Access to Affordable Eye Care: Task Shifting for Primary Eye Care via Community Pharmacies

Primary eye care is an integral part of primary healthcare and is a priority area of the World Health Organization (WHO). With the maldistribution of healthcare professionals in general, including optometrists and ophthalmologists, it is imperative to identify and implement efficient and sustainable models to achieve universal health coverage (UHC) across Africa. One way is through sensible task shifting models. It is to complement the efforts of trained professionals by empowering community health workers and others to deliver quality healthcare services in their communities, while reducing mortality rate and improving access to quality healthcare. Tasks are moved, where appropriate, to less specialized health workers, a practice gaining grounds from Thailand to Rwanda, from Sierra Leone to India, from Nigeria to the United States of America. Task shifting has been implemented in diverse areas including HIV prevention and management, family planning services and even uncomplicated cesarean sections as well as primary eye care. A research paper on “Task-shifting Eye Care to Ophthalmic Community Health Officers (OCHO) in Sierra Leone: A Qualitative Study” (Journal of Global Health, March 2021) shows that task shifting has the potential to improve provision of health services in under-resourced specialties such as eye health. However, the success of this approach will be dependent upon a robust and supportive health policy environment and collaborative partners with the focus to improve access to affordable quality healthcare.

Essentially, an efficient primary healthcare system is hinged on deep community involvement and a strong referral system. According to the International Agency for Prevention of Blindness (IAPB), clinical tasks can be shifted to clinical-based rehabilitation workers, primary healthcare workers, traditional birth attendants/healers etc. Primary eye care services cover conditions that are simple to prevent and manage; as well as those that are common to many communities. Based on WHO guidelines, such conditions include simple eye injuries, eye infections, refractive errors (myopia, hypermetropia etc) as well as reading difficulties.

On task shifting, Dr Lobga Babila Galega, a primary healthcare medical doctor has this to say, “I think task shifting is quite important and necessary for more efficacy within the health system. However, the challenge is that of oversight provision, so that the services are provided within ethical boundaries. It is also important for appropriate and sustainable mechanisms to be put in place, to ensure competency on the job.” This is essential. Hence, Community pharmacists, who work at the frontline of healthcare in cities, towns and villages have continued to offer such services and oversight in their licensed premises across the world. They are currently playing a pivotal role in distribution and administration of the COVID vaccine in many countries and will remain relevant at grassroot levels for primary healthcare. The community pharmacy is where patients can receive advice, often without prior appointment; access quality and efficacious medicines; obtain pharmaceutical care in dosing, storage and compliance to medication therapy as well as instructions on self-testing kits for several illnesses including non-communicable diseases like diabetes. Little wonder, pharmacists are regarded as one of the top-most trusted health professionals around the world. Having been licensed to practice as drug experts, pharmacists undergo series of clinical trainings, certifications and continuing education to enable them deliver premium value to their patients. This makes them pivotal to UHC.

It is a wise step to task shift primary eye care to community pharmacists given their background in biological sciences, their expertise in filling eye prescriptions e.g eyedrops; as well as the health education and promotion activities which they carry out in the pharmacy and environs. Studies have shown that in Nigeria, patients visit community pharmacies as much as primary healthcare centres, if not to a greater degree. Patients also shop for eyeglass frames and support for prescription glasses in pharmacies. As the roles of pharmacists in patient care continue to expand, access to quality care will become more achievable for the common man, especially those at the BoP (bottom of the pyramid -which constitutes a huge proportion of the population in Nigeria), and this will bring us a step closer to achieving universal health coverage in Nigeria. Multitudes in this segment battle with poor vision and this hampers their work productivity!

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Therefore Advantage Health Africa’s commitment to access, affordability and quality of healthcare has triggered this initiative. Through their work at the franchise chain known as myPharmacy, AHA has partnered with DOT Glasses, a Czech company that has developed a radical solution to address the needs of the world’s 1 billion people who are visually impaired but who have no access to prescription eyeglasses. Now, patients can walk into a community pharmacy near them for vision screening and prescription glasses, obtained in less than 30 minutes and for less than five thousand naira (N5,000). The feedback has been encouraging. The prescription glasses are for persons with refractive errors – both short- and long-sightedness (myopia and hypermetropia). Typical distribution channels for the DOT team include primary healthcare centres, pharmacies, mobile clinics, government programs etc. With this partnership, myPharmacy facilitates the distribution of the eyeglasses to community pharmacies and works with the DOT team to facilitate trainings to empower pharmacists to utilise the simple vision testing tools as well as provide oversight as needed. DOT Glasses is supported by the European Investment Fund and Czech Development Agency and is a member of EYElliance.

Speaking at the launch of the partnership at its head office in Lagos, Nigeria, the Operations Manager of AHA, Pharmacist Yewande Adekoya said this offers community pharmacists an opportunity to optimize quality service delivery, which is the thrust of their presence in cities, towns and villages. She is optimistic that, with DOT Glasses made available through community pharmacies, there is hope for more visually impaired persons above the age of nine, and the glasses promote the mission of bringing vision to the world, including Nigerians. Undoubtedly, a collaborative effort with community pharmacists will enable the efficient delivery of primary eye care services to the community. It will largely contribute to health systems strengthening by improving access to affordable quality healthcare. It will also foster interprofessional collaboration as pharmacists will partner with relevant professionals and clinics for referral of major cases. To sustain this model successfully, AHA calls for a further enabling regulatory framework. CEO of AHA, Abimbola Adebakin said, “we must also begin to ponder on how an effective task shifting policy can be implemented in our healthcare system. An efficient, cost-effective and quality healthcare system is not farfetched, if we utilise creative models like task shifting for the benefit of the BoP”. Her 2020 interview with some visually challenged athletes can be found here https://youtu.be/GFaIMTP2iS8. According to the 2005-2007 National Survey of Blindness and Visual Impairment, it is estimated that 1.13 million individuals aged 40 years and above are currently blind in Nigeria. A further 2.7 million adults in this age category are estimated to have moderate visual impairment while an additional 400,000 adults are severely visually impaired. 4.25 million are visually impaired or blind. The numbers might be much more now in 2021.

Advantage Health Africa (AHA) promotes access, affordability and quality healthcare through various novel initiatives (www.advantagehealthafrica.com). They were first in setting up an aggregated online pharmacy platform (my-medicines) in 2017, first franchise pharmacy chain launched in February 2020 with 51 franchisees (myPharmacy) and they serve a large number of Health Maintenance Organisations (HMOs) with their medicines fulfillment programme (myCare) and recently began the distribution of genuine locally manufactured pharmaceuticals through Advantage Pharmaceuticals Ltd. AHA works on the principle of aggregation, collaboration and health technology. The company is ready to partner with ophthalmologists and other healthcare providers who can help ensure success in addressing the millions of Nigerians who need basic prescription eyeglasses for better sight and work productivity.