Framing professional programs within development projects: Driving longer term recognition and integration

Background: Optometry has, over the past ten years, emerged as a profession strategically positioned to address the burden of uncorrected refractive error in developing countries. Estimates suggest that 285 million people in the world are needlessly visually impaired, mainly due to the lack of trained eye health professionals in the developing world. Development initiatives in eye care have therefore moved away from vertical, service delivery approaches to supporting the establishment of more sustainable, locally owned training programs. This research is based on one the evaluation of one such initiative known as the Mozambique Eyecare Project. Methods: This study followed a qualitative research design. Ethical approval was granted by the Research Ethics Committee at the Dublin Institute of Technology, which followed the tenets of the Declaration of Helsinki. A qualitative, interview-based study was undertaken between 2012 and 2014 with eighteen key informants involved in the design, planning and implementation of the project. A semi-structured interview guide was developed to explore, inter alia, challenges relating to the establishment of the new profession of optometry in Mozambique. Data was coded and analysed thematically and results derived from a process of descriptive-interpretive analysis. Results: The establishment of a new profession within the ambit of a development project presents several challenges, principally the establishment of the profession's identity in relation to similar professional cadres' in-country. The risk of not addressing professional regulatory requirements for new programs, where equal or similar qualifications have not previously existed, are that the profession may not be officially recognised by the relevant health authorities and therefore not mainstreamed into public health services, or that training standards and scope of practice may be inappropriate to local needs. Overall, the public may become vulnerable to unscrupulous health care practices. Conclusions: Health professions are regulated in order to ensure patient safety, as well as minimum standards of care and training within professions. Development projects must address issues of professional identity and official recognition of health professions and their respective qualifications through relevant local authorities, so that graduate qualifications are legitimised and the longer term objectives of the development investment are supported.