Africa: Eye Health Advocate Hortance Manjo Shuwon Championing Equity in Africa

Cataract patient undergoes eye screening.
30 November 2023

Lusaka, Zambia — Vision is more than just seeing clearly; it's a gateway to the world, influencing health, prosperity, and opportunities. Yet, millions grapple with impaired sight, facing barriers to quality eye care that limit their potential and hinder societal progress.

This stark reality underscores the profound impact of eye health on our overall well-being, socioeconomic prosperity, and the very fabric of our societies.

This burden disproportionately affects individuals in low- and middle-income countries. While over 90% of these cases are preventable or treatable, disparities persist, impacting individuals across all age groups, particularly children and older adults, as well as marginalized groups such as women, rural populations, and ethnic minorities.

The statistics paint a sobering picture.

In 2020, an estimated 596 million people worldwide had distance vision impairment, with 43 million experiencing blindness. An additional 510 million people suffered from uncorrected near vision impairment. These figures are not mere numbers; they represent the faces of countless individuals whose lives have been dimmed by the lack of access to quality and affordable eye care.

By 2050, population aging, growth, and urbanisation might lead to an estimated 895 million people with distance vision impairment, of whom 61 million will be blind. This looming crisis demands immediate and decisive action.

The Lancet Global Health, published a report on global eye health calls for eye care to be included in mainstream health services and development policies. It argues that this is essential to achieve the World Health Organization's goal of Universal Health Coverage (UHC) and the 2030 United Nations Sustainable Development Goals (SDGs). Conversely, improving eye health can significantly contribute to achieving the SDGs by reducing poverty, enhancing education, and promoting gender equality.

During the vibrant atmosphere of the third International Conference on Public Health in Africa (CPHIA) hosted in Lusaka, Zambia, allAfrica's Melody Chironda engaged in an enlightening conversation with Hortance Manjo Shuwon. As a global technical lead for refractive error at Sightsavers, Hortance tirelessly spearheads initiatives that empower communities and transform lives.

Hortance's passion for eye health was ignited by a deeply personal experience. Her mother, a glaucoma patient, was not diagnosed early enough, leaving her susceptible to vision loss. This realization ignited a fire within Hortance, propelling her to dedicate her life to ensuring that no one else suffers the same fate. With unwavering determination, Hortance now plays a pivotal role in supporting eye health programs across Africa. Her expertise and leadership have been instrumental in expanding access to essential services, empowering communities to take charge of their eye health, and fostering a culture of prevention.

"I felt a profound sense of responsibility to play my part, however small, in ensuring that everyone has access to high-quality, sustainable, and equitable health services when they need them. No one should suffer the tragedy of avoidable blindness," she said.

What are your thoughts on the current state of eye healthcare accessibility and affordability, particularly in underserved communities?

"Regrettably, when we examine the global burden of disease, Africa falls behind," she said.

"Over 1.1 billion people worldwide have visual impairments, and of those, 100 to 110 million in Africa are at risk of vision loss."

"This is a significant concern because it has far-reaching consequences for our children's education, economic development, and the well-being of individuals. Many people needlessly go blind, placing a strain on families and reducing economic productivity," added Hortance.

What are the current prevalence and burden of vision impairment globally, and what urgent improvements to eye health services are needed to prevent an estimated 61 million people from being blind by 2050?

"We are anchoring and joining the global discussions on how to achieve universal health coverage," Hortance remarked. "We believe that integrating primary eye care into primary healthcare services will go a long way towards achieving this goal."

"This integration should encompass the entire continuum of care, from prevention and promotion to treatment. And, of course, we already have the necessary services in place. That's why we recognize that we cannot accomplish this alone," she said.

To succeed, we must collaborate with our respective countries and advocate at the local, national, sub-national, and global levels. We must explore how countries can begin to incorporate eye health into their health budgets, plans, employment plans, financial plans, and even educational plans. We are adopting an approach that integrates eye health into school health programs, and we are exploring how to integrate this approach so that children with identified eye problems can be detected early on, even within the school setting. Our school health programs provide us with a platform to reach a large number of children, and it is also becoming a very effective and efficient way to manage our already limited resources," she said.

With funds and efforts being diverted elsewhere, what do you think the development sector should do to ensure other health programs, such as those around eye health, continue?

"Our development partners need to continue collaborating and working in partnership," Hortance said.

"Firstly, we must recognize that eye health is a development issue, not just a health issue. Until we address this, achieving both the Sustainable Development Goals and universal health coverage will remain a challenge."

What are the unique challenges and opportunities related to eye health in Africa, and how can we address them effectively?

"The challenges to accessing eye health services in Africa are multifaceted," Hortance acknowledged. "On one hand, we face the issue of inaccessible health facilities, particularly in hard-to-reach areas and smaller communities. Even when primary health centers exist, they often lack dedicated eye care services. Furthermore, financial constraints pose a significant hurdle, as families may be forced to choose between out-of-pocket healthcare expenses and essential needs like food or other services. The stigma surrounding eye conditions also hinders access, as many individuals remain unaware of the issue or are hesitant to seek treatment due to societal misconceptions. In addition, traditional customs can act as barriers to care-seeking. These challenges are compounded by the growing demographic shift towards an aging population, leading to an increased prevalence of age-related eye diseases.

"We recognize the urgent need to address these challenges," Hortance asserted. "In collaboration with nine partners, we are working to ensure that eye health is recognized as a critical component of both development and healthcare. At the national level, we are collaborating with governments to strengthen policies and advocate for accountability in policy implementation. We are also partnering with health facilities and the Ministry of Health to test efficient and effective service delivery models, optimizing the utilization of available funds. We are joining forces with other NGOs and partners to raise awareness of eye health issues and advocate for solutions at the global level," she added.

Sightsaver is making significant strides in improving eye health in Africa. Can you share some examples of their impactful work?

"Yes, we are actively engaged in various interventions across Africa," Hortance affirmed. "We have ongoing programs in 34 countries, with a presence in 29 of those countries. Our work spans West, Central, East, and Southern Africa."

"In addition to addressing eye health and refractive errors, we are also committed to economic empowerment, particularly for persons with disabilities. We aim to empower them to make informed financial decisions for themselves. We also focus on inclusive education, ensuring that children with disabilities are integrated into mainstream schools and not left behind. We are actively involved in influencing curriculum development for teachers in these schools and advocating for policies that support inclusive education. Furthermore, we promote inclusion at the decision-making level, collaborating with organizations of persons with disabilities to empower them to advocate for their rights."

Could you share some personal stories of individual (s) whose lives have been transformed through Sightsavers' projects?

"We have countless success stories from across Africa," Hortance remarked with enthusiasm.

"One particularly inspiring example comes from Uganda, where we met a woman named Binta*. Binta was a hardworking farmer who had been walking off-farm since she was a young girl. She was fiercely independent, supporting her daughter, two grandchildren, and herself through her agricultural endeavors. However, Binta's life took a tragic turn when she developed cataracts, causing her to lose her sight for over five to ten years. Her vision deteriorated rapidly, making it difficult to navigate and perform everyday tasks. This loss of independence had a profound impact on Binta's life and her family's well-being. Her grandchildren struggled to continue their education due to financial constraints, and Binta's inability to contribute to the household income added to their hardships."

"Fortunately, a community health worker identified Binta's situation during one of their outreach activities and referred her to a Sightsavers-supported healthcare facility. Binta underwent successful cataract surgery, restoring her vision and allowing her to reclaim her independence. The joyous celebration that erupted upon her return home was a testament to the transformative impact of Sightsavers' work. Binta's newfound ability to assist her family and community members rekindled her spirit and demonstrated the profound impact that treating preventable eye conditions can have on individuals and their communities," she said.

Binta's story is a beacon of hope, illustrating the power of eye care to restore lives and empower individuals to reach their full potential.

What are your expectations from this CPHIA conference?

"I was particularly impressed that this is the third time this conference has been held,  and yet, it's the first time Sightsavers has been invited to participate," said Hortance.

"We're honored to be a part of these important conversations, and we believe our presence can serve as an eye-opener for many. We hope that the next time we gather for the International Conference on Public Health in Africa (CPHIA) in 2024, Sightsavers will not only be present but also actively involved in shaping the discussions. We recognize the crucial role of Sightsavers and other partners in supporting various health initiatives and promoting universal health coverage in alignment with the SDGs. We firmly believe that primary healthcare is the cornerstone of achieving universal health coverage, and we are committed to playing our part in this endeavor."

What last message would you want to convey?

"So my last message is eye health is important. By empowering our children to learn and enabling others to earn, eye health should be on the tables with us," she said. "Eye health is not just a health issue; it's a development issue as well."

AllAfrica's reporting from CPHIA2023 is supported by the African Union and Africa CDC

AllAfrica publishes around 500 reports a day from more than 100 news organizations and over 500 other institutions and individuals, representing a diversity of positions on every topic. We publish news and views ranging from vigorous opponents of governments to government publications and spokespersons. Publishers named above each report are responsible for their own content, which AllAfrica does not have the legal right to edit or correct.

Articles and commentaries that identify as the publisher are produced or commissioned by AllAfrica. To address comments or complaints, please Contact us.