title: Improving services for glaucoma care in Nigeria: implications for policy and programmes to achieve universal health coverage.
abstract: Glaucoma in Africa is sometimes referred to as the silent thief of sight. In Nigeria, glaucoma is common, it is serious, ophthalmologists face many constraints in managing it, people do not even know they have it until it is advanced, patients do not understand or comply with treatment after they are diagnosed and the poor are more likely to be glaucoma blind. Available evidence indicates that the health system in Nigeria is failing to meet the needs of patients with glaucoma. Based on evidence, we propose future directions for improving services for glaucoma care in Nigeria, and the implications for policy and programmes to control glaucoma blindness, using a health system-oriented approach. Three complementary strategies are required: (i) strengthening clinical services for glaucoma-by developing models of glaucoma care, improving clinical treatment options, making medicines and equipment available, financing glaucoma care and training eye care workers; (ii) introducing initiatives for earlier detection of glaucoma in the clinic and approaches in the community and (iii) strengthening health system governance. Glaucoma is a complex disease to manage and addressing it as a public health problem is challenging. However, we need to change the paradigm to recognise that glaucoma is a potentially avoidable cause of blindness in Africa.
authors.affiliation: Department of Clinical Research, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK.|Baze University, Abuja, Nigeria.
authors.forename: Fatima
authors.initials: F
authors.lastname: Kyari
authors.affiliation: Department of Clinical Research, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Clare
authors.initials: C
authors.lastname: Gilbert
authors.affiliation: Department of Global Health and Development, Health in Humanitarian Crisis Centre, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Karl
authors.initials: K
authors.lastname: Blanchet
authors.affiliation: Department of Clinical Research, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK.|Department of Ophthalmology, Moorfields Eye Hospital, London, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Wormald
mesh_terms: D001766:Blindness / Q000517:prevention & control; D003695:Delivery of Health Care / Q000458:organization & administration* / Q000592:standards; D005901:Glaucoma / Q000175:diagnosis / Q000628:therapy; D006297:Health Services Accessibility / Q000458:organization & administration; D006301:Health Services Needs and Demand; D006801:Humans; D009549:Nigeria; D009907:Optometry / Q000458:organization & administration* / Q000592:standards; D019472:Universal Health Insurance / Q000458:organization & administration*
keywords: Glaucoma; Public health; Treatment other