The Optometrist as an Indispensable Partner in Primary Health Care
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In his keynote address at the 47th Annual National Conference of the Nigerian Optometric Association, Dr. Kayode Fayemi emphasized the crucial role of optometrists in primary health care, citing Nigeria's poor health indices and the need for comprehensive policy reform. He shared his administration's efforts in Ekiti State to provide free medical services to vulnerable populations and improve health care quality through various programs. Fayemi concluded by advocating for sustainable and inclusive health policies that address socio-economic inequalities to enhance overall health outcomes.
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The Optometrist as an Indispensable Partner in Primary Health Care
- 1. @kfayemi @JKFayemi John Kayode Fayemi PhD. Dr. Kayode Fayemi (CON) Former Governor, Ekiti State & Professor, School of GlobalAffairs, King's College, London 47th Annual National Conference of the Nigerian Optometric Association Ibadan, Nigeria | August 1, 2024 The Optometrist as an Indispensable Partner in Primary Health Care
- 2. The Optometrist as an Indispensable Partner in Primary Health Care It gives me immense pleasure to give this keynote statement at the 47th Scientific Annual Scientific Conference of the Optometric Association of Nigeria. It is exciting being in the distinguished company of renowned medical practitioners of the eye specialty - optometrists, and not least being asked to give a keynote address and chair your scientific conference. Clearly, these are huge shoes I’m being asked to step into – as a non-medical science professional. So, let me state from the beginning and in the tradition of academy that I shall only take partial responsibility for any errors in my presentation. The bulk of the responsibility should be ceded to Ambassador (Dr) Eniola Ajayi and the team that identified me as your keynote speaker and chair today. I therefore sincerely want to thank DrAjayi and the current leadership of the Association for giving me the privilege of addressing this August audience on the very first day of August. Health Care Delivery in Nigeria To put matters bluntly, Nigeria’s national health indices are uninspiring and it is worrisome that Nigeria’s healthcare delivery performance index is still struggling with those of war torn and less endowed countries even after 64 years of independence. The maternal morbidity and mortality figures are the fourth worst globally. Peri-natal mortality is at equally astronomical levels with a high incidence of diseases, particularly the emerging pandemic episodes of HIV/AIDS, cancers of all kinds and rising cases of hypertension and diabetes with their attendant complications. Coupled with all these is the very low life expectancy of 52 years for males and 54 for females. Many factors and challenges have conspired against the realisation of the laudable objective of the Walter – Harkness ten-year development plan and the enunciation of the first National Health Development Plan in 1960. 2 @kfayemi @JKFayemi John Kayode Fayemi PhD.
- 3. The Optometrist as an Indispensable Partner in Primary Health Care Before the 21st century, Nigeria would have achieved universal health coverage with all her citizens having access to quality healthcare, if there had been good governance at all levels of government.The problems militating against healthcare delivery in Nigeria range from policy inconsistency, lack of political commitment, and corruption to infrastructural decay, the undue politicisation of the health sector, human capital flight and declining professionalism. Whilst some significant steps have bern taken on constitutional and legal framework for healthcare delivery with the enactment of a National HealthAct that clearly defines the roles and responsibilities of government in the management of the three levels of Healthcare, the full effect of the Act is yet to be felt in terms of concrete improvement in the indices highlighted above. Otherobstacles militating against improved health conditions and universal access include: weak co-ordination, integration and implementation of health policies and programmes; inadequate budgetary provisions for health, inequitable distribution ofthehealthworkforceandweakprimaryandsecondarylevelsofcarewithaweak referral system. The challenges are literally legion. Health, Social Inequities and Universal Access Like the age old saying goes, “Health is wealth”. Healthcare is a social service and is essential for sustainable economic production. Indeed, good health is a priceless resource in the economic life of households, communities and nations. The resulting high economic production is also necessary for sustaining the delivery of qualitative health service. This cycle is so important that health can no longer be regarded as a social service alone but rather as a developmental programme with economic implications. The role of healthcare as a vehicle for human and social development has long been understood and countries with functional health systems, particularly the OECD nations, are known to have made giant strides in the developmental arena. 3 @kfayemi @JKFayemi John Kayode Fayemi PhD.
- 4. The Optometrist as an Indispensable Partner in Primary Health Care This conception of healthcare allied with empirically-derived policies and best practices in healthcare delivery has enabled developed economies of the world to sustain high levels of economic productivity which in turn has led to the continuous evolution of their societies into secure, responsive, prosperous and egalitarian examples of the modern nation state. The yawning gap in development between the First World and the Third World – which is obvious in most African countries and indeed in the developing world – stems in part from our collective inability to offer high-quality, affordable and accessible preventive, curative and rehabilitative health solutions to the people who our hopes of building resilient and prosperous societies depend upon. Developing nations require bold and imaginative healthcare policies to accelerate the attainment of optimum socio-economic development with the people at the centre of policy planning. In as much as a nation cannot rise beyond the collective capacity of its people, creative thinking and necessary investments in health care remains a top requirement for the emergence of development in Africa and provide real validation for the axiom, “Health is Wealth”. Having established the primacy of healthcare in the broader spectrum of development, let me state here that achieving universal access to qualitative health care services has remained one of the major challenges of developing nations like ours. Without prejudice to previous attempts to expand healthcare coverage for our constantly growing population, it remains a fact that the intentions and goals captured in those developmental agendas have not translated to results, particularly for the most vulnerable. In most parts of our nation, there remains a chain of considerable cultural, socio-economic and systemic factors that constrain access to quality health care for a sizeable proportion of Nigerians. 4 @kfayemi @JKFayemi John Kayode Fayemi PhD.
- 5. The Optometrist as an Indispensable Partner in Primary Health Care As clearly stated by WHO in an assessment of health systems contained in the World Health Report of 2000 “Better health is unquestionably the primary goal of a health system”. Further to this, the same report notes that because health care can be costly and the need for them unpredictable, mechanisms for sharing risk and providing financial protections are important. Anothergoal of adequate healthcare policy is therefore “fairness in financial contribution”’ A third goal, “responsiveness to people`s expectations in regards to non-health matters”, reflects the importance of respecting people`s expectations in regards to non-health matters”, reflects the importance of respecting people`s dignity, autonomy and the confidentiality of information. It also burdens stewards of public trust with the responsibility of marshalling public assets across all sectors-education, agriculture, water and sanitation, infrastructure development etc. in a manner that achieves meaningful synergies for the improvement of the health outcomes of the population. However, inequities still exist in our health system making the rich and educated access better health care services than the poorly educated and poverty stricken that need it most. This has continued to bedevil the legitimacy of our health system and remains the most important factor for our not being on course to achieving health Sustainable Development Goals (SDGs) by 2030. In locating the Optometrist as an Indispensable Partner in Primary Health Care, it is therefore important to first understand these broad contextual and conceptual challenges and then explore possible ways of addressing them. While it is way beyond my pay grade to provide universally applicable solutions, I can at least offer some perspectives on what we did in Ekiti State whilst at the helm of affairs. 5 @kfayemi @JKFayemi John Kayode Fayemi PhD.
- 6. The Optometrist as an Indispensable Partner in Primary Health Care The Ekiti State Health Sector story As part of my administration’s agenda, the 5th item of my 8-point agenda represents the Health component of this all-important document and is focused on “Provision of Free medical services for children under 5, all pregnant women, the physically challenged and senior citizens; establishment of health centres in all localities, increased immunisation coverage”. The Ekiti State Government launched the free health programme for the delivery of high impact quality health services to the targeted groups through a facility-based model. The programme ensured the removal of financial barriers to healthcareandprioritisedthedeliveryofservicesforthevulnerablesegmentofthe population in a bid to scale-up efforts at achieving the Health-related MDGs and SDGs. Theprogrammeservedpregnantwomen,childrenunderfiveyears,elderly citizensabove65andphysicallychallenged,includingPeopleLivingwithAIDS. To access the free health programme, individuals within the defined groups are required to register at any of the 35 designated health facilities. The programme provided essential services to the prioritised groups including free antenatal care and facility deliveries, assisted deliveries and caesarean sections, free treatment for ailments like malaria, acute diarrhoea and acute respiratory tract infection with essential drugs for the designated groups. Generally, there was an improvement in utilization of services as evidenced by the available data and elderly citizens are the highest users of the free services accounting for 51.15% of registered clients and 42.40% of total facility attendance in the first year of the programme. There was relative increase in utilisation by pregnant women and under-5 children. The programme has also promoted referrals to higher levels of care with a 12.7% increase in volume of referrals over the first 12-month period. The current maternal mortality in the State reduced to 95 per 1000,000 compared with 420 per 100,000 reported in 2010 October (unpublished data). 6 @kfayemi @JKFayemi John Kayode Fayemi PhD.
- 7. The Optometrist as an Indispensable Partner in Primary Health Care Free Health Missions: We also embarked on Free Health Missions till date, the last of which took place in April 2019, just before the COVID-19 pandemic. The Free Health Mission was designed to consolidate the Free Health Services to all the citizens of the State through a population-based outreach model. The philosophy of the scheme was to deliver services to the wider population not protected or covered by the facility-based burden and improve health outcomes of the general population.This intervention was carried out because: It assured Greater Equality: Compared with higher levels of care, free medical missions are more accessible geographically, financially and culturally to local communities, and provide more personalised care to the most vulnerable. It reduces the Disease Burden: By effectively addressing the most common health needs of the people. Medical missions can bring the greatest benefits to the health of families and communities, because a predominant share of the burden of disease is concentrated in children under age 15. It produces Economic Savings: by improving family health, free medical missions reduce the economic consequences of ill-health. It is a known fact that illnesses lower worker productivity and drain household assets. The scope of services include screening for chronic medical conditions and infections, medical out-patient services, dental services, health promotion, eye care services, immunisation services, simple emergency services and provision of essential drugs. Complicated cases are referred forfurthertreatment at secondary and tertiary facilities. In all editions of the mission implemented since January, 2011 to June 2019, a total of 900, 000 people were reached with this intervention amounting to overa quarter of the entire population of Ekiti State. 7 @kfayemi @JKFayemi John Kayode Fayemi PhD.
- 8. The Optometrist as an Indispensable Partner in Primary Health Care MedicalAssistanceSchemes Ekiti State has a very low resource base being ranked thirty-fifth on the state-by-state index of resource allocation from the federation account. Thus, poverty is more entrenchedamongthepeopleandthisinformedthefreehealthprogrammeandthefree healthmissioncomponentofitem5ofouragenda. Becauseofthelevelofpovertyandthe palpable social inequities, people who cannot afford hospital medical bills were often assisted to take care of the rising medical bills through the medical assistance scheme/Board. In my eight years in office, over 1 Billion naira was distributed to the financially limited clients to take care of surgical and chronic medical illness including cancers, kidney transplants, pacemaker insertions within and outside this country. I believe the current administration has continued with this and the request for this supportcontinuestobeontheincrease. Equally, in order to make the cost of medication, medicaments and consumables affordable tothepeople,wehavethemostvirileunifieddrugrevolvingfundwhichwas ratedthebestinthecountrywhileinoffice. ThisUDRFissupportedbytheWorldBank anditensuresthatdrugsaredeliveredtoeverybodyintheStateataffordablepricesand access is made very easy while avoiding polluting the market with fake drugs. We continuetoimproveinthisareawiththedevelopmentofthemegadepotatourCentral MedicalStore. TheHealthFacilities/InstitutionsinEkitiState Thehealthinstitutionsareorganisedintoprimary,secondaryandtertiaryinstitutionsbut these lack coordination, appropriate linkage and referral systems, and were faced with human resource challenges and lack of modern equipment. Besides, they were beset by infrastructural decay with many untouched since their construction forty years before wecameintooffice.Wesuccessfullyrenovatedmanyofthesefacilitiestomakethemmore responsivetotheneedsofourpeopleandconstructednewones. TheTeachingHospital was given a total face-lift with a newAccident and Emergency Centre, a new ICU, new dentalandophthalmologycentresandnewequipmentincludingaCTScan, ultra 8 @kfayemi @JKFayemi John Kayode Fayemi PhD.
- 9. The Optometrist as an Indispensable Partner in Primary Health Care modern x-ray facilities and mammogram to name a few. The bulk of the secondary facilitieswereupgradedandatleastonefullyfunctionalprimaryhealthCentreinevery wardofEkitiState. Yet, we also recognised thatThere are otherissues that are fundamental in addressing thehealthchallengesandthebroadersocialinequitiesinthestate.Weactivelydealtwith these issues too. In the areas of education, we provided free education up to senior secondary level with the provision of bursaries and scholarships to students that are genuinelypooratthetertiarylevel. Weembarkeduponsimilaractivismwithregardto women empowerment and gender equity, agriculture and construction of roads particularly those linking the urban to the rural areas. We also put in place a welfare package that provided a form of social security to the elderly citizens of Ekiti which helpedinbridgingthegapscreatedbyinequality. Wedevotedagreaterproportionof our financial resources to water development and environmental sustainability. While theprevalenthealthchallengesinEkitiarenotdifferentfromotherstatesinthecountry, we have learned enough from our experience to be able to argue that a proper repositioningofthehealthsectorinNigeriaandinmanydevelopingcountriesdefinitely requires political commitment to healthcare by all levels of government. It calls forthe transparent implementation of poverty reduction schemes, commitment to universal health coverage by government at all levels, increased budgetary provision for healthcare to at least 15% of the national and state budgets with effective utilization of thefundsandalliedhealthresources. Yet, free health programmes and missions by themselves are not the panacea to the healthinequitiesinoursocietyasourexperienceinEkitihasshown.Theymayworkfor a while as a short term solution but ultimately we must develop an effective insurance scheme that will sustainably transform our health system. That is the junction we reachedinEkitibeforeIpassedthebatontomysuccessor.ThepresentNationalhealth insurance scheme,thoughnotperfectanduniversalatthemoment,is noteworthyas a stepintherightdirectionanditshouldbeembracedandimproveduponthrough 9 @kfayemi @JKFayemi John Kayode Fayemi PhD.
- 10. The Optometrist as an Indispensable Partner in Primary Health Care community-based health insurance which has the tendency to cover both formal and informal sectors of the economy using the appropriate tools of performance-based financingandhealthcarecontracting. Overall, my administration believed in and undertook a holistic approach to the provision of healthcare. Beyond constructing supply-side facilities, we crafted an approach based around two questions. The first question – how diseases operate – informed the nature of the remedial intervention. The second question – what conditions give rise to the disease – helped us shape a broader spectrum of policy conception and execution. We recognize that health itself is an outcome of other socio-economic indices. Thus, policy design should take note of such factors as how women empowerment and girl child education impact on early pregnancy and maternal mortality and how access to clean water and the prevalence of waterborne diseases impact on child mortality. Development is best seen as a policy continuum ratherthanaseriesofcompartmentalizedreforms.Withinthisframework,sustainable healthcare gains can only be achieved when we address the social dimensions within which citizens operate. Issues such as good housing, adequate nutrition and stewardship of the environment among othervariables have to be addressed.Without doing so, health sector programmes by themselves will yield marginal returns. This is thethinkingthatinformedouradministration’sdrivetoimprovethelivesofourpeople anditenabledustoachieveoneofthebesthealthoutcomesinthecountry. Itismyhopethatastopnotchmedicalprofessionals,thereareafewnuggetsofpractical wisdom that this scientific conference can draw from our experience in the quest to makeoptometristsindispensabletoprimaryhealthcareinourcountry. Thankyouforyourattention. 10 @kfayemi @JKFayemi John Kayode Fayemi PhD.