ADDRESSING OPHTHALMOLOGISTS

TRAINING IN FRANCOPHONE WEST AFRICA

Adidja AMANI, MD, MPHHR PROGRAMME MANAGER , SIGHTSAVERS

“Skills have become the global currency of the 21st century. Without proper investment in skills, progress does not translate into economic growth”

Outline

1Overview

2The Analysis of the situation

3The Regional

Strategic Plan

Overview of the Problem1

How did we get there?Nigel Crisp, the

inspirer

Caroline Harper,

CEO

Ronnie Graham, HRH D

• 10-Year Strategy to respond to the HReH Crisis in Africa

Objective 4:Meeting the specific health workforce

challenges in Francophone and Lusophone Africa

Francophone West Africa at a Glance

16 countries - 8 francophone Area=3, 455, 984 km2 Population of 99, 599, 066 (CIA fact book, 2012)

Average life expectancy = 53 years % of Urban Population = 37% (17-50%) the population aged over 50 years will

double during the next 20 years (UNFPA)

greater number of people with visual loss and blindness from cataract that will need eye services

Health budgets =5.84%

The CSR in Francophone Africa remains<500

CSR AFRO , 2003

CSR AFRO, 2004

SOURCE: Prevention of Blindness and Visual Impairment WHO-AFRO

CSR Global, 2004

What is the problem? The Escalating Number of avoidable

blindness Heavy non operated cataract

burden in FWAC -------- >>>> unnecessary losses in productivity

How best can we support FWAC to meet its needs /the vision 2020

targets?

2 The Analysis of the situation

July 2012-

The situational analysis: the process

Goal: generate evidence to deepen the appreciation of the challenges and the opportunities of in the region 8 Countries

360 degree stakeholder’s consultation…

Benin, Dean and Chief of department

Senegal, Dean Cheik Anta Diop

Residents in ophthalmology

CBM D.O

Cote d’Ivoire OCO, ON and Chief of department

Patients at USE Niger with HR Director, NEEC

Burkina Faso, Medical council

Findings: The Gap

Country Training program

Population

OphtalomologistsCurrent Required Gap

BENIN YES 9598787 26 38 18BURKINA F

NO 17275115 27 68 48

COTE D’IVOIRE

YES 21952053 82 84 2

GUINEE YES 9300000 24 37 13MALI YES 14533511 34 57 23

NIGER NO 17078839 14 68 54

SENEGAL YES 12969606 54 51 +3

TOGO YES 6191155 18 24 6Total  

279 427 167

Who perform eye surgery in FWAC?

Ophthalmologists who reported to perform surgery vs Medical ophthalmologist Source: Adapted from WAHO data, 2010

Cataract surgeons are not really present nor accepted as a cadre.#IOTA

TSO= conflicts of competences Various INGOs “Not welcomed”

: Mercy Ships, Nadi El Bassar, Islamic relief, etc= “Neither integrated nor sustainable, they are a strong disruptor of health system”

The regions has the lowest % of surgically-active o’gists (Resnikoff and al., 2012)

Med-ical

oph-tal-mologists 44%

Oph-thalmol-ogistwho re-

ported to

per-form surgery 56%

.

The number of O’gists in FWAC range from 14 in Niger to a maximum of 60 in Senegal

Findings: Shortage, quality, equipment …

U. of Lome-TOGO12%

UCAD-SENEGAL14%

DESSO- GUINNEE16%

U of Bamako-MALI17%

U. Abomey Calavi-

BENIN19%

U of Coccody-COTE D’IVOIRE22%

53% of the Residents in ophthalmology do not perform surgery at all

53%

Training centres for

ophtalomologists

Faculty

Cataract

surgery /10

N. of functional wet lab

Max per

batch

Current batc

h

Faculté des Sciences de la Santé of the

University of Abomey Calavi -Benin

5 3 0 N/A 5

Unités de Formation et de Recherche of the University of Cocody – Cote

d’Ivoire

16 1 0 10 3 

Faculty of Medicine, Pharmacy and

Odontostomatology of the University

Cheickh Anta Diop in Dakar -Senegal

8 5 1 6 4

Faculty of Medecin and Pharmacy of the University of Lome-

Togo3 4 0 4 2

1 2 3 4 5 6

18in 2013

28

34 in 2015

23

28 in 2017

36 in 2018

N. of graduates

Projection of the N. of graduates in ophthalmology in the region /year

Evolution of the number of post graduates in ophthalmology in the Francophone West Africa

for the last 40 years

1973-1982 1983-2002 2003-201368707274767880828486

7475

84

50% are more than 55 years

Retirement rate is up, the production is not enough and the quality of graduates do not meet the population needs

Priorities are crosscutting: Strengthen surgical skills and

Equipping Country Priority n°1 Priority n° 2Benin Upgrade surgical skills for trainees &

o’gists Start to train TSO’s

Burkina Faso Start training og’ists upgrade surgical skills for O’gists

Equip health centers

Cote d’Ivoire Upgrade surgical skills for trainees and o’gists

Equip the training institution and health centers

Niger Start training og’ists Equip

Sénégal Upgrade surgical skills for trainees Equip the training institutionTogo Upgrade surgical skills for trainees Equip training institution

Mali Training of trainers Equip health centers

3 The Regional Strategic Plan

The Need To Rethink Approaches To Training Is Not New, But Is Becoming URGENT

• Training institutions: Dean, Chief of Department of ophthalmology• MoH: Human Resources Directors, NECC of 8 countries• INGOS: Nadi El Bassar, CBM, HKI,OPC• WHO, WAHO, Independent consultant

NOV 2012 OPEN & INCLUSIVE consultation with 52 stakeholders

Click icon to add picture

The strategic planThe goal: produce surgically skilled ophtalomologists well equipped to address eye health challenges

1. Increase the number of surgically skilled ophthalmologists at the regional level( Residency program, medical o’gist CPD)

2. upgrade and scale up the infrastructures of the training institutions

3. Upgrade the equipment and training materials for all the training institutions and for their university teaching hospital

4. mobilize resources and coordinate the implementation of the regional strategic plan

“Erasing red dividing line” between training and Needs

Accreditation of non-academic high volume surgery centres for internships of residents

Post trainees in high volume centers like Dabou, IOTA ,Bopp,Gléï, CADESSO

CPD for medical ophtalomologists upgrade the infrastructures of training institutions and Upgrade the equipment and training materials for all the training

institutions and the university teaching hospitals Train domestically (Niger and Burkina Faso) Equip residents improve the productivity and retention Regionalize areas of sub specialization (Paediatric ophthalmology)

according to the relative endowment of individual institutions

Better Skills, Better Lives

COUNTRIES  COSTS

GUINEE £ 76,984

CROSS CUTTING ACTIVITIES

£ 291,005

MALI £ 506,613

BENIN £ 507,275

SENEGAL £ 515,211

COTE D'IVOIRE £ 836,068

TOGO £ 1,012,566

NIGER £ 1,136,243

BURKINA FASO £ 4,412,698

TOTAL£ 9, 294,

663

There is a need, and the potential to do things differently

Do more with less by integrating useful skills

Avoid costly medical evacuations

However, the successful delivery of these interventions will require broad-based partnerships

“Massive scaling up = Massive funding”

On trainees9%

On trainers14%

CPD for medical

ophtalmo-logist4%

Equipment and Upgrading

63%

Con-struction and ex-tension

7%

Advocacy, M&E,etc3%

Where will the money go? NIGER

13%

COTE

D'IVOIRE9%

SENEGA

L6%

TOGO11%

BENIN

6%

BURKINA FASO49%

MALI6%

GUINEE1%

Budget By Country

Half full

Half empty

The elimination of avoidable in blindness in FWAC is within our

grasp. When it is achieved, it will be a major public health triumph.

What is stopping us?