PDF(Pubmed)
Abstract：
BACKGROUND: Even though the burden of uncorrected refractive error could potentially be addressed through innovative and cost-effective approaches, integration of the services into the National Health Services (NHS) is desirable. However, minimal information exists on the current situation warranting the need for evidence about the integration of refractive error service provided by optometrists into the national health services in Kenya.
METHODS: A situation analysis of the Kenyan refractive error services provided by optometrists within the NHS was undertaken based on access to service delivery, service coverage, and human resource. A strengths, weaknesses, opportunities, and threats analysis was undertaken based on the existent evidence to identify the core factors that could potentially facilitate or hinder the integration of refractive error services provided by optometrists within the National Health Services. The proportion of optometrists to be integrated in the NHS was estimated based on the minimum ratios recommended by the World Health Organization.
RESULTS: A section of tertiary and secondary healthcare facilities in Kenya have specific services to address refractive errors within the NHS with most facilities lacking such services. Treatment of refractive error occurs at the level of eye care general services. There are 11,547 health facilities offering primary care services in Kenya. However, none of them offers refractive error services and only a section of facilities offering county health referral services provides eye care services which is limited to refraction without provision of spectacles. The existing workforce comprises of ophthalmologists, optometrists and ophthalmic clinical officers, together with nurses and other general paramedical assistants. Optometrists, ophthalmologists and ophthalmic clinical officers are allowed to undertake refraction. However, optometrists majorly practices in the private sector. Centralization of eye care services in urban areas, weak referral systems, and a shortage in the workforce per population was observed.
CONCLUSIONS: The Kenyan NHS should advocate for primary care and reorient the current hospital-based delivery approach for refractive error services. This is attributed to the fact that provision of refractive error services at primary care remains effective and efficient and could translate to early detection of other ocular conditions. The existing human resources in the eye health ecosystem in Kenya should maximize their efforts towards addressing uncorrected refractive error and optometrists should be integrated into the NHS.
METHODS: A situation analysis of the Kenyan refractive error services provided by optometrists within the NHS was undertaken based on access to service delivery, service coverage, and human resource. A strengths, weaknesses, opportunities, and threats analysis was undertaken based on the existent evidence to identify the core factors that could potentially facilitate or hinder the integration of refractive error services provided by optometrists within the National Health Services. The proportion of optometrists to be integrated in the NHS was estimated based on the minimum ratios recommended by the World Health Organization.
RESULTS: A section of tertiary and secondary healthcare facilities in Kenya have specific services to address refractive errors within the NHS with most facilities lacking such services. Treatment of refractive error occurs at the level of eye care general services. There are 11,547 health facilities offering primary care services in Kenya. However, none of them offers refractive error services and only a section of facilities offering county health referral services provides eye care services which is limited to refraction without provision of spectacles. The existing workforce comprises of ophthalmologists, optometrists and ophthalmic clinical officers, together with nurses and other general paramedical assistants. Optometrists, ophthalmologists and ophthalmic clinical officers are allowed to undertake refraction. However, optometrists majorly practices in the private sector. Centralization of eye care services in urban areas, weak referral systems, and a shortage in the workforce per population was observed.
CONCLUSIONS: The Kenyan NHS should advocate for primary care and reorient the current hospital-based delivery approach for refractive error services. This is attributed to the fact that provision of refractive error services at primary care remains effective and efficient and could translate to early detection of other ocular conditions. The existing human resources in the eye health ecosystem in Kenya should maximize their efforts towards addressing uncorrected refractive error and optometrists should be integrated into the NHS.
摘要：
背景：即使未矫正的屈光不正的负担可以通过创新和具有成本效益的方法来解决，将这些服务整合到国家卫生服务(NHS)中是可取的。然而,关于当前情况的信息很少，因此需要将验光师提供的屈光不正服务纳入肯尼亚的国家卫生服务的证据。
方法：根据获得服务的情况，对NHS内验光师提供的肯尼亚屈光不正服务进行了情况分析，服务范围,和人力资源。一个优势，弱点,机遇,根据现有证据进行威胁分析，以确定可能促进或阻碍视光师在国家卫生服务中提供屈光不正服务的核心因素。纳入NHS的验光师比例是根据世界卫生组织建议的最低比例估算的。
结果：肯尼亚的一部分三级和二级医疗机构提供特定服务，以解决NHS内的屈光不正，而大多数机构都缺乏此类服务。屈光不正的治疗发生在眼睛护理一般服务的水平。肯尼亚有11547个提供初级保健服务的医疗机构。然而,他们都不提供屈光不正服务，只有一部分提供县健康转诊服务的设施提供眼保健服务，仅限于屈光而不提供眼镜。现有的劳动力包括眼科医生，验光师和眼科临床人员，以及护士和其他一般辅助医疗助理。验光师,允许眼科医生和眼科临床人员进行屈光。然而,验光师主要在私营部门执业。将眼部护理服务集中在城市地区,薄弱的转诊系统，并观察到人均劳动力短缺。
结论：肯尼亚NHS应倡导初级保健，并重新调整目前以医院为基础的屈光不正服务方式。这归因于以下事实：在初级保健中提供屈光不正服务仍然有效和高效，并且可以转化为对其他眼部疾病的早期检测。肯尼亚眼健康生态系统中的现有人力资源应最大限度地努力解决未矫正的屈光不正，验光师应纳入NHS。
方法：根据获得服务的情况，对NHS内验光师提供的肯尼亚屈光不正服务进行了情况分析，服务范围,和人力资源。一个优势，弱点,机遇,根据现有证据进行威胁分析，以确定可能促进或阻碍视光师在国家卫生服务中提供屈光不正服务的核心因素。纳入NHS的验光师比例是根据世界卫生组织建议的最低比例估算的。
结果：肯尼亚的一部分三级和二级医疗机构提供特定服务，以解决NHS内的屈光不正，而大多数机构都缺乏此类服务。屈光不正的治疗发生在眼睛护理一般服务的水平。肯尼亚有11547个提供初级保健服务的医疗机构。然而,他们都不提供屈光不正服务，只有一部分提供县健康转诊服务的设施提供眼保健服务，仅限于屈光而不提供眼镜。现有的劳动力包括眼科医生，验光师和眼科临床人员，以及护士和其他一般辅助医疗助理。验光师,允许眼科医生和眼科临床人员进行屈光。然而,验光师主要在私营部门执业。将眼部护理服务集中在城市地区,薄弱的转诊系统，并观察到人均劳动力短缺。
结论：肯尼亚NHS应倡导初级保健，并重新调整目前以医院为基础的屈光不正服务方式。这归因于以下事实：在初级保健中提供屈光不正服务仍然有效和高效，并且可以转化为对其他眼部疾病的早期检测。肯尼亚眼健康生态系统中的现有人力资源应最大限度地努力解决未矫正的屈光不正，验光师应纳入NHS。
