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Africa is a huge continent with varied challenges
from setting to settings, from country to countries.
But I'd like to start by saying that the major challenge now
would be the lack of data, lack of data on refractive error
and refractive services.
So it makes planning and implementation and even
assessment of implementations very difficult.
Another challenge would be the varied human resources,
providing refractive error services.
We have some that have been trained
for a few weeks, those who have been trained for six years.
And so in some parts, the skills are almost not there.
And then you have the super skilled ones.
Even those who are now trained as optometrists-- for instance,
in some countries where you have adequate number
of optometrists, there is the issue of maldistribution.
So you have very well-trained personnel,
but they are all crowded in the city areas.
And why is this so?
Because it is private-sector driven.
And, of course, because it is private-sector driven,
these optometrists set up their own clinics
so that they can make money.
And we end up having a vertical programme, more or less.
So refractive error hasn't really
been embedded in the comprehensive eye care system
as it should be.
In some countries, for instance in Nigeria
and in Ghana, where a little bit of refractive error
is going on in the public hospitals,
we seem to not have the provision of spectacles.
So these are some of the challenges
that we have in refractive errors in Africa.
That leads me on to the next part,
which is, you've raised the point of human resources.
What has been the progress that has
been made in terms of human resource development in Africa?
One of the key developments, I would say,
is the existence now of training schools in Africa.
So training schools are available now
for the French speaking.
They are also available for English speaking,
so there are four-year BSc programmes in Malawi.
And there's another one in Uganda that's coming up.
And Eritrea actually has started graduating students.
So this is a very important development.
And we also have a school in Mozambique for the Portuguese speaking.
So this has opened up access to all Africans
who intend to study optometry.
So this is actually a good development, optometry.
It's great to see the development that's
being made in terms of human resource training.
In your experience and in the Nigerian setting, then,
what would you say is the acceptance of spectacles.
How are they received in the community?
They're not well received in the communities.
Now, in the cities and amongst those who are educated, yes,
spectacles are accepted.
But quite a large number of people
still reject spectacles as a management
or a means of treatment.
There's quite a lot that needs to be done.
There's quite a lot of investment
that needs to be done to change this belief.
Their culture belief sometimes is the cause.
Sometimes it's peer pressure.
Sometimes it could be as a result of not feeling the need
to have spectacles on.
And we also find that some have actually
developed coping skills.
So even with large uncorrected refractive errors,
they are able to carry on life, at least to some extent.
And they think that that is fine.
So we still have a lot to do.
I would say no, spectacles are not accepted to a large degree.
Anne, thank you for summarising such a huge and vast topic
of uncorrected refractive errors.
The points that you've raised, the challenges, the barriers--
they cannot just be seen in Africa.
We see them globally.
So if there were three key messages
that you would say are necessary in terms of prioritising
refractive error services at a more local, district level,
what would you say those are?
Nigeria is ready to deploy optometrists
at the primary eye-care level.
So if I have three take-home messages,
I would mention-- one, that quantified,
skilled personnel should be at all the levels of care,
including the primary eye-care level.
And the second would be to invest in health education
and promotion, targeting the barriers that have stood
against the optical spectacles.
And then the third would be to recognise that the government
and everyone needs to recognise that refractive error is
a disability that can be treated and therefore should be part
of the national insurance scheme.
Thank you, Anne, for summarising that for us.
It's been very informative, and it's
helped to raise some key points that
are needed in terms of overcoming
the correction of refractive errors.
It's my pleasure.