Nigeria, the 20th world largest economy is a democratic secular country which gained independence in 1960 from Great Britain. It is located in West Africa on the Gulf of Guinea along the Atlantic ocean coast line. One in every four Africans is a Nigerian therefore it is a very important African country with at least 8 cities having over a million population each (e.g. Lagos has 17 million, Port Harcourt 1.3 million in 2016, etc.)
Population : 188 million (2016) mostly heterogeneous people.50.6% are male
Percentage of population under 15 years : 41% are 15y and younger (2015)
Life expectancy : 46.8 years for males and 48.4 years for females
Birth rate : 40 births/1000 population
Infant mortality : 8.4 deaths/1000 births (2010)
Language : Over 500 languages though only about 250 are still being spoken.
Yoruba, Ibo and Hausa are the mainly spoken ones.
Official language : English
Education : Nigeria provides free, government-supported education, but attendance is not compulsory at any level, and certain groups, such as nomads and the handicapped, are under-served. Private education is also available to university level
Youth literacy rates : 72.79%
Registered doctors : 82,000 registered doctors with 4000/year more being produced
Number actually practicing : 40,000 (2016) others practicing abroad
Number of registered Ophthalmologists : 363 Ophthalmologists
Number of Pediatric ophthalmologists: 22 (1 to 8 Million population)
Health care system : The health workforce is concentrated in urban tertiary health facilities particularly in the southern parts. Policymakers are now focusing strongly on primary healthcare which is the frontline to address these gaps in the healthcare system, plagued by ‘brain drain’ of skilled doctors due to poor working conditions and few functional and modern equipment. National health insurance system is not very functional and effect not palpable due to poor stock of drugs and consumables. Government hospitals go on frequent strikes so most access private care during these periods. Training programs very actively going on at postgraduate level to stem the tide of efflux of doctors and to improve the quality of care. Two colleges available: the National Postgraduate and the West African College of surgeons. Examinations are held twice a year. The pediatric healthcare is generally improving in recent years with more and more preterm babies surviving with emergence and increasing numbers of ROP cases.
General eye care : Relatively few numbers of ophthalmologists with most older ones practicing general ophthalmology. There’s a concerted move now to subspecialize with only about 10% actually making any move to seek further training mostly available outside the country (generally expensive and distant from Nigeria) but nevertheless most aligning themselves with a subspecialty and annually attending national and regional meetings to improve practice.
Paediatric eye care : Very few ophthalmologists aspire to be paediatric ophthalmologists due to the poor remuneration and low perceived benefits but active interest being generated to increase the numbers by the umbrella body, The Nigerian Pediatric Ophthalmology and Strabismus Society (NIPOSS) which recently just had its yearly Subspecialty meeting with the Theme Management of Pediatric cataract and evaluation of Strabismus for 2016 on Wednesday, the 23rd of August 2016 in Port Harcourt, Rivers state, Nigeria. Well attended by renowned pediatric ophthalmologists and those in training both from all over the country and outside including Prof Marilyn Miller and Dr. Linda Lawrence in addition to Prof. Scott Lambert of the USA along with Dr. Ramesh Kekunnaya of Hyderabad, India.
Other notable speakers included the chairperson of NIPOSS Dr. Dupe Ademola-Popoola and Secretary of NIPOSS, Dr. Adedayo Adio and Prof. Ose Dawodu who is a past chairperson of NIPOSS.
Average Cost to patient of squint surgery under GA : 1500 dollars in private;120 dollars in government.
Average Cost to patient for pediatric cataract under GA per eye : 800 dollars in private and 100 dollars in government.
Major successes :
1) Improving numbers of those now getting interested in the subspecialty from the establishment of a coordinated multicenter time bound paediatric subspecialty training program with clear objectives a few years ago. This has significantly increased the numbers of trained personnel in recent years. Interest is now being shown in this program by neighbouring African countries.
2) Coordinated center for almost complete care of retinoblastoma in at least two tertiary centers. Heightened awareness programs going on to sensitize the populace in different parts of the country.
3) Moves being made to develop and enforce national vision screening guidelines.
4) Concerted efforts being made in at least three tertiary centers to develop an ROP screening program with two centers with an identifiable team in place.
5) Vibrant paediatric ophthalmology Society making active moves for partnership with stakeholders like OB-GYN, pediatric and community health colleagues to improve awareness of referral guidelines.
6) Renewed interest in the education and rehabilitation of the irreversibly blind.
Major challenges :
1) Unequal access to healthcare and poor access to rural areas located on desert and riverine areas. Most pediatric ophthalmologists are located in major tertiary centers with predominant locations in the middle belt and southern Nigeria. Very few in the northern parts.
2) Few fully trained paediatric ophthalmologists. Strabismus not as common but a lot of congenital and developmental cataracts.
3) Extremely poor funding for eye care in children with virtually none in certain regions. Most depend on private care with this sometimes superior to government care in certain regions making it out of reach to the common man. Only very few tertiary centers have vitrectomy machines.
4) No coordinated Nationwide eye screening going on in a sustainable manner. Few areas have a functional school eye screening program. Some efforts being made from one region to promote teacher-led screening to improve rapid coverage. Legislation not enforced.
5) There are very many optometrists but other allied eye care professionals virtually nonexistent. Currently an orthoptist is being trained in India to start training of others with faculty being drawn from the International Orthoptists federation and NIPOSS (local body of Paediatric Ophthalmologists). Very few low vision specialists- less than 5 in the whole country.
6) Rehabilitation and care of the severely visually impaired and the blind not given priority. Advocacy is going on in addition to awareness programs.