Integrating eye health into policy: Evidence for health systems strengthening in KwaZulu-Natal

Background: Available evidence is that eye health care receives less attention compared to other allied health professions in public health services across South Africa, yet vision impairment is known to have significant social and economic consequences. Rural areas appear to be more affected, with KwaZulu-Natal (KZN) representing the second-most populous province in the country. The World Health Organization formulated a health systems framework which describes health systems in terms of six building blocks. This approach was applied in KZN, to assess the Department of Health's capacity to provide comprehensive primary eye health services in KZN, South Africa. Aim: To determine the capacity for comprehensive primary eye care service delivery within the public health sector in KZN. Setting: All health disctrict in KwaZulu-Natal. Methods: An explorative-descriptive cross-sectional design, gathering both quantitative and qualitative data, was used. Data were collected utilising questionnaires, observation, and interviews. Results were analysed against the health systems framework. Results: A total of 28 optometrists responded to the survey, representing 60% of public health facilities that provide eye health care in KZN. The majority (53.6%) of optometrists were from district hospitals in rural areas. Facilities were generally inadequately equipped, with inefficiencies in service delivery including long waiting times and multi-tasking of clinicians. The absence of a financing model impacted the service at all levels. Conclusion: Policy development for eye health is necessary for KZN to deliver comprehensive eye health services. In particular, emphasis should be placed on the integration of eye health into primary health care and appropriate planning to foster accessibility and sustainability of services.