KMD Section One
Eye Care in Kenya – Where Are We?
Eye care in Kenya has grown exponentially in the last decade in proportion to the growth of social-economic growth of the country during the same period.
Although there is need for Eye Care at all ages, most eye diseases that cause blindness are common in advancing ages of 50 years and above. As the economic growth leads to increase in life expectancy, it is therefore expected that the number of patients requiring eye care will increase simultaneously.
The commonest, potentially blinding eye conditions in Kenya include Cataracts, Glaucoma, Diabetic eye complications and Trachoma. On the other hand, refractive errors, conditions that are corrected by use of spectacles, are a leading cause of poor vision.
Other common eye ailments include eye allergies, infections, injuries and reduced tear production. Cataracts and refractive errors contribute about 70% of reduced vision in the country and yet they are both easily and completely treatable.
The single most important measure of standard of eye care in a country is the Cataract Surgical Rate [CSR]. This is the number of cataract surgeries done per million population per year. Kenya is expected to achieve a minimum of 2,000 CSR to control the blindness from cataracts.
Official information from the Ministry of Health indicate that Kenya is at CSR 800 currently with wide disparity in the regions. Other countries like India are at upward of CSR 6,000 and some high-income countries are as high as 8,000. From the health care business point of view, the situation in Kenya present a huge opportunity for investment.
There is a big shortage of eye care personnel in Kenya. The few who are available are haphazardly distributed and underutilized. Majority of the older generation who require eye care live in rural areas whereas over 60% of ophthalmologist work in large urban centres leaving 40% to deal with the bulk of the work.
The country has also not gotten it right with the training and distribution of mid-level eye care personnel. An eye surgeon should be supported by minimum four well-trained mid-level eye care personnel to perform optimally. There are hardly any training programmes in the country for this cadre of personnel whose sole role is to assist an eye surgeon perform efficiently.
The delivery of eye care services in the country is mainly through the Government, Faith-based hospitals, Service clubs and Private enterprises. The first three have been in operation for decades with the last one being the new kid on the block. The recent mushrooming of eye health private enterprises is bringing in quality and significantly adding to the numbers of people treated and surgeries done to improve the CSR.
Procedures that previously could be found only in foreign countries like India, South Africa, Europe and USA are now routinely done in Kenya with great success. Health Insurance coverage with National Hospital Insurance Fund [NHIF] has been a great incentive in establishing these centres. The greatest growth in eye care delivery in the recent years has therefore been on this sector.
The Social Enterprise model has been tried in some centres with astounding success. This model brings into the table high volume, high quality, low cost and sustainable eye care delivery. It offers the quality eye care services to all in the community, especially in the rural areas, irrespective of the socio-economic status with cost cross-subsidization.
With the Universal Health Coverage soon becoming a reality, the Social Enterprise model will find it easier to leverage on the system since they are already well established in the communities and those who were left out before.
(The author of this article Prof. Dan Kiage is the Founder and Medical Director of Kisii Eye Hospital)