Millions of people are affected by a crisis that often goes unnoticed - the issue of eye health.
Despite its critical importance, this topic is frequently overlooked, leading to long-term consequences for individuals and society as a whole. Studies show that the major causes of avoidable blindness in sub-Saharan Africa are cataracts, glaucoma, diabetic retinopathy, childhood blindness, trachoma, and onchocerciasis.
Cataracts occur when the natural lens in the eye becomes cloudy, leading to a decrease in vision. Glaucoma is a group of eye diseases that damage the optic nerve, which connects the eye to the brain. Diabetic retinopathy is a complication of diabetes that affects the blood vessels in the retina, the light-sensitive tissue at the back of the eye. Childhood blindness can be caused by a variety of factors, including genetic conditions, infections, malnutrition, and trauma. Trachoma is a bacterial infection of the eye, and onchocerciasis, also known as river blindness, is caused by a parasitic worm that is transmitted to humans through the bites of black flies.
Each condition can cause blindness if left untreated but can be prevented or treated through various measures, including medication, surgery, and hygiene education.
The crisis is fuelled by lack of access to eye care services, poverty, and limited resources. It's a situation that demands our attention, as the consequences of neglecting eye health are far-reaching and devastating. Efforts are being made by organizations like the WHO, Sightsavers, NGOs, and local governments to address the problem by increasing access to eye care services, raising awareness, and implementing preventive measures.
Boresha Macho in Swahili means "improve sight" or "enhance your vision"
The Boresha Macho project is one such initiative that aims to prevent avoidable blindness and promote eye health in Tanzania. The project is a beacon of hope for millions of individuals facing the challenges of impaired vision. The project takes a multi-faceted approach that includes providing eye care services, distributing medication, and advocating for inclusive policies to make a lasting impact on those affected by visual impairments. However, despite the progress made, there is still a significant amount of work to be done to enhance eye health throughout Tanzania.
Sightsavers Programme Manager Edwin Maleko, delves into the harsh reality of eye health in Tanzania, highlighting the challenges, exploring the consequences, and shedding light on the urgent need for action to address this growing problem. He provided an overview of the Boresha Macho project which aims to restore and protect vision by providing equitable access to eye care across the Morogoro and Singida regions of Tanzania. The project, developed in collaboration with the Tanzanian Ministry of Health and funded by UK Aid Match, effectively provided essential basic eye health services to over 178,000 people.
"Access to eye care was improved through initiatives such as community-based screenings, more than 17,000 cataract surgeries, and the provision of more than 7,000 glasses. We also supported the government and other partners with professional training for eye health workers, assessment of accessibility and improvements of health facilities for people with disabilities, disability and gender inclusion training for health professionals, and outreach to raise awareness about the importance of good eye health," Maleko said.
The project focused on addressing the barriers faced by women and people with disabilities, including training and liaising with social welfare officers and women's groups and supporting people with disabilities to advocate for their right to access health services. They worked with Tanzania Gender Network to tackle these challenges through training and liaising with social welfare officers and women's groups.
Maleko outlined some of the challenges faced in reaching people at risk of vision impairment and encouraging them to undergo surgery, especially in areas with limited healthcare access. He said, "Good health and well-being is a human right but more than 400 million people worldwide lack access to basic health care."
"Effective, affordable, accessible eye health services should be available for everyone, including women and people with disabilities. No one should be left behind when it comes to eye health," he added. "Eye health services in particular can be a postcode lottery. More than 90% of people who are blind and more than 85% of people with visual impairment live in low- and middle-income countries."
According to Maleko, budget constraints, a lack of health education, socio-cultural factors, and travel costs are significant barriers to accessing eye health services. The facility environment and healthcare professionals can also impact people's willingness to seek help. No one should be left behind in terms of eye health, and access to these services should be available to everyone. Maleko said that global collaboration is crucial in the fight against vision impairment. 1.1 billion people globally have an untreated or preventable visual impairment, and an estimated 61 million people could be blind by 2050 without concerted effort.
"But a global eye health crisis is not inevitable. We can stop it if we come together to act now. By increasing the attention eye care is given, recognising how integral it is to every facet of life, and focusing on gender and disability inclusion, we can reduce inequality and ensure that no one is left behind when it comes to eye health."
"Last October, Sightsavers launched our 'Eye Health Equals' campaign, calling for eye health to be made a global priority. It is vital that governments, organisations, donors, and communities, work together to make ambitious but achievable changes to reduce the global eye health burden. This includes recognising the importance of eye health, integrating eye health into global and national health programmes, and investing in inclusive eye health services.
"Prioritising eye health plays an important part in creating a ripple effect across education, well-being, economics, and health outcomes. Which ultimately helps reduce poverty and allows individuals, communities, and the nation, to thrive," he said.
The Tanzania Ministry of Health and its partners have made commendable efforts in improving eye health services across the nation through the Boresha Macho project. Maleko explains that the initial project for improving eye health in Tanzania was active from October 2019-December 2022, and its success has formed the foundations that governments and partners will continue to build on. There have been increases in health budgets and resourcing, as well as improvements planned to training processes.
This success has resulted in increased health budgets and resources, improvements to training processes, and better legislation and plans for eye health and the inclusion of people with disabilities. The Prime Minister's Office has implemented the National Disability Act and supported the training of disability committee members in villages. The Ministry of Health also formed an eye health technical working group to ensure eye health strategies and actions are monitored. However, there is still more to be done to ensure that everyone has access to eye health care. Maleko encourages the government to continue scaling up eye health services, integrating eye care into school systems, working with organizations for women and people with disabilities, and further integrating eye health services into primary care facilities.
Maleko shared lessons learned from the Boresha Macho project that could be applicable to other health projects in Tanzania or similar contexts.
"Eye health should be accessible everywhere and to everyone."
He emphasised the importance of ensuring that eye health services are accessible to everyone, especially remote communities, and marginalized groups. He also highlighted the challenges faced by women and people with disabilities in accessing health services due to cultural barriers and physical limitations. With the support of the government and other partners, Maleko and his team raised awareness about the importance of eye health, promoted inclusive healthcare practices, and made health services accessible to everyone.
"The development of a planning roadmap for eye health projects and building capacity for eye health coordinators and other technical members of health management is also important. This will help them to gradually consider eye care activities in local health plans and cost-sharing for patients who are able to pay for services. Integrating eye health services with insurance schemes would also help generate revenue to help improve eye care services. There are examples of hospitals we worked with for Boresha Macho who are now able to generate funds in this way," he added.
Maleko highlighted that the 'Boresha Macho' project has strengthened collaboration and supported partners in the Ministry of Health, eye health professionals, and other organisations. National discussions were set up to call for more resources from the health department, which helped emphasise the impact of treating cataracts and other eye health issues on reducing poverty. The project also focused on developing human resources for eye health, including training general health practitioners as cataract surgeons and procuring equipment to support cataract surgeries. The project's outcomes have been incorporated into the current health sector strategic plan, and efforts will continue to advocate for resource allocation for eye health care.
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For Maleko, success is best demonstrated by the stories of people who were supported by the project.
Boresha Macho transformed the lives of people like Holo from the Singida region. He gave an example of Holo, who farms and cares for her grandchildren but loss of sight from cataracts made these tasks difficult. Holo, experienced difficulties due to cataracts. However, after receiving cataract surgery through the project, Holo feels revitalised and is able to work and move around with ease. Moreover, her positive experience has encouraged her brother to seek treatment for his vision impairment.
In her own words, cataract surgery through the project gave her a "new beginning".
"She now feels joyful, and energetic, and can work and walk around again. A further ripple effect of Holo's eye health care is that she has now encouraged her brother to seek treatment for his vision impairment."
He also gave an example of another woman whose sight was restored after years of vision loss. According to Maleko, she told others in the village about Boresha Macho and encouraged them to accept treatment or cataract surgery where it was needed. She would tell them about the surgery she had on one eye and that she couldn't wait to have it done on her other eye. She became an excellent eye health ambassador in her village.
"Partners and people with disabilities have also said the project has helped implement new methods and structures in the health system to reduce barriers. Hamis, a shepherd from Singida who is blind and was involved in accessibility training, said changes are happening in the health sector as people learn how to better understand how to support people with disabilities."
