An evaluation of the public sector optometric service provided within the health districts in KwaZulu-Natal, South Africa

Abstract

Background: In South Africa, optometry has been traditionally positioned within the private sector. The situation has gradually changed over the past two decades, with optometry being introduced into the public sector in many parts of the country. Despite the growing numbers, optometrists are still new within the public health sector, motivating this study to evaluate the eye care services they provide.

Methods: A cross-sectional, retrospective, descriptive study was undertaken. Stratified random selection was applied to select the study sites, and systematic sampling was used to select patients’ files. A saturated sample of public sector optometrists employed in the selected districts completed study questionnaires. Data were analysed using the Statistical Package for Social Sciences, Version 21.

Results: A total of 2968 records were reviewed, and gender distribution was 67.6% female and 32.4% male. Refraction (86.73%) was the most frequently conducted test, followed by ophthalmoscopy (74.73%), colour vision (0.07%) and gonioscopy (0.03%). The response rate for the questionnaires was 64.7%. Optometric outreach services were conducted by 54.5% of optometrists, and the majority (83.3%) reported that the farthest outreach facility was more than 50 km from their base hospital. The availability of equipment at outreach facilities was less as compared to base hospitals, while some reported not having the necessary equipment even at base hospitals. None of the optometrists did contact lens fitting at outreach facilities. A lack of equipment was cited as one of the reasons for not providing this service by 100% of optometrists. Most optometrists (63.6%) believed that more than 30% of their referrals might have been avoided if they had prescribed therapeutic agents to manage ocular conditions.

Conclusion: Introducing optometrists within the public sector improves access to services for rural communities. However, the minimum standard of optometric care is not practised, allegedly because of a lack of equipment. Therefore, resources should be made available to enable optometrists to provide comprehensive optometric services. In addition, the study highlighted the need for more optometry posts in rural communities and for the implementation of career growth paths to attract and retain optometrists within the public sector.