Eye care in Ghana

The eye care system in Ghana can be said to be one in its infant or growing stages. Today there are less than 300 eye care professionals taking care of the eye needs of over 23 million Ghanaians.

The general setup of an optometry clinic

History

Since Ghana's independence on March 6, 1957, there has been much work done to promote and improve the eye care needs of Ghanaians. The main groups who are championing this goal now are the Ghana Society of Ophthalmologists and the Ghana Optometric Association.

Regulatory bodies

Ophthalmological Society of Ghana (OSG)

The Ophthalmological Society of Ghana^[1] is a professional body of ophthalmologists in Ghana which governs the practice of ophthalmology in Ghana. At its inauguration in 1992, there were only 15 members including several expatriates. As of 2011, their numerical strength has increased to 50 with not less than 5 expatriates. Their objectives include promoting good eye health in Ghana and maintaining professionalism in their profession as ophthalmologists. Their activities include organizing continuous medical education for their members and collaborating with each other and members of other ophthalmological societies around the world to improve patient care. They are associated with the Illinois College of Optometry, the American Academy of Ophthalmology, and the WGA.

Ghana Optometric Association

The Ghana Optometric Association (GOA) is the country's governing body for the optometry profession.^[2] Since 2009 all optometrists wanting to be members have been required to write a professional exam. Upon successfully passing the exam, the certification required to practice optometry is awarded. The group has about 200 members. In 2010 the Ghana Optometric Association along with the Kwame Nkrumah University of Science and Technology's Faculty of Distance Learning^[3] rolled out a two-year program to offer all members of GOA who did not have the Doctor of Optometry degree to enroll for it.

Services

The Ministry of Health through its hospitals and health facilities is the main provider of eye care services in the country. Over the years it has taken various initiatives to train more eye care professionals through the various universities, teaching hospitals, nursing schools, training schools, etc. The aim of the Ministry of Health is to ensure that there is at least one functioning eye unit in every district of the country. Despite the current work, much work is still needed to improve access to eyecare in Ghana due to the low number of eye care professionals per 1000 people. Another group that is helping the Ministry of Health is the Christian Health Association of Ghana. Thirty-five percent of Ghana's health service provision is done by the Christian Health Association of Ghana. Most of the facilities that CHAG runs have eye clinics and these aid in service delivery in those towns and villages that are situated in.

The services that eye care professionals offer are varied and include:

• Cataracts surgery
• Glaucoma surgery
• Refraction
• Rehabilitative care

The chart below shows the number of eye care professionals in the various regions and also the progress made to restore sight to people with Cataracts in 2005.^[4]

2005 Eye report of Ghana

Eye care personnel

Cataract Surgeries

Western Ghana

Despite a population exceeding 2.1 million,^[5] the eighteen districts in Ghana's Western Region are among the least resourced in terms of eyecare services.^[4] Professional eye care services are available in four districts, Wassa West, Bibiani/Anhwiaso/Bekwai, Ahanta West and Shama Ahanta East Metropolitan.

In 2005 there were five eye care specialists in the region, comprising two ophthalmologists, two optometrists, one optician and an ophthalmic nurse.^[4] Specialists operate from the Imperial Eye Care Centre and the SAEMA district hospital in Takoradi, and from the Government Hospitals in Tarkwa and Dixcove. Supporting services are provided by the region's 106 general practitioners.^[6] International assistance is offered through Operation Eyesight Universal, which funds three district hospital satellite eye clinics in the Western Region.^[7]

Training Schools

Ophthalmologists

Teaching hospitals in Ghana train medical doctors for a period of three to five years in Ophthalmology. A total of at least ten years is needed to train an individual from the Undergraduate level to the level of an Ophthalmologist in Ghana.

Optometrists

The first optometrist school in Ghana started at the department of Physics, Kwame Nkrumah University of Science and Technology^[8] in 1992. The first class had just five students and were under the tutelage of Ghana's first Optometrist, Dr. K Monny. It was opened to only to those who had had their first degrees in either Biochemistry, Physics or Biology. Graduates from the school were awarded the Postgraduate Diploma in Optometry (Pg. Dip. Optometry). In 2000, a four-year Bachelor of Science Degree program was started to phase out the Pg. Dip. Optometry program and also accelerate the training of more eye care professionals in Ghana. In 2004, just as the first batch of Optometrist with the BSc. Degree had graduated, they were enrolled for the two-year Doctor of Optometry (O.D) program. They passed out in 2007. In 2002, the University of Cape Coast^[9] also rolled out its Doctor of Optometry program. Five students enrolled for the program and graduated with the 2008 batch of O.Ds from KNUST. Today, there are about two hundred Optometrists in Ghana working hand-in-hand with other eye care professionals to save sight.

Ophthalmic nurses

Trained nurses who wish to become ophthalmic nurses undergo a one-year post nursing school training in eye care at the Korle-Bu Teaching Hospital. Their training involves training in detection of eye condition and referring to the right eye care professional for treatment. They also are trained in managing common disease conditions of the eye as well as training to assist the Ophthalmologist in surgery.

Opticians

The Oyoko town in the New Juaben district of the Ashanti Region hosts Ghana's only school for the training of opticians. Secondary school graduates who qualify undergo a three-year training in lens glazing and fitting, optics and a lot more to qualify as an optician. They work closely with Optometrists in refractive therapy and refraction.

Major Eye conditions

There are a lot of ocular conditions in Ghana and as of now virtually all conditions can be treated in the country including those that require laser surgery. Occasionally, though, some conditions require the individual being taken outside the country for treatment. Below are the more common conditions in Ghana.

• Refractive errors
• Cataracts
• Diabetic Retinopathy
• Hypertensive Retinopathy
• Glaucoma
• Bacterial Infections
• Viral Infections
• Agricultural injuries to the eye
• Trauma
• HIV/AIDS associated ocular complications
• Sickle cell retinopathies
• Allergic conjunctivitis

Glaucoma

Ghana is ranked second in worldwide statistics for the prevalence of glaucoma.^[10] It is estimated that 600,000 Ghanaians are said to be suffering from glaucoma out of the number, 30,000 are likely to become blind if the disease is left untreated.^[11] The statistics continues to show that 8.5 percent of persons above 40 years have the disease and 7.7 percent of persons above 30 years also are with the disease.^[12] Furthermore, 15 to 20 percent of blindness cases in Ghana are due to glaucoma.^[12] The Ghana Health Service (GHS) is the government agency responsible for health care administration and delivery in the country. GHS has over the years initiated various programs aimed at improving the eye care system in the country. One of such measure is the celebration of World Sight Day which falls on every second Thursday in October. In 2008, the day was celebrated under the theme “Eyes on the Future - Fight Vision Impairment in Later Life Now ^[12] In Ghana, it is only the Ophthalmologist and optometrist who are licensed to manage glaucoma.

Challenges in Eye care

There are many challenges in the growth of eye care sector in Ghana:

• Lack of personnel (about 300 eye care professionals taking care of the needs of 23 million Ghanaians).
• Lack of funds to undertake major outreaches and screening.
• Lack of equipment and diagnostic tools in many parts of the country
• Lack of adequate eye care education for the public
• Continual use of uncertified herbal preparations to treat conditions

The Patient's Needs

As the average Ghanaian becomes more enlightened concerning they eye and its conditions, eyecare professionals would be required to do more too for his or her patient. The major concerns that eye patients raise are:

• the long wait periods for them to see the eye doctor. One the average it take about two hours for patients to access eye care services in most MOH hospitals and clinics.
• poor patient education practice from doctor to the patient

With respect to the above most eye care professionals the world over are adapting ICT to help the patient better. With respect to the long wait hours, various Electronic Medical Records EMRs are being used. These do away with paper and manual recording of patient data. As such the patient does not need to wait for his or her records before seeing the doctor. EMRs the world over have been shown to reduce doctor-patient interactions by up to three times. Ghanaian Optometrist are now turning to the use of EMRs^[13] to improve their daily work. Those who are using these EMRs bear witness to this fact and are continually advocating for the use of EMRs among their colleagues. One of the EMRs in use in Ghana are:

• the Facility Overall Versatile Eyecare Application (FOVEA).^[14]
• the Personal Digital Assistant for Eye Clinics (PDAEC).^[15]

Concerning patient education, various ICT tools are also being used. They include:

• TV based educational tools that play (with vocal renditions in the most widely spoken language within the location of the clinic) whiles patients wait their turn in the waiting area.
• Computer Assisted Patient Educational tools, that serve as a one-on-one tool for the eyecare professional during his or her patient education.

With all these new changes the sky will indeed be the limit for the well trained, well informed, computer assisted eyecare professional. And this will in turn impact positively on the Ghanaian who will seek their services.

Future

Due to the general living conditions of the country, many citizens of Ghana are unable or unwilling to access eye care when their income is too low to pay for basic living essentials. The low number of eye care professionals in the country along with the living standard need to improve before eye care is readily accessible in Ghana. As the number of professionals in the field increase, Ghanaians will experience available, accessible and afford eye care services throughout the country.

See also

• Optometry in Ghana
• Department of Optometry, KNUST
• Optometry, UCC, Ghana

References