Task-shifting eye care to ophthalmic community health officers (OCHO) in Sierra Leone: A qualitative study

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Task-shifting eye care to ophthalmic community health officers (OCHO) in Sierra Leone: A qualitative study


Journaljournal of global health
Article typeJournal research article – Clinical research
Publication date – Mar – 2021
Authors – Vladimir Pente , Stevens Bechange , Emma Jolley , Patrick Tobi, Anne Roca , Anna Ruddock , Nancy Smart , Kolawole Ogundimu, Matthew Vandy, Elena Schmidt
KeywordsOphthalmic Community Health Officers, Preventing, Sierra Leone
Open access – Yes
SpecialityOphthalmology
World region Western Africa
Country: Sierra Leone
Language – English
Submitted to the One Surgery Index on March 24, 2021 at 11:52 am
Abstract:

Background :Preventing visual impairment due to avoidable causes has been a long-standing global priority. Of all blindness in Sierra Leone, 91.5% is estimated to be avoidable and 58.2% treatable, however, there are only 6 ophthalmologists for the whole country. Task-shifting has been suggested as a strategy to address this issue and a training intervention was developed to create a cadre of community-based staff known as Ophthalmic Community Health Officers (OCHOs). This qualitative study aimed to explore the experiences of OCHOs, their relationship with other eye health workers, and how they interact with the wider health system, in order to provide recommendations for the design and delivery of future task-shifting strategies.
Methods Between April and May 2018, we conducted semi-structured interviews with 42 participants including: OCHOs (n=13), traditional ophthalmic staff (n=17)
and other stakeholders from the districts (n=6), training institution staff (n=4) and MOH headquarters (n=2). We identified participants using purposive sampling. Interviews were audio-recorded, transcribed, and thematically analysed. We draw largely on in-depth interviews but complement the analysis with evidence from a
document review.
Results In Sierra Leone, the roll-out of the OCHO programme presented a mixed picture. OCHOs participating in the study expressed a strong commitment to their new role. However, policy changes proposed to clearly demarcate roles and responsibilities and institutionalise the cadre in the civil service were not implemented, resulting in the posting of some staff at an inappropriate level, dissatisfaction with the OCHO certification, and lack of opportunities for advancement and training. These challenges reflect structural weaknesses in the health system that undermine a cohesive implementation of eye health initiatives at the primary health care level in Sierra Leone.
Conclusions: Task-shifting has the potential to improve provision in under-resourced specialities such as eye health. However, the success of this approach will be contingent upon the development of a robust and supportive health policy environment

OSI Number – 20972

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