Services for refractive error in Kenya: extent to which human resources and equipment are meeting VISION 2020 targets

Objective: To obtain information on Refractive Error (RE) services in Kenya in terms of human resources and equipment, their distribution and levels of provision. Methods: All eye health facilities in Kenya were identified (77), through the Division of Ophthalmic Services. The following information was collected by postal questionnaire and telephone calls/visit (two purposively selected provinces) number refracting by cadre, equipment (whether functioning) and refractions performed in the last month. VISION 2020 recommendations were used to benchmark human resources (targets met/not met) and functioning equipment (exceeds/met/not met minimum). Results: Seventy six out of seventy seven facilities responded (98.7%). Sixty eight (88%) were able to provide data. Study facilities were 83% government, 13% NGO/mission and 4% private. Kenya has less than 1/3 of recommended workforce for eye care. Nairobi province was best served (56.8% of target) with rural provinces having greater deficiencies (low as 3.8%). Urban facilities were better equipped than rural (22.9% vs. 9.1% units exceeded targets, p=0.035). Fifty eight point four percent of refractions were performed at NGO/mission/private facilities although they represented only 17%. The number of refractions done per month by each refractionist varied from 12.6 (Nyanza) to 125.3 (Nairobi). Conclusions: There is shortage of eye care workers at all levels of service delivery and lack of essential equipment for refractive services. Most refractions are not performed in the public sector, although more personnel in the sector have been trained on how to refract. The challenge of REs can be addressed with a public health approach. It requires integration at different service levels: diagnosing REs and other ocular conditions, clear referral pathways, health education/awareness and spectacle dispensing.