The Gambia – Swansea Vision 2020 Eye Link

Case Study: Mr Sillah the Director of the National Eye Care Programme
Interviewer: Miss E Laws

November 2011

I had the opportunity to interview Mr Ansumana Sillah about the National Eye Care Programme (NECP). Mr Sillah is responsible for the overall coordination of the programme and he provides logistic support and supplies to the organization.

We started by discussing how the programme started. Mr Sillah described how it began after a nationwide survey about general eye health was conducted in the mid 1980s. After finding that 0.7% of the Gambian population were blind and that most of the conditions causing the blindness were preventable or curable, a number of people decided that something could be done to solve this national health problem.

            Mr Sillah explained how care was once only available in the capital city, Banjul, and therefore they felt that they needed to extend the service so that it would be accessible to more of the population. However, there were limitations as there wasn’t enough capacity in resources and professional medical staff so they needed to work out a strategy of organising the service to solve the problem. They created a “Programme design” in order to deal with the restrictions they faced where in different levels of society there would be people who could be contacted if any problems were to arise. They educated people in the communities about basic hygiene, trained a number of paramedics to handle common cases and various other people were trained to diagnose a variety of conditions and offer advice as to where they should go for specialist treatment. As a result, the general population became more aware of the services available in their local area. By 1986 the National Eye Care Programme had begun.

            Mr Sillah recounted how after only ten years the percentage of blindness reduced from 0.7% to 0.4%, which was a huge achievement by the programme. Also, the number of Trachoma cases decreased dramatically from 17% to only 5%, which was also a great accomplishment. In order to achieve these results they decided to prioritise diseases with the most common and severe conditions with greatest preference to attention and resources.

            Mr Sillah made sure it was clear that none of the work could have been successful without the partnership from organizations like Sight Savers and HHO.

            He went on to explain how 1999 the Health for Peace Initiative was set up to combat the most threatening health conditions in six countries of West Africa including Guinea Conakry, Guinea Bissau, Senegal, Liberia, Sierra Leone and The Gambia. It was decided that Malaria, HIV/AIDS, emergency complexes and immunisation would be targeted in order to increase general health throughout the regions. However, in 2001 it was decided that blindness should also be included in the Health for Peace Initiative and that The Gambia would be the coordinators of this particular aspect of the project.  It was established in the Sheikh Zayad Eye Care Centre, which is now responsible for training refractionists, nurses and cataract surgeons and is playing a major role in helping to improve the standard of eye health across not only The Gambia but throughout other regions of Africa as well.

             We then discussed the successes and achievements of the NECP in The Gambia. Mr Sillah seemed extremely pleased with the progress the programme has made as firstly, it has encouraged the government to take on more responsibility by providing funding and support for the service. Secondly, the programme has been a major factor in helping to reducing blindness in The Gambia and the other countries involved to 0.4%. Also, it has decreased the number of cases of Trachoma so greatly that it is close to elimination.

            Although there are many positive factors about the programme, there are also some challenges. We discussed how the main problem with the system is that the standards of tertiary care is difficult to maintain as there are no permanent Ophthalmologists in SZRECC at present. Although there are two doctors in training, the equipment available is of a minimal degree of sophistication. Another problem with SZRECC and other hospitals in the area is that there is a lure to staff to move for better prospects in more developed countries. He expressed great annoyance by the fact that they spend a vast amount of time and resources only lose their staff once they are qualified. He felt that something needed to be done in order to try and persuade the staff to stay in the country they trained in. Traditional practitioners are also available in the area. They often advise people to take harmful substances in order to treat their diseases and this is proving to be a major problem as more and more patients are being admitted with conditions caused by ill informed practitioners. Mr Sillah felt very strongly about this topic and is determined to advise the communities not to trust the practitioners lacking in qualifications. Finally, he expressed concerns about the increasing expectations from surrounding communities, how there is increasing demand for more high tech equipment that is not available at this stage. He made it clear that they still rely largely on funding and that a lot of the time money is sparse and that it will take time and patience to reach the standard of care available in developed countries.

                        Following this Mr Sillah was asked about the role of the Swansea-Gambia Vision 2020 link of helping to address the challenges of eye care delivery in The Gambia. He commented on how the link has enabled a transfer of professional skills and training with specialist equipment and materials, which was an invaluable to the hospital. He also spoke about how the link has motivated the staff in the hospital to work hard in order to reach the highest standard that they now believe can be achieved due to the example set by the team that have been visiting the hospital over the past three years. Finally, and most importantly, the link has improved the standards of service in training, general organisation of the hospital and maintenance of equipment. It has resulted in a greatly improved service now available.

                        To conclude the interview, Mr Sillah was asked about his hopes for the future of the link. He replied that he would like the link to continue to facilitate for dreams to come true, to allow SZRECC to become a centre of excellence where subspecialties will be developed and management will be as efficient as possible.

Elinor Laws

November 2011