While the Optometrist is defined as an independent primary eye care provider who examine, diagnose, treat and manage diseases and disorders of the visual system, the eye and associated structures; as well as diagnose related systemic conditions. {1}

World Council of Optometry went further to define Optometry as a healthcare profession that is autonomous, educated, and regulated (licensed/registered), and optometrists are the primary healthcare practitioners of the eye and visual system who provide comprehensive eye and vision care, which includes refraction and dispensing, detection/diagnosis and management of disease in the eye, and the rehabilitation of conditions of the visual system.

But the Act establishing Optometrists and Dispensing Opticians Board of Nigeria (Chap 09. Part VI, Section 29 [interpretation]) defined optometry thus:

"Optometry” means a health-care profession specializing in the art and science of
vision care and whose scope of practice includes—
(a) eye examinations to determine refractive errors and other departures
from the optimally healthy and visually efficient eye;
(b) correction of refractive errors using spectacles, contact lenses, low
vision aids and other devices;
(c) correction of errors of binocularity by means of vision training
(orthoptics);
(d) diagnosis and management of minor occular infections which do not
pose a threat to the integrity of the occular or visual system; and
(e) occular first aid;

And that worrying inclusion of the clause in the Dr Joe Owie  led "Political Action Committee" setup by the current President of Nigerian Optometric Board, Dr Damien Echendu. To wit,
" To ensure that Optometry is designated as a Primary Care Profession by the Ministry of Health in all enabling health Act."

Then the question, is Optometry a primary eye healthcare profession? Why is it not captured thus in the ODORBN Act? And the issue of gazetting the Nigerian Optometrist as a primary eye care professional, it befuddles me that nothing has been done to question the reason why it is taking eternity to gazette us as primary eye care specialists. If the Nigerian Optometrist is not designated as primary eye care provider, then who is a primary eye care provider in Nigeria?

What is Primary Health care?

Essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community… It forms an integral part of the country’s health system…and of the social and economic development of the community…bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process.” {2}
 The primary health care system is a grassroots approach meant to address the main health problems in the community by providing preventive, curative and rehabilitative services. {3}

The concept of primary health care emerged in the 20th century as a strategy to provide access to comprehensive, effective health services for populations. Many forces and historic events shaped the evolution of primary health care.
Historically, China provided the first broad experiences of primary health care beginning in the 1930’s, this was expanded into the concept of the “barefoot doctor” on a national scale and subsequently the largest experience has been and continues to be on the Indian sub-continent.{4}

Mable and Marriott (2002) state that Primary Health Care (PHC) “recognizes the broader determinants of health and includes coordinating, integrating, and expanding systems and services to provide more population health, sickness prevention, and health promotion, not necessarily just by doctors. It encourages the best use of all health providers to maximize the potential of all health resources.”

The Alma-Ata declaration of 1978 on Primary health care summarizes five (5) core principles on which Primary health care should be built on:
(1) active public participation, 
(2) accessibility; 
(3) health promotion and chronic disease prevention and management, 
(4) the use of appropriate technology and innovation (including knowledge, skills and information),
(5) inter-sectoral cooperation and collaboration.

Primary Health Care Service was first introduced in Nigeria in 1975 by Yakubu Gowon, Nigeria’s leader announced the Basic Health Service Scheme (BHSS) as part of the Third National Development Plan (1975-80). The objectives of the scheme were to increase the proportion of the population receiving health care from 25 to 60 percent, correct the imbalances in the location and distribution of health institutions and provide the infrastructures for all preventive health programmes such as control of communicable diseases, family health, environmental health, nutrition and others and establish a health care system best adapted to the local conditions and to the level of health technology. {5}

Optometry practice in Nigeria is mainly a private health care initiative with little or no practical solution to the lacunae orchestrated by the burden of blindness in our society today. The burden of blindness in Nigeria, in Africa, is a result of poverty and ineptitude by the authorities in the health sector.
Primary health care in Nigeria revolves round maternal (pregnancy) and child (0-5 years) care. Chronic disease conditions like Diabetes, Hypertension, Osteoarthritis etc other health care issues like Glaucoma, Cataract prevention and management, refractive errors in children and in presbyopic adults, congenital and inherited ocular disease conditions that could be easily accessed in the primary health care level are not only left to fate, quacks end up preying on that lacunae created by the dearth of such health services at that level.

It is not in doubt that we practice a selective kind of Primary health care system in the country, but it is ominous that even the legislative framework that brought about Optometry as a health care practice in Nigeria neither recognizes the Nigerian Optometrist as primary eye care professionals nor does it empower us as the first port of call for eye care disease conditions and until this and other measures are taken to ameliorate this contending issues, the burden of blindness will forever weigh us down to a breaking point. It is rather unfortunate that our primary health care policy is so out of sync with the realities of universal health determinants and little wonder our elites troop out in droves on medical tourism to other developed countries and leaving the rest of us subjected to a life expectancy of less than 55 years!

References:

{1}  ( http://www.noanigeria.org/about-us.html)

{2} [Alma Ata Declaration 1978]

{3}  [Gofin (2005), Olise (2012)]

{4}  [Cynthia Haq et al.,( 2009) 'Primary Health Care: Past. Present and Future.' Global Health Education Consortium.]

{5} [Sorungbe, (1989)]


Ezebuiroh Victor