CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
The negative impact of visual impairment and blindness cannot be over emphasized. Visual impairment and blindness affect virtually every aspect of an individual and the society at large. According to WHO, 285 million people are estimated to be visually impaired worldwide: 39 million are blind and 246 have low vision. In view of this, Vision 2020: The Right to Sight was launched jointly by the World Health Organization and the International Agency for the Prevention of Blindness with other nongovernmental organizations, professional associations, eye care institutions and corporations. The three core targets of this global initiative are specific disease control, human resource development and infrastructure and appropriate technology development (WHO, 2009). It has been reported that eye care services and utilization are the key factors to achieving these goals. The health workers form the bedrock of every health system. The term health workers has been described to be all people engaged in “paid activities†whose primary intent is to improve health. Health workers are said to include people employed by organizations primarily involved in health improvement as well as people who improve health by their activities but are employed by other types of organizations. The health workers are believed to be better informed in health related matters compared to the general population. Unfortunately, studies have shown that even the medical practitioners who are supposed to be the head of the health workers and the most knowledgeable in health related matters do not utilize the available health care services (Agarwal et al. 2010). The health workers are said to disregard the advice they give to the patients when they become ill themselves. They also tend to place the patients first thereby sacrificing their own well-being for the sake of their patients. Eye care services rendered include promotive, preventive, curative and rehabilitative services. Patients and providers could have different perspectives regarding access to care. Providers may care much more about outcomes, whereas patients also value convenience, timeliness, a comfortable environment, the provider’s attitude, communication, and other aspects of care. Any mismatch between provision of services and need is regarded as evidence of inequitable access to health care (Frazier et al. 2009). Identification of factors affecting utilization of primary eye health services would help the government and other eye care providers to address inequity issues in their eye care program. In a study by (Powell et al. 2009) on utilization of primary eye health services by people from a rural community of Nepal, it was found that low level of education, poor knowledge of eye diseases and great distance from home to health facilities were found to be factors on the demand side while inadequacy of eye health services and perceived inadequate skills among health workers were identified as factors in the supply side affecting utilization of eye health services among people of Mustang District. Borrel et al. (2013) in their study on utilization of eye care services in rural south India found that more than 40% of those with bilateral blindness had never visited an eye doctor. Previous studies have reported on the barriers to eye care services in south India and have found that economic reasons and access to care (including transportation and lack of persons to accompany patients) were among the most important reasons that persons blind with cataract did not seek care (Borrel et al. 2013). This study is therefore aimed at exploring the extent of utilization of eye care services by health workers as well as determining the barriers to utilization in order to proffer suggestion for improved utilization.