Human resource development for Vision 2020 in developing countries: a change from absolute numbers

Abstract

Purpose: To critically review the numbers, distribution, staff mix, and productivity of eye care workers (ECW) in Kwara State, north central Nigeria.

Methods: A cross-sectional descriptive survey of all ECW identified from all eye care facilities in July 2008 was carried out using a structured questionnaire. Output data on cataract surgery of each institution were also collected and data analyzed using SPSS 16.

Results: A total of 157 ECW comprising 8 ophthalmologists, 4 diplomates, 16 residents training ophthalmologists, 96 mid-level ophthalmic personnel (67 ophthalmic nurses, 3 optometrists, and 26 others), and 33 administrative and supporting staff were available to a population of 2.37 million. Ophthalmologist to population ratio was 1:300,000, optometrist 1:790,000, and ophthalmic nurses 1:35,000. Eighty percent of ECW and institutions are located in the state capital. There were no orthoptists, low vision specialists, counselors, or cataract finders, while optometrists, managers, and primary ECW were inadequate. The staff mix was 1 surgeon to 12 other ECW and an average of 182 cataract surgeries per surgeon per year.

Conclusions: Emphasis should shift to team building and ensuring available workers perform optimally rather than meeting the absolute numbers of some cadre, which does not guarantee improved output. Issues of equitable distribution, appropriate staff mix, filling identified gaps in human resources, and addressing poor service uptake should be the focus to reach the goals of Vision 2020: The Right to Sight.