The needs and opportunities for post-graduate education and training programmes for the optometry profession in post-apartheid South Africa

English: This research study was undertaken to determine the needs and opportunities for post-graduate education and training programmes in optometry in post-apartheid South Africa. The rationale for this study can be found in the stimuli which contributed to the commencement of the study, namely the Vision 2020 - The Right to Sight Campaign of the World Health Organisation that resulted in the resolution of the World Council of Optometry, entitled the Global Vision Care Campaign. That the abovementioned are fully endorsed by the South African government, is substantiated by policy documents such as the White Paper for the Transformation of the Health System (RSA DoH 1997) and the National Prevention of Blindness Programme (RSA DoH 2000). These aspects resulted in, inter alia, the identification of issues like preventable blindness; the importance of public health; public needs; the lack of human resource development; demographic representation; and the lack of clear clinical competency guidelines. The problem statement pertains to the career ladder for optometry, already accepted in South Africa. It opened the door for magister programmes, allowing practitioners to develop clinical and speciality skills within the scope and parameters set forth and regulated by the Professional Board for Optometry and Dispensing Opticians. Despite this career ladder, there. is a need for a programme aimed at providing education and training to learners in order to become competent to render a professional specialist service in optometry and to contribute to the enhancement of the discipline through research. Such a programme must afford professional optometrists the opportunity to further their education and training in terms of the optometry career ladder, in addition to gaining certain therapeutic privileges and speciality skills. The research took the form of a descriptive and an exploratory survey, comprising a literature review and an empirical investigation. The literature study covered two aspects, namely in the first place factors . influencing the design of optometry education and training programmes. Features like the changing health scene; the history of the development of the optometry profession; the transformation of the health care system in South Africa and the eye care needs of the South African population; as well as the transformation of education and training in South Africa were dealt with. The second aspect covered by the literature review was a selective review of optometry training, which dealt with optometric education and training in South Africa; its history and the current state of affairs; as well as legislation in South Africa. Subsequently optometric training in the rest of Africa and the developed world was discussed in broad terms. The empirical study entailed a questionnaire survey carried out among South African optometry practitioners. A quantitative design was employed, but - because the questionnaire also contained some open-ended questions - the study had a qualitative dimension as well. The overall goal and objectives were to make a contribution to eye care and the prevention of blindness, as well as to make a meaningful contribution to education and training in optometry. The aim was to determine the needs of optometrists with regard to optometric education and training and the opportunities existing in South Africa, measured against the background of the needs of society (from the optometrists' perspective). The objectives were in the first place to enhance competence beyond graduate level, thereby better serving the eye care needs of the population of South Africa in particular and, in an indirect way, of neighbouring countries. In the second place the objective was to make recommendations concerning the delivery of relevant and applicable post-graduate studies at Optometry Schools/Departments. All of these aspects were achieved by conducting the above-mentioned literature study and by using the findings from the questionnaire. The research design consisted of a needs analysis in the form of the questionnaire survey used as the method to determine the needs of optometrists in respect of post-graduate studies, as well as to obtain their views regarding existing opportunities in this regard. The questionnaire consisted of six categories, each containing five different types of items (cf. 5.4.1; Appendix C). Four rounds of questionnaires were sent out over a period of 16 weeks and the response rate was 70.2% (cf. 5.5). After the returned questionnaires had been analysed by the Department of Biostatistics at the University of the Free State, it became possible for the researcher to draw conclusions; discuss the findings; make recommendations; and identify the limitations of the study. Each of the six categories was followed by a summative conclusion as well as by the main findings of the content of that specific category. The main findings as well as those obtained via the literature study, enabled the researcher to make recommendations on post-graduate optometric education in South Africa. Different factors, which are listed under the following headings and subheadings, influenced these recommendations: - Points of departure: These include accessibility; affordability; personal development; professional development; addressing public need; addressing higher education and health policies; addressing research; addressing management skills; and addressing HPCSA Regulations. - Role-players: The role-players include, infer alia, students; providers; the Professional Board; individual optometrists and associations; industry; the public; the State; professional stakeholders; SAQA; and the CHE. - Post-graduate optometric education and training itself was divided into three aspects, namely: -Recommendations concerning the programme. -Recommendations with regard to CPO. -Recommendations on clinical competence based on public needs. The recommendations on clinical competencies were extensively detailed, since they may serve as a basis for the SGB of Optometry and Opticianry. As this study also focused on the public need, the detail in the recommendations regarding competency will help to ensure that the care which the public receive, is optimised. In order not to confuse the professional competencies with the categories of the questionnaire, they were divided into six sections, namely Sections A to F. Each of these sections was divided under the headings "Outcomes"; "Performance criteria"; and "Indicators". Hereafter a framework as a starting point for post-graduate education and training programmes was proposed. In summation, the researcher is of the opinion that the overall goal and objectives of the study were addressed and realised and that meaningful recommendations were made. The latter are in line with legislation and with the policy documents referred to earlier. In addition, recommendations on clinical competencies are in line with international norms. Conclusions are, infer alia, as follows: - Based on current undergraduate programmes, there is a need for a post-graduate programme aimed at providing education and training to learners. - The articulation between the under- and post-graduate programmes will result in an overview of the undergraduate programme. - The role and functions of the Professional Board are pivotal to the success of education at both under-and post-graduate level. - As the current optometry educational model fails to address the immediate public need, this study provides at least some of the guidelines in the design of a new model. - It is clear that CPO (Optometry) is in its infancy in South Africa and its success depends on whether it can influence the delivery of services positively. It is of the utmost importance, however, that - for CPO to be effective - it will need to articulate with formal qualifications. The researcher realises the limitations of the study, namely in the first place that the opinion on the public need was limited, as it was optometrists who were the respondents to this category of the questionnaire. In the second place, literature and statistical sources of the South African situation were limited in that epidemiological data are incomplete and fragmented. In addition, clinical training in optometry had stagnated during the apartheid years. It is recommended that this study be followed by the compilation of a model for post-graduate education and the development of a detailed curriculum plan, as that is essential in order for these recommendations to be successfully implemented. The researcher is of the opinion that the profession as a whole needs a leadership and management model that would ensure cohesion between all the facets of the eye care field. These facets must include, but not be limited to, elements like the providers of education; the quality assurer; professional associations; the State; clinical training networks; service delivery structures; programme development at all levels; as well as CPO articulation with all education and training structures and neighbouring countries. Such a model will provide direction and momentum to education- and needs-driven eye care services in South Africa and will open the way for the profession to develop to its full potential.