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Algeria stands as unique example of universal health care in Africa

Ocular Surgery News Europe Edition

The country is committed to eliminating preventable blindness, and the prevalence of blinding trachoma has been reduced to 0.7%. At the end of the Algerian war, in 1962, there were only five ophthalmologists in the whole country. Since then, Algeria has gone through a large reorganization, established a national health care system and greatly increased human resources in all branches of medicine. “We are now 1,500 ophthalmologists, which is undoubtedly a great progress. Nevertheless, this number is not yet sufficient to serve a population of 38 million. We are far from covering the needs of our patients,” Boualem Chachoua, MD, president of the national association of private ophthalmologists, said.

In the years of French colonization, access to higher education was limited for native Algerians. “At high school, only seven were Algerians in my class; the rest were French. Our parents were poor, and only a small minority could afford to pay for us to go to university. Moreover, access was mostly denied to us. You had to fight your way through by showing the very best results at school to be admitted. When I entered university in 1966, Algerian students were around 1,000 in the whole country,” Chachoua said. After the war, Algeria went through a difficult process of reconstruction. The new government placed medical training among its priorities, medical schools were established in all major cities, and a new class of native doctors and physicians formed rapidly. In 1975, a new system of universal health coverage was introduced. Algeria is now a unique example in Africa of free, universal access to hospitalization, medical and surgical treatment, and outpatient care. “The great problem is geographic distribution. The north is fairly well served because 70% of the total number of ophthalmologists live and work here in the public and also in a growing private sector. The south is underserved, and definitely more ophthalmologists are needed,” Chachoua said.

Fighting preventable blindness: Of the total number of ophthalmologists, 900 work in the public sector and 600 work in the private sector. Women represent at least half of ophthalmologists. Public care encompasses primary care basic units, hospital specialty units and university hospitals, where care, training and research are provided. In the private sector, primary care, specialist consultation and ambulatory surgery are offered. In 2008, a national survey of blinding diseases was carried out, and in 2009, Algeria committed to the global initiative of Vision 2020. A master plan for the elimination of trachoma was launched, leading to reduction of blinding trachoma to 0.7%. Strategies aimed at complete eradication are still ongoing. Other causes of preventable blindness are now a priority. The prevalence of cataract is 13.8%, glaucoma is 4.6% and diabetic retinopathy is 2.4%,” Chachoua said. Corneal diseases affect 1.2% of the population, and transplantations are a problem because corneal grafts are imported. “We have no eye banking facilities. We need specific regulations and campaigns to promote awareness regarding eye donation,” Chachoua said.

Actions toward elimination of avoidable blindness include screening programs and management of blinding diseases within primary care centers. The government plans to raise the investment in health care to 10% of the gross domestic product, which should increase financial availability for screening and disease monitoring equipment. “Our government has already made considerable investment in technological advances, and our hospitals, as well as the private sector, are fully equipped with the latest technologies,” Chachoua said. In all major hospitals, about 50 cataract operations are performed each week, as well as 15 to 20 vitreoretinal procedures, 10 glaucoma operations and about two corneal transplantation procedures.

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