Gichangi, head of the Ophthalmic Services Unit.

“Some counties have ignored ophthalmologists and the unequal field distribution cannot allow us to say we have met the WHO threshold, but we are trying,” said Dr Gichangi in Nairobi last week as the country marked the World Sight Day. whose themewas ‘‘Universal Eye Health.’’

He said that if ophthalmologists were fairly distributed across the country, Kenya would meet the WHO recommendation of 1:250,000 patients.
Of the 39 million people living with blindness in the world, 224,000 are Kenyans, according to WHO.

A further 750,000 Kenyans are visually impaired while 28 million people worldwide have severe vision impairment.

This is according to a Lancet report titled ‘‘The Global, Regional, and National Incidence, Prevalence, and Years Lived with Disability for 310 Diseases and Injuries, 1990–2015: A Systematic Analysis for the Global Burden of Disease Study 2015.”

Seventy-five per cent of permanent blindness cases are avoidable. Last year, 237 million people around the world had moderate vision impairment while 690 million had near vision impairment, according to the Lancet report.

Dr Gichangi said that an additional nine million Kenyans are struggling with the burden of blindness, visual impairment and ocular morbidity.

The most common causes of permanent blindness and visual impairment in the country include ageing, cataracts (which are treated by surgery), trachoma, glaucoma, vitamin A deficiency among children, refractive errors and diabetic complications.

Others include allergies, injuries among industrial workers or during farming, and short and long-sightedness.

Dr Gichangi said that the high number of Kenyans becoming blind is also an indicator that they are living longer.

He said that 65 per cent of those with visual impairment are aged above 50 years.

Official data shows that a child born in Kenya in 2015 can expect to live to the age of 65 years, while that child’s parents, born in 1990, have a life expectancy of 62 years.“Age-related blindness actually means that Kenyans are living longer,” said Dr Gichangi. “This means that the cataract lenses of the ageing patient become opaque yet they are supposed to be clear.”

Largely due to ageing, the number of people with blindness in the world increased by 23·3 per cent between 2005 and 2015.

Severe visual impairment due to ageing also increased from 22.4 per cent to 26 per cent of the world population, with moderate visual impairment rising from 20·1 per cent to 23·7 per cent and near vision impairment from 20.9 per cent to 24 per cent.

Health secretary Cleopa Mailu said that blindness is a serious public health problem and a cause of human suffering.

Dr Mailu said that loss of productivity, rehabilitation and educational needs of blind people constitute a heavy economic burden for the affected individual, their families and society yet they can be avoided through early screening.

Eye screening at a public health facility costs between Sh50 and Sh200, compared to between Sh2,000 and Sh5,000 in private hospitals.

“Of the diseases causing visual impairment and loss, 75 per cent are avoidable and curable through interventions that are cost-effective,” said Dr Mailu.

Cost-effective interventions include surgical procedures for conditions such as cataracts. Of all the visual impairment cases in the country, 47.9 per cent are caused by cataracts.

Cataracts are also the leading cause of visual impairment in the world except for developed countries. A cataract is the clouding of the eye’s natural lens which lies behind the iris and pupil.

“Some of the interventions offered for cataract, which is the commonest cause of blindness in the country, include corrective surgical procedure. It costs about Sh15,000 in public hospitals,” said Dr Gichangi.

He said that the government meets Sh10,000 of the total with a patient paying Sh5,000 for consumables.

Dr Gichangi said they are engaging the National Hospital Insurance Fund (NHIF) and other insurance providers to include comprehensive eye care cover in benefits for members. Dr Gichangi urged insurance firms to expand the cover for eye care.

“Like is in the case of diabetic eye conditions, if they cover for diabetes treatment does it mean that they will not treat another part of the body since it does not fall under their cover?

Eye care has been overlooked by insurers but we are in talks to change the scenario,” he said. Although corrective surgeries such as cornea transplants can be done locally, not many are willing to donate their cornea to the visually impaired.

In 2010, the Lions SightFirst Eye Hospital in Nairobi opened an cornea bank. It has been trying to raise awareness and urge Kenyans to pledge their corneas to the hospital “so that when they die the organs can be used to offer sight to thousands of blind children. This has not been so forthcoming,” said Jyotee Trivedy, an ophthalmologist at the facility.

“To address the shortage of corneas we import them from the US.” Dr Gichangi said that 12 counties are trachoma endemic. They include Laikipia, Isiolo, Kitui, Embu, Meru, Marsabit, Samburu, Kajiado, Narok, Baringo, West Pokot and Turkana.

“These are areas where the disease is prevalent with more than 10 per cent of the populations infected. This needs a public health approach as intervention,” said Dr Gichangi.

He said that the Health ministry’s approach includes the coordination of eye care, infrastructure development, human resource development, health research, and equipping eye health products and consumables in public hospitals.

He said that there is need to manage diseases such as diabetes so they do not develop into diabetes retinopathy. This is a complication of diabetes, caused by high blood sugar levels damaging the back of the eye (retina). It can cause irreversible blindness if left undiagnosed and untreated.

Treatment of diabetic retinopathy is taking shape at Kenyatta National Hospital (KNH). Dr Gichangi said that they were also running health promotions for disease and disability prevention.

“The World Sight Day, for instance, is celebrated to educate nations on blindness, visual impairment and rehabilitation of people with visual impairments.” Trachoma is another infectious eye disease which can be transmitted from one individual to another.

Capacity

It is the leading cause of preventable and infectious blindness, associated with dirt, mostly in nomadic communities.

One can get trachoma through rubbing eyes with dirty hands, flies that have come into contact with animal or human faeces, and sharing of towels, among other unhygienic practices.

Dr Gichangi said that the health sector suffers from scarcity of skilled eye care specialists, skewed distribution of eye care workforce and limited productivity of the existing workforce.

“The solution is to build capacity for training, training more eye care workers, innovation and technology and improving on efficiency and screening,” he said.

Ministry data shows that sight restoration was the main focus between 1930 and 1970. From the 1970s to 2010, the sector focused more on training more staff and outreach. This evolved to comprehensive eye health care from 2010 to date.

The Health ministry is currently training 10 ophthalmologists at the University of Nairobi to boost skilled manpower.It takes three years to train one ophthalmologist at a cost of more than Sh3 million. The government has also introduced salaries of about Sh60,000 for students specialising in ophthalmology.

 

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