Main Objectives

• To evaluate an 18-month training programme for ophthalmology community health officers (OCHOs) in Sierra Leone in order to ascertain whether the OCHO cadre is operating as planned

Summary

Sierra Leone has high prevalence of blindness, much of which can be avoided. Even though eye care is included in core health services and there are plans in place to train new eye care staff, there are significant weaknesses in the eye health system. Consequently, many people at the peripheral level experience barriers to accessing eye health services. This evaluation examined the design and delivery of the programme and sought to understand how the OCHOs operate in practice and where and how well they fit within the eye health and general health systems.

Data was collected through a document review, key informant interviews and a task analysis. MoHS documents were reviewed for information on the number and distribution of OCHOs and the legal framework supporting their operation.

The study has generated a detailed picture of the OCHO cadre and the health system context in which it operates. It found that although the majority of newly trained OCHOs were highly motivated to take up their new role and help their local communities successful implementation, this innovative approach has been affected by a number of challenges experienced by the broader health system of Sierra Leone.

As the OCHO programme so clearly demonstrates, in resource-poor and struggling health systems, the barriers to programme effectiveness are formidable and not quickly overcome. Strong and sustained action and commitment will be needed by all partners, external and local, and should be directed both at the level of the programme and the health system.