This analysis of eye care services was conducted to support the development of appropriate objectives and strategies for South Africa's national VISION 2020 strategy, which is currently in preparation.
Questionnaires about human resources, facilities, and number of cataract operations and refractions performed were sent to hospitals with eye units and to provincial coordinators. Semi-structured interviews were held with VISION 2020 committee members to describe how services were implemented. The study was limited to the public sector, which serves 80% of the population.
The study found that cataract services had been established in 43 of the 53 districts in South Africa. There were 65 ophthalmic nurses, 5 managers, 78 optometrists, and 124 cataract surgeons. The ratio of eye surgeons to population was 1:305,721, whereas the recommended ratio is 1:250,000.
The cataract surgical rate (number of operations per year, per million population members) was 1,056; this is just over half the rate of 2,000 needed in South Africa. There were 62 hospitals with eye units, but most used the theatre facilities only once per week. Although refraction services had been implemented in most districts, standardised refraction figures were not available.
Human resources could not be deployed where they were needed. Ophthalmic nursing was seen by some planners as specialised nursing and therefore not appropriate in primary care, a priority in South Africa. The appointment of ophthalmologists in district hospitals was also seen as contradictory to the principles of primary care.
District health committees had a limited effect on curative services because they lacked members with executive powers and functioned more as discussion groups. Committee members appeared to lack managerial and leadership skills.
It is therefore recommended that the national policy on the deployment of human resources in eye care services be reviewed. The effectiveness and structure of district committees should be improved and leadership and managerial training for committee members should be coordinated.