Orbis: Sustainability of Eye Care Into Existing Health Systems – The Ghana Approach

Between January 2017 and September 2020, Seeing is Believing (SiB) partnered with Orbis to implement two primary eye care projects in four districts Afigya Kwabre; Atwima Kwanwoma, Bosomtwe and Ejisu in Ashanti Region of Ghana.

The two projects “Strengthening the Ghanaian health system to promote the uptake of child eye health services” and “Strengthening Child Eye Health at Komfo Anokye Teaching Hospital, Kumasi and in the Neighbouring Regions of Ghana” focused on integrating primary eye care into the existing health system. The two projects closed out and left behind an approach that can be used to expand primary eye care services to other districts and regions across Ghana. The project used engaged stakeholders and partners on all levels of the Ghanaian health system to ensure buy-in and support. The project supported various changes from the national down to the community levels.

On the national level, the project supported the rollout of eye health indicators into the national Health Management Information System (HMIS). Expanding indicators provide a basis for effective management and monitoring of eye care services across the country as progress in any region, including Ashanti region, is monitored by the office of the National Eye Care Coordinator.

By the end of the project, eye care indicators had been integrated into Ashanti Regional Health Directory’s routine monitoring and supervisory visits to all districts within the region. Performance review indicators were amended to include eye care services for all districts within the region. As such, all districts in Ashanti region now have consolidated reports that include eye care services for entry into the HMIS. This ensures that comprehensive health service data, including eye care data is routinely monitored and subsequently entered into the HMIS. The Regional Health Directorate is building the capacity of other districts to integrate eye services into their routine programs. This will lead to the expansion of eye care services into all other districts within the region.

Additionally, the Ashanti Regional Health Directorate conducted a peer review and assessment of all eye clinics within the region. This peer review is the first of its kind to be conducted in Ghana within the Ghana Health Service. The exercise highlighted the current capacity to provide quality eye care services of each eye clinic; the level of support required to raise each facilities’ standards to acceptable levels; identified gaps and ways to bridge those gaps; and the contribution of eye clinic service to the overall service delivery in the region.

The implementing partners showed commitment to delivering primary eye care services despite the challenges imposed by COVID-19. The project team and the partners took steps that ensured that primary eye care services were not negatively impacted by COVID-19 pandemic. Integrating eye health into the comprehensive health system allowed the Ashanti Regional Health Directorate and the Ghana Education Service in Ashanti Region to adapt during the outbreak of COVID-19. School screenings were cancelled due to government-mandated shutdowns. Following consultations with the project team, the Ashanti Regional Health Directorate, Ashanti Regional Educational Office, school screenings will be rolled into existing school health programmes on malaria. Eye screening will be extended to all schools within the Ashanti when school activities resume. Schools within the region have been mapped to health facilities for follow-up care services to students.

These are some of the steps Orbis Ghana has taken to ensure the sustainability of eye care in Ghana’s health system.