PLOS Global Public Health · 4 authors, 4 centres
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This mixed-methods study assessed the capacity of primary health care facilities in Anambra State, Nigeria, to deliver eye health promotion. It found significant gaps, including limited health promotion targeting the elderly and people with diabetes, lack of supervision, and insufficient transport. The findings highlight the need for a robust eye health promotion strategy integrated into national policy, with trained health workers, appropriate materials, and supportive supervision.
**Background:** Over 25 million people in sub-Saharan Africa are blind or visually impaired, mostly from avoidable causes. Health promotion is a key strategy for eye health, but its delivery at the primary health care (PHC) level is often inadequate. The World Health Organization Africa Region developed a package of interventions for primary eye care (PEC), which includes health promotion. This study aimed to assess the capacity of PHC facilities in Nigeria to deliver eye health promotion, using a mixed-methods approach.
**Methods:** The study was conducted in Anambra State, Nigeria, between October 2018 and May 2019. A representative sample of 48 government-owned PHC facilities (33 health centres and 15 health posts) was selected using two-stage stratified random sampling. Data collection included: (1) structured questionnaires and observational checklists administered to one (J)CHEW per facility; (2) in-depth interviews with facility heads in 9 purposively selected facilities; (3) structured questionnaires with 18 village health workers (VHWs); (4) interviews with district health supervisors; and (5) a desk review of national policy documents. Findings were benchmarked against capacities needed for health promotion, agreed through a Delphi exercise, and analysed using the WHO health system building blocks.
**Key Results:** - **Policy:** Eye health promotion policies exist but are fragmented across different national health policies. The National Health Promotion Policy (2019) does not include eye health. - **Human resources:** Less than half (43.2%) of facilities had VHWs conducting community health promotion. (J)CHEWs conducted community health promotion in 84.1% of facilities. Only 47.7% of (J)CHEWs were confident in delivering eye health promotion, but 95.5% were willing to be trained. - **Health promotion activities:** Health promotion focused mainly on maternal and child health (e.g., measles immunization, vitamin A supplementation). Only 20.5% of facilities conducted eye health promotion in the community, and 11.4% targeted the elderly. In facilities, health talks were given for vitamin A supplementation and measles immunization in all facilities, but only 15.9% covered diabetes prevention and 6.8% covered care of the elderly. - **Materials:** Over two-thirds (68.2%) of facilities had health promotion materials for community use, but only 20.5% were in the local language. No materials targeted people with diabetes or the elderly. In facilities, 75% of materials were in the local language, but none targeted diabetes or the elderly. - **Supervision:** Supervision of health promotion in facilities was reported in 43.2% of facilities. Supervision of VHWs was rare (6.3% of health centres). - **Transport:** Less than 10% of facilities had transport for staff to visit communities.
**Clinical Implications:** The study identifies critical capacity gaps that must be addressed to effectively implement eye health promotion in Nigeria. A robust eye health promotion strategy should be integrated into the National Eye Health Policy. The scope of existing health promotion needs to expand to include eye conditions, the elderly, and people with diabetes. This requires training health workers, developing targeted health promotion materials in local languages, providing transport for community visits, and ensuring supportive supervision. Addressing these gaps could improve eye health literacy, increase uptake of eye care services, and reduce avoidable visual impairment.