healthworkforce development in francophone west africa
TRANSCRIPT
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?