articles sampson listowell abu, od - the history and current status of

Volume 51, Number 4, October 2020

THE HISTORY AND CURRENT STATUS OF OPTOMETRIC

EDUCATION IN AFRICA

Sampson Listowell Abu, OD

Department of Ophthalmology

and Visual Sciences University of

Alabama at Birmingham

Birmingham, Alabama 35233

[email protected]

10.14434/hindsight.v51i4.31557

ABSTRACT

Over the past decade, 16 new optometry programs have been established across Africa and there are eorts to set up additional

training institutions in the future. Also, existing optometry programs are undergoing modications to oer an international standard

of optometric education and training. This paper focuses on the history and further assesses the current status of optometric education

on the continent of Africa. Additionally, optometric education in Africa is compared to North American training programs. Challenges

facing optometric programs in Africa are highlighted with recommendations to address them.

KEYWORDS

International optometry, optometric education, optometry

school curricula, optometry degrees, optometry history.

INTRODUCTION

It is believed that the noble beginnings of optometry

are tied closely to the invention of spectacles in the early

1300s.

1, 2

Optometry has evolved from the art of making

eyeglasses into a sophisticated health care profession.

The World Council of Optometry (WCO) proers the most

contemporary denition of optometry– “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”.

Even though formal optometric education and training

began over 130 years ago,

2, 4

the level of education and

scope of practice varies around the globe.

3, 5, 6

In Africa,

the rst optometry training institution was established in

South Africa in 1924. By 1993, three more countries, Ghana,

Nigeria, and Tanzania, had optometry training programs.

recent report by the International Agency for the Prevention

of Blindness–Africa identied 27 optometry training

institutions in 15 Sub-Saharan African countries.

The

growing number of optometry programs stems partly from

a regional campaign

to provide more human resources

for eye health in Sub-Saharan Africa. This eort aligns with

the core strategies to achieve the targets of VISION 2020: a

global initiative to eliminate avoidable blindness.

As new schools emerge on the continent, it is imperative

to keep an updated historic account of the development

of optometric education in Africa. A record of the history

juxtaposed to the current status of optometry education will

give cause for reection on the strides that have been made

in expanding optometric education in Africa. Highlighting

the obstacles that confronted the establishment of

existing programs oers guidance to emerging optometry

institutions. Furthermore, such an account can serve as a

reference in the teaching of the distinguished heritage of

optometric education in Africa and further help students

obtain a better understanding of the roots of their chosen

profession. The purpose of this paper is to provide a concise

historical account of optometric education on the continent.

This paper also describes the current status of optometric

education in Africa and how it compares to optometric

training in North America.

Information provided in this paper resulted from

interviews of resource persons and a review of the existing

literature. Resource persons consisted of current deans

of optometry programs, individuals involved setting

up optometry programs in Africa and foreign nationals

who teach or have taught in African optometry schools.

Interviews were conducted through video calls, telephone

conversations and, in some cases, written responses to

questions of interest. In all cases, published and unpublished

documents relating to the subject matter were obtained

from veriable sources.

HISTORY OF OPTOMETRIC EDUCATION IN AFRICA

The continent of Africa has 55 recognized states grouped

geographically into ve subregions: Northern Africa, Central

ARTICLES SAMPSON LISTOWELL ABU, OD

HINDSIGHT: Journal of Optometry History

ARTICLES SAMPSON LISTOWELL ABU, OD

Africa, Eastern Africa, Western Africa, and Southern Africa.

These subregions are frequently used by the United Nations

Statistics Division for statistical purposes. The history of

optometric education in each subregion is described below.

Due to the dierent levels of optometric education oered

across Africa,

only training programs consistent with WCO

competency categories 2 to 4 are considered in this section.

The categories 2 to 4 describes a set of competencies that

expands from the provision of visual function services and

ocular diagnostic and therapeutic services. In the WCO

competency module, practitioners at level 2 and upwards

are considered as optometrists.

A map of Africa showing the subregional distribution of optometry

programs.

Northern Africa

With a population of approximately 244 million, Northern

Africa has four recognized optometry training institutions, all

situated in Sudan.

Sudan

Optometric education in Sudan started in 1954 with the

establishment of the School of Refractionists.

The program

was initially intended to train assistants for ophthalmologists

at the Khartoum Eye Hospital. The program evolved into

the Institute of Optometry, which modied the refraction

training course into a Diploma in Optometry program. In

1977, the Institute of Optometry merged with Al-Neelain

University and was renamed the Faculty of Optometry and

Visual Sciences. Following the merger, Al-Neelain University

instituted a ve-year Bachelor of Science in Optometry

program. In 2002, the Faculty of Optometry and Visual

Sciences rolled out graduate optometry degree programs

(master’s and PhD). Since then, three additional institutions

(one public and two private) have started the ve-year

Bachelor of Science in Optometry program. Ibn Sina

University and Makka College of Optometry started their

optometry training programs in 2016, whereas University of

West Kordofan, another public university, commenced their

program in 2017.

Central Africa

Currently, there is no optometry training program in this

region. The Brien Holden Vision Institute (BHVI) previously

surveyed the feasibility of starting an optometry program in

Cameroon to serve the French-speaking Africa countries.

In recent eorts, the Cameroon Optometry Association

has reached an agreement with the University of Buea

to commence optometry education in 2020. The School,

located in Southwestern Cameroon, will oer a six-year

Doctor of Optometry (OD) degree program. Currently

oered in Ghana and Nigeria, the six-year program is

the highest level of optometry education in Africa and

it includes pre-optometry basic science courses and

optometry curriculum.

Eastern Africa

There are 14 optometry training institutions in 10 of the

19 Eastern African Countries: Ethiopia, Eritrea, Kenya, Malawi,

Mozambique, Somaliland, Tanzania, Uganda, Zambia, and

Zimbabwe.

Ethiopia

Ethiopia has two institutions oering the Bachelor of

Optometry degree program. The rst program was set up

in 2005 at the University of Gondar in Gondar, north of

Addis Ababa, Ethiopia’s capital city.

The Department of

Optometry, which is administratively under the Faculty of

Health Sciences, also oers a Master’s in Optometry degree.

The optometry program at the University of Gondar came

into being through the joint eorts of Mrs. Gemma Peters, a

UK-trained optometrist, and ORBIS International, a non-prot

organization committed to saving sight around the globe. In

2008, another four-year Bachelor of Optometry degree was

started by the College of Medicine and Health Sciences of

Hawassa University,

which is approximately 280 kilometers

south of Addis Ababa.

Eritrea

The only optometric training program in Eritrea is oered

by the Asmara College of Health Sciences, in the city of

Asmara. BHVI, in partnership with the Eritrean Ministry of

Health and Asmara College of Health Sciences, initially

developed a two-year diploma program in 2009.

8, 13

The

program started training optometric technicians in 2010 as

a short term and immediate solution to the dire need for

refractive services in Eritrea. A 5-year Bachelor of Science

in Optometry was implemented in 2013 to replace the

Volume 51, Number 4, October 2020

diploma program, which was phased out in 2016. The rst

cohort of students who were enrolled in the bachelors’

program graduated in August 2019.

Kenya

A three-year diploma course and a four-year Bachelor of

Science in Optometry program are oered at the Kenya

Medical Training College (KMTC) and Masinde Muliro

University of Science and Technology (MMUST), respectively.

The diploma program was introduced in 2006 under the

Department of Occupational Therapy of KMTC, located in

Nairobi. The program stood on its own as the Department

of Optometry in 2011. With continued eorts to train more

doctors, BHVI collaborated with the Kenyan government to

establish in 2009 the four-year program at MMUST, located

at Kakamega.

The Department of Optometry and Vision

Sciences oversees the four-year Bachelor of Science in

Optometry program. The department additionally oers a

master’s degree program in optometry.

Malawi

Malawi has two optometry training programs. Established

in 2008,

the School of Optometry at the Mzuzu University

in Mzuzu started to train the country’s rst group of

optometrists in 2009.

The school runs a ve-year Bachelor

of Optometry program. The program was established

through partnership between BHVI, the Malawi Department

of Health and Mzuzu University. Two other nonprot

organizations, Optometry Giving Sight and Sightsavers,

provided funds to support the establishment of Mzuzu

University School of Optometry. The Malawi Colleges

of Health Sciences, located in Lilongwe, commenced

a three-year diploma course in 2010.

8, 14

This program

trains optometric technicians to assist optometrists and

ophthalmologists in the country.

Mozambique

The University of Lúrio in Nampula, a public university

located in northern Mozambique, oers a four-year Bachelor

of Science in Optometry.

6,15

The University of Lúrio is the

rst and only institution that oers optometry training

in Mozambique and in the entire Lusophone Africa. The

optometry training program was established in 2008

through the Mozambique Eyecare Project with support

from the Irish Aid and the BHVI.

The Dublin Institute of

Technology and the University of Ulster provided additional

support.

Tanzania

The optometry school at the Kilimanjaro Christian Medical

University College in Moshi is the oldest training program

in Eastern Africa. A joint eort by the Tanzanian Ministry

of Health, Swedish Federation of the Visually handicapped

(SRF) and the Eye Department of the Kilimanjaro Christian

Medical Center (KCMC) led to the establishment of a three-

year diploma course in optometry. The SRF was instrumental

in the development of the program’s curriculum. The

program is taught within the optometric facilities of the

KCMC Eye Department. In 1985, the government of Tanzania

assumed sole ownership of the training program. The

program has increased its initial enrollment capacity of 10

students per year to 30 students per year, which include

students from neighboring countries. Since 2005, there

have been eorts to transition the program into a four-year

Bachelor of Science in Optometry degree program that

would train students to a globally-recognized higher level of

competency and to create an opportunity for the Diploma

in Optometry holders to upgrade their knowledge and skills.

It is believed the four-year program, which kicked o in

2019, will eventually replace the diploma program.

Uganda

Eorts to establish an optometry training program in

Uganda started in 2004 with Dr. Naomi Nsubuga, the

Sub-regional manager for the BHVI, playing an active role.

In 2013, the Makerere University in Kampala opened its

doors to the establishment of the country’s rst optometry

training program.

The College of Health Sciences, in

partnership with the BHVI, developed a four-year Bachelor

of Optometry training program. The BHVI provided training

equipment, curriculum development and teaching sta to

ensure the program’s smooth inception. Other organizations

that contributed immensely to the development of the

program include the Australian Department of Foreign

Aairs and Trade, the University of New South Wales in

Australia, Optometry Giving Sight, Light for the World and

the Optometrist Association of Uganda.

16, 17

The rst cohort

of trainees consisted of ve individuals who graduated in

January 2019 and became the school’s rst optometrists.

Zambia

Zambia’s rst optometry program was established in

2010 through a partnership between Vision Aid Overseas

and the Chainama College of Health Sciences in Lusaka.

The college oers a three-year diploma program that trains

optometric technicians.

While the program was developed

and supported by Vision Aid Overseas, it received additional

funding from Specsavers. In 2018, the Chainama College of

Health Sciences merged with the Dental Training School,

Levy Mwanawasa University Teaching Hospital and the

Chainama Hills Hospital to form the Levy Mwanawasa

Medical University (LMMU). After its establishment as a

public university, LMMU introduced a four-year Bachelor of

Science in Optometry program in addition to the three-year

optometric technician diploma program. These optometry

programs are administered by the LMMU School of

Medicine and Clinical Sciences.

ARTICLES SAMPSON LISTOWELL ABU, OD

HINDSIGHT: Journal of Optometry History

ARTICLES SAMPSON LISTOWELL ABU, OD

Zimbabwe

The latest African country to train optometrists locally is

Zimbabwe. Two training programs were established in 2018

at the University of Zimbabwe and the Bindura University

of Science Education. Both institutions oer the four-year

Bachelor of Optometry degree program. The Cimas Medical

Aid Society supported the optometry program at the

University of Zimbabwe by providing training instruments

and furnishing the optometry training units within the

Kaguvi Hospital in Harare. The Bindura University optometry

program, which commenced late in 2018, was supported by

the Premier Service Medical Investments. Dr. Finn Juncker,

an optometrist from Denmark, also facilitated the donation

of training equipment to the program.

Somaliland

The University of Hargeisa in Hargeisa established a four-

year Bachelor of Optometry program in 2014. Its rst class of

students graduated in 2018. Available information from the

school’s website indicates a temporary suspension of the

program.

Western Africa

Four out of the 17 West African countries have institutions

that oer optometric education.

Ghana

There are two public universities that oer optometric

education in Ghana: the Kwame Nkrumah University of

Science and Technology (KNUST) and the University of Cape

Coast (UCC). Each institution oers a six-year optometry

degree program.

Optometric education in Ghana was

necessitated by the need to increase the number of

optometrists for legal recognition and registration of

optometry as a profession in the country. Following earlier

unsuccessful attempts to get public universities to set up

an optometry training program, the late Dr. Francis K. Morny

(a British-trained Ghanaian optometrist) established the

Premier College of Optometry in 1998.

19, 20

Prior to the establishment of Premier College of

Optometry, optometric training in Ghana existed only in

the form of an apprenticeship. The college retrained and

awarded ophthalmic optician certicates to practicing

refracting opticians who had no formal training. In 1990,

the college oered a one-year postgraduate diploma

in optometry. This program was later accepted by the

University of Science and Technology (now KNUST) and

expanded into a two-year course oered under the

Department of Physics.

The program only admitted

students who had already obtained their bachelor’s degrees

in any of the basic sciences. In 2000, KNUST adopted a

four-year Bachelor of Science in Optometry curriculum

despite an initial proposal for a six-year optometry program.

Not relenting on his ambition, Dr. Morny approached the

University of Cape Coast with a six-year optometry degree

program proposal. The University of Cape Coast welcomed

the idea and established the rst OD program in 2002.

Subsequently, the Department of Optometry at KNUST

abandoned its four-year program and adopted the six-year

model in 2004.

Both institutions have since expanded and

are laying the groundwork to oer postgraduate degrees in

optometry and vision science.

Nigeria

Records indicate that Nigeria was the rst country to

have both the Bachelor and Doctor of Optometry degree

programs in Africa.

6, 7

Currently, seven institutions oer a six-

year optometry degree program. Optometric education in

Nigeria began in 1970 with a four-year Bachelor of Science

in optometry degree oered by the University of Benin in

Benin City.This four-year program was revised in 1994 to

be consistent with the optometry degree programs that

had been introduced by Abia State University and Imo

State University in 1980 and 1993, respectively.

A Master

of Science and a PhD in optometry also are oered at the

University of Benin. In the past two decades, four more

universities have established optometry degree programs

in Nigeria. Madona University, a private institution, began to

oer optometric education in 2006. The Federal University

of Technology in Owerri changed its bachelor’s degree

in optical technology to the optometry degree in 2010.

University of Ilorin and Bayero University established their

optometry programs in 2013 and 2015, respectively.

Mali

The School of Optometry at the African Institute of

Tropical Ophthalmology in Bamako was established in

2009.

6, 8

The school trains optometric technicians in a three-

year diploma program. It is the rst and only optometric

education program oered in Francophone Africa. The

program has been supported by the International Centre

for Eyecare Education (BHVI). The rst cohort of trainees

graduated in 2011. The program has beneted from visiting

lecturers from the School of Optometry at the University of

Montreal, Canada.

The Gambia

In 2001, the Regional Ophthalmic Training Program (ROTP)

was established in The Gambia to oer dierent ophthalmic

training programs, which included a one-year optometric

technician diploma course. The ROTP is currently based

at the Sheikh Zayed Regional Eye Care Centre in Kaning,

which was commissioned in 2007. It was built with funds

provided by Sightsavers and Zayed Bin Sultan Al Nahayan,

a nonprot organization based in the United Arab Emirates.

Volume 51, Number 4, October 2020

Since its inception, the ROTP has welcomed and trained

students from other African countries without optometry

programs. During the Centre’s 10-year anniversary in 2017,

it was reported that the Regional Ophthalmic Training

Program had trained over 400 eyecare professionals from 20

Sub-Saharan African countries.

Southern Africa

Five states make up Southern Africa; however, optometric

education in this subregion is currently oered by four

institutions, all based in South Africa.

South Africa

Historically, formal optometric education on the continent

of Africa began in South Africa with the establishment of a

diploma program in 1924 at the Technikon Witwatersrand

in Johannesburg. This initial two-year, part-time course

underwent a series of transitions. By 1969, it was oered

as a four-year, full-time diploma program.

6, 22

The Rand

Afrikaans University also started a four-year Bachelor of

Optometry program in 1985. Due to the apartheid system

then, these two programs enrolled only white South African

students. The two universities merged in 2004 to become

the University of Johannesburg, which continues to oer

the four-year Bachelor of Optometry degree. Prior to this,

the rst four-year Bachelor of Optometry program had

been established in 1975 at the University of the North in

Turoop.

The program provided optometric training for

black South Africans. The University of the North and the

Medical University of South Africa merged in 2005 and

became the University of Limpopo. Four years after the

establishment of the University of the North optometry

program, a similar training program was started by the

University of Durban-Westville in Durban.

This program

was set up to oer optometric education to the Indian

population who had largely settled in and around the

Durban area during apartheid. After its merger with the

University of Natal in 2004, the University of Durban-

Westville was renamed the University of KwaZulu-Natal

and continues to oer optometric education at the

Durban campus. Post-apartheid, the University of Free

State in Bloemfontein commenced a four-year Bachelor of

Optometry program in 2002. All the four universities also

oer postgraduate education in optometry.

THE STATE OF OPTOMETRIC EDUCATION IN AFRICA

Thirty-three institutions in 16 countries provide

optometric education to approximately 1.2 billion people

ARTICLES SAMPSON LISTOWELL ABU, OD

Name, number, year of establishment and location of optometry schools within each subregion

HINDSIGHT: Journal of Optometry History

ARTICLES SAMPSON LISTOWELL ABU, OD

living in Africa. While there are optometry programs in

most regions of Africa, with the majority being found in

Eastern Africa, there is yet to be an optometric institution

established in Central Africa. Most of the optometry

programs are taught in English, though Africa is

linguistically diverse. Currently, only the University of Lúrio

in Mozambique oer optometric education in Portuguese.

There is a two-year training program in Cote D’Ivoire that

teaches opticians how to perform refraction

; however, the

African Institute of Tropical Ophthalmology in Mali oers

most advanced optometric education in Francophone

Africa.

Level of Optometric Education and Training

The fundamental objective for optometry programs

in Africa is to train competent optometrists to provide

primary eye care.

The curricula of the programs reect

a strong emphasis on refractive error correction and the

detection and management of ocular abnormalities.

Notwithstanding, training programs that span over 4 to

6 years expose students to advanced or specialty areas in

optometry, such as binocular vision, contact lenses and

low vision rehabilitation. Moreover, optometric education

is not standardized across Africa.

Over the years, training

institutions, governmental agencies and other stakeholders

have determined the duration of education and curriculum

deemed satisfactory to train optometrists in a given country.

This has contributed to the existence of dierent levels of

optometric education on the continent. While the six-

year optometry degree program oered by the Ghanaian

and Nigerian institutions remain the highest level of

optometric education in Africa, optometric institutions in

other countries are phasing out the diploma -level training

and adopting the four- or ve-year Bachelor of Optometry

degree program.

The lack of standardized education and clinical training

implies dierent licensure requirements and scope of

practice across the continent. In view of this, the African

Council of Optometry is championing eorts to address

the non-existence of an initiative or policy to standardize

optometric education on the continent. Past attempts to

upgrade the level of optometric education in countries with

lower levels of education and training have been met with

internal and external resistances.

Certain political actors

and professional bodies with competing interests in eye care

cause deliberate impediments and undue complications

to frustrate initiatives that advance optometric education.

Additionally, the scal implications that come with higher

levels of training, such as higher salary demands, discourage

the advancement of policies supporting higher optometric

education and expanded scope of practice.

Sta Strength

A common challenge facing all the optometry programs

in Africa is insucient teaching and clinical sta.

The few

available educators are overburdened by heavy course

loads, large class sizes and, in some instances, teaching

courses outside their scope of expertise. Due to insucient

clinical sta (preceptors), the teaching sta may take

on additional clinic supervisory duties. To boost sta

strength, most programs retain some of their graduates

and mobilize support in terms of scholarships for them to

pursue higher academic degrees.For example, three of the

rst optometrists who graduated from the University of

Cape Coast in 2008 were retained and have subsequently

obtained their PhD degrees. They now teach in the

program. Similar initiatives are being pursued by optometric

institutions in Kenya, Mali, Mozambique, and Uganda.

Through international partnerships, some faculty members

of foreign optometry institutions have taught in Africa as

visiting lecturers. The optometry program at the University

of Gondar in Ethiopia is one of the many institutions that

have beneted from such an initiative.

Training Resources

As expected, the training institutions have labs and clinic

facilities for the practical aspect of optometric education.

However, these facilities are not well equipped with the

state of art instruments. In other cases, the available

teaching and learning resources may be inadequate,

thereby presenting a challenge for practical demonstrations

by educators and for hands-on practice by students. Again,

the limited resources break down frequently due to overuse

by students who may not have the funds to purchase

personal, basic training equipment. The situation is likely to

worsen, given the recent higher records of enrollment and

adoption of an advanced level of optometric education.

Externship and Internship

Externship and internship programs have been valuable

resorts to augment the students’ clinical knowledge and

experience, considering the insucient sta and limited

training resources. Some training institutions structure

externship programs around vacation periods and require

students to spend an approved minimum number of

hours at recognized eye care facilities. In some countries,

internship programs are regulated and done after

graduation. For instance, in Ghana, Nigeria and Sudan, new

optometry graduates must undergo a yearlong internship

before being permitted to sit for the state licensure

exam. The internship period involves working under

the supervision of an experienced optometrist in both

primary care and specialty clinics. This supervised training

program enhances the condence and competence of new

graduates and further exposes them to a diverse scope of

optometric practice.

Volume 51, Number 4, October 2020

Sources of Support

Most optometry programs in Africa are oered by public

universities and, therefore, rely on government support

that is infrequent or often delayed. Optometry institutions

in Africa rely heavily on partnerships with local and

foreign non-prot organizations, as well as private entities.

There also are optometry schools that were established

through collaborations between governments and non-

prot organizations. For example, BHVI has been involved

in such collaborations in six or more African countries

and elsewhere in the world.

The agency’s involvement

in the expansion of optometric education in dierent

parts of the world includes need assessment, advocacy,

resource mobilization, implementation and development

of optometry curricula. Optometry Giving Sight, Optical

Foundation, Sightsavers, Volunteer Optometric Services

to Humanity, Cimas Medical Aid Society and Vision

Aid Overseas add to the long list of agencies that have

contributed to the development of optometry in Africa.

COMPARISON OF OPTOMETRIC EDUCATION BETWEEN

AFRICA AND NORTH AMERICA

Currently, there are 25 optometric institutions across North

America, which includes the University of Waterloo and the

University of Montreal in Canada. Each of these institutions

oer a four-year optometry program. Optometric education

continues to expand across Africa, while existing programs

aspire to meet international standards of education

and training. It is therefore of essence to highlight the

similarities and dierences that exist between optometric

education in Africa and that oered in North America,

which is considered the most advanced level of optometric

education in the world.

Similarities

The evolution of optometric education in Africa is

comparable to the development of formal optometry

training in North America. In both continents,

apprenticeship in opticianry were oered by optical shop

owners who were refracting opticians trained in England.

2, 4,

16, 22

Subsequently, well-structured training programs oered

by academic institutions went through several modications

in terms of duration and curriculum. The current six-year

Doctor of Optometry program oered in Ghana and Nigeria

is synonymous to an earlier form of optometric education

in the United States.

6, 20

In the 1960s, all optometry schools

operated a two-year, pre-optometry plus a four-year

intensive optometry curriculum.

Remnants of that system

are seen in North American optometry programs that

require at least three years of college education followed by

the four-year Doctor of Optometry training.

Apart from the historical resemblance, similar foundational

courses are taught in optometry programs oered in both

Africa and North America. Geometric and physical optics,

visual optics, ophthalmic lens and materials, ocular anatomy

and physiology and ocular biochemistry are just a few of the

preclinical courses that can be found in optometry curricula

on both continents. Another similarity is that graduates from

optometric programs in both Africa and North America

are required to takeboard-regulated examinations in order

to obtain licensure to practice. These exams are, however,

structured dierently in both continents. To the best of the

author’s knowledge, Ghana, Nigeria and Sudan are the only

African countries that have board-regulated licensure exams.

Dierences

Optometric education is standardized in North America,

as the Doctor of Optometry degree is the only recognized

level of education and training for licensure to practice.

In contrast, dierent levels of optometric education are

recognized in Africa. Diploma, Bachelor and Doctor of

Optometry degrees are awarded across the continent.

The

minimum level of optometric education recognized in a

particular African country is partly determined by its eye

care needs and capacity to train optometrists.

Unlike the

standard four-year duration in North America, optometric

education in Africa can take two, four, or 6 years to

complete. The dierences in the level and years of training

make it challenging to institute standardized competency

board exams across Africa.

The minimum entry requirements for admission

into optometry programs dier between Africa and

North America. In North America, three to four years of

undergraduate education is required for acceptance into a

Doctor of Optometry program.

2, 4

Optometry institutions in

Africa require at least completion of secondary (high) school

education

15, 20

or its equivalent and usually admit students

with strong backgrounds in mathematics, biology, chemistry

and physics. In contrast to the optometry school admission

process in Africa, Northern American institutions require

applicants to take standardized admission tests, such as the

Optometry Admissions Test.

Moreover, postgraduate clinical education in the form

of residency and fellowship programs are non-existent in

Africa. North American optometry programs oer well-

structured and coordinated residency training in more than

10 specialty areas. The Association of Schools and Colleges

of Optometry recently reported a total of 475 residency slots

aliated with optometry schools in the United States and

Canada.

Residency training, which mostly lasts for a year,

further deepens clinical knowledge and expertise in areas

such as primary care, pediatric optometry, ocular disease,

cornea and contact lenses and low vision rehabilitation,

among others. The African Council of Optometry has

outlined guidelines for regional optometry institutions to

obtain accreditation to oer advanced training in low vision

ARTICLES SAMPSON LISTOWELL ABU, OD

HINDSIGHT: Journal of Optometry History

ARTICLES SAMPSON LISTOWELL ABU, OD

rehabilitation.

It is hoped that this would be the rst step

towards the development of optometry residency programs

relevant to eye care needs in Africa.

RECOMMENDATIONS

An appraisal of the current status of optometric education

in Africa reveals that training institutions and programs

face similar challenges. The most common challenges are

insucient teaching sta and limited training equipment.

These challenges having been highlighted in earlier reports

persist.

6, 7

Graduate retention has been a major conduit

to increase sta strength and must be strengthened.

Optometry institutions in Africa should also establish

new state-of-the-art relationships and deepen existing

partnerships with foreign optometry schools in the

interest of pursuing an active visiting professor program.

Alternatively, training institutions can leverage recent

technological advancements to develop online teaching

platforms. These platforms can be used to facilitate remote

teaching and learning, whereby experts or foreign professors

may be invited to speak on certain topics or teach courses

for which expertise is lacking in African schools. Depending

on the nature of relationships with foreign optometry

schools, students in Africa can use electronic media to

access live classes or recorded lectures.

State of the art training equipment for eective

optometric education and training also is lacking in

most programs. Since almost all optometry institutions

in Africa are state owned, appropriate government

ministries are expected to provide the needed nancial

support to procure teaching and learning resources. Apart

from donations from non-governmental organizations,

optometry institutions should identify additional means of

raising funds to support the program. For instance, funds

generated internally from campus and satellite training

clinics can be put towards the cause of purchasing new

equipment.

The implementation of the African Continental Free

Trade agreement calls for renewed interest in standardizing

optometric education across the continent. The African

Council of Optometry and other stakeholders must solidify

eorts and develop roadmaps to ensure that optometric

education is harmonized across Africa. In this vein, similar

eorts must be directed to developing much needed

postgraduate clinical programs focusing on primary care,

low-vision rehabilitation and community health optometry.

The pursuit of standardized optometric education and

residency programs will go a long way to expanding the

scope of optometric practice in Africa and elevating its

quality to rival that of other parts of the world.

CONCLUSION

Formal optometric education in Africa began nearly a

century ago. There has been a remarkable increase in the

number of optometry institutions over the past decade with

the establishment of 16 new training programs. This trend

is expected to continue as the entire continent increasingly

becomes aware of the optometry profession and the

immense need it serves. As new programs emerge, existing

institutions must upgrade the level of optometric education

and training to emulate the higher global standards of

the profession. There are signicant and similar challenges

facing all optometric institutions on the continent. Solutions

to these problems demand a multifaceted approach

involving all key players: governments, national optometric

associations, domestic and foreign nonprot organizations

and private entities.

ACKNOWLEDGEMENTS

This work was supported by the David and Diane Goss

Optometry History Fellowship through the American

Academy of Optometry Foundation. The author thanks Dr.

Lyne Racette, University of Alabama, Birmingham, for her

support during the fellowship period. The author also is

grateful to the following individuals who spared valuable

time to share useful information on optometric education in

Africa.

Luigi Bilotto, OD; Former Director of Global Education, BHVI

Kesi Naidoo, Global Resource Centre Manager, BHVI-Africa

Khathutshelo Percy Mashige, PhD; Department of

Optometry, University of KwaZulu-Natal

Bharat Kumar Bhayal; Former Lecturer, Asmara College of

Health Sciences, Eritrea

Daniel Achugwo, OD; Lecturer, Department of Optometry

Asmara College of Health Sciences

Lynett Masiwa; Lecturer, Department of Optometry,

University of Zimbabwe

Mauricio Pene; BHVI- Mozambique

Diane van Staden; Head of Optometry Department,

University of KwaZulu-Natal

Dr Thokozile Ingrid Metsing; Head of Optometry

Department, University of Johannesburg

Jerey Walline, OD, PhD; Associate Dean for Research, The

Ohio State University College of Optometry

Douglas Horner OD, PhD; Professor Emeritus, Indiana

University School of Optometry

Ayukotang Enowntai Nkongho, OD; Secretary for AFCO and

Cameroon Optometry Association

Husseinali Datoo; Optometrist, Vision Plus Eye Clinic,

Tanzania

Volume 51, Number 4, October 2020

Saif Alrasheed, PhD; Former Lecturer, Faculty of Optometry

and Vison Sciences, Al-Neelain University

Atif B M Ali Osman, PhD; Lecturer, Faculty of Optometry and

Vison Sciences, Al-Neelain University

Samuel Kyei, OD, PhD; Department of Optometry, University

of Cape Coast, Ghana

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