title: Mapping human resources for eye health in 21 countries of sub-Saharan Africa: current progress towards VISION 2020.
abstract: BACKGROUND
  Development of human resources for eye health (HReH) is a major focus of the Global Action Plan 2014 to 2019 to reduce the prevalence of avoidable visual impairment by 25% by the year 2019. The eye health workforce is thought to be much smaller in sub-Saharan Africa than in other regions of the world but data to support this for policy-making is scarce. We collected HReH and cataract surgeries data from 21 countries in sub-Sahara to estimate progress towards key suggested population-based VISION 2020 HReH indicators and cataract surgery rates (CSR) in 2011.
  
  
  METHODS
  Routinely collected data on practitioner and surgery numbers in 2011 was requested from national eye care coordinators via electronic questionnaires. Telephone and e-mail discussions were used to determine data collection strategies that fit the national context and to verify reported data quality. Information was collected on six practitioner cadres: ophthalmologists, cataract surgeons, ophthalmic clinical officers, ophthalmic nurses, optometrists and 'mid-level refractionists' and combined with publicly available population data to calculate practitioner to population ratios and CSRs. Associations with development characteristics were conducted using Wilcoxon rank sum tests and Spearman rank correlations.
  
  
  RESULTS
  HReH data was not easily available. A minority of countries had achieved the suggested VISION 2020 targets in 2011; five countries for ophthalmologists/cataract surgeons, four for ophthalmic nurses/clinical officers and two for CSR. All countries were below target for optometrists, even when other cadres who perform refractions as a primary duty were considered. The regional (sample) ratio for surgeons (ophthalmologists and cataract surgeons) was 2.9 per million population, 5.5 for ophthalmic clinical officers and nurses, 3.7 for optometrists and other refractionists, and 515 for CSR. A positive correlation between GDP and CSR as well as many practitioner ratios was observed (CSR P = 0.0042, ophthalmologists P = 0.0034, cataract surgeons, ophthalmic nurses and optometrists 0.1 > P > 0.05).
  
  
  CONCLUSIONS
  With only a minority of countries in our sample having reached suggested ophthalmic cadre targets and none having reached targets for refractionists in 2011, substantially more targeted investment in HReH may be needed for VISION 2020 aims to be achieved in sub-Saharan Africa.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Palmer
authors.forename: Farai
authors.initials: F
authors.lastname: Chinanayi
authors.forename: Alice
authors.initials: A
authors.lastname: Gilbert
authors.forename: Devan
authors.initials: D
authors.lastname: Pillay
authors.forename: Samantha
authors.initials: S
authors.lastname: Fox
authors.forename: Jyoti
authors.initials: J
authors.lastname: Jaggernath
authors.forename: Kovin
authors.initials: K
authors.lastname: Naidoo
authors.forename: Ronnie
authors.initials: R
authors.lastname: Graham
authors.forename: Daksha
authors.initials: D
authors.lastname: Patel
authors.affiliation: International Centre for Eye Health Clinical Research Department, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel St,, London WC1B 7HT, UK. karl.blanchet@lshtm.ac.uk.
authors.forename: Karl
authors.initials: K
authors.lastname: Blanchet
mesh_terms: D017954:Africa South of the Sahara; D002386:Cataract / Q000628:therapy; D002387:Cataract Extraction; D005123:Eye; D006282:Health Personnel / Q000706:statistics & numerical data*; D006296:Health Services; D006301:Health Services Needs and Demand; D006801:Humans; D009885:Ophthalmology / Q000706:statistics & numerical data; D009907:Optometry / Q000706:statistics & numerical data; D014785:Vision, Ocular; D000078329:Workforce