The challenge

In the long-term

OT  speaks to VAO about its evolution from an ‘aid’ charity into an organisation that is focused on the long-term development of sustainable eye care

Man having his sight tested

Established 32 years ago in order to address the lack of eye care services that existed in Tanzania, today Vision Aid Overseas (VAO) is still very much focused on ensuring that everyone has access to eye care, no matter where they live around the world.

However, the work that the charity undertakes in order to achieve this goal has certainly changed over the years, as VAO’s director of programmes, Anne Buglass, shares with OT.

“We have probably seen our biggest transformation as a charity over the last 10 years as we evolved from working with an ‘aid-based’ model to much more of a developmental approach,” she said.

Natural evolution

“Starting life organically, VAO was essentially established by a group of optometrists who had travelled to Tanzania and were exposed to the real lack of health care services that existed. They observed the vast need for eye care in the country and wanted to do something about it,” Ms Buglass explained.

Returning to the UK, the practitioners collected up as many used spectacles as they could and returned to Tanzania to offer free sight tests and spectacles to those in need – thus, in 1985, VAO was born.

The charity operated effectively in this manner for a number of years to the benefit of thousands of people, Ms Buglass emphasised. “Flying into a country and addressing a need directly has its merits, and the immediate benefits were both huge and tangible,” she highlighted.

However, as the charity grew and the work that it carried out in developing countries expanded as a result of an increased volunteer base, VAO realised that its work lacked a long-term view. And a long-term view was “very much needed if VAO was going to be able to make the impact that was needed in the countries where it provided eye care,” Ms Buglass emphasised.

Adapting to the need observed across Africa and further afield, Ms Buglass shared: “We are now very focused towards building sustainable eye care systems in the countries where we work so that there is a long-term solution to the problem.”

Man having his sight tested

Long-term development

VAO’s change in approach means that today its work is based around three core activities: training and education, infrastructure development and advocacy.

Training and education is pivotal, Ms Buglass explained. “There is an element of training and education in everything we do – that’s the only way we are going to be able to address the crisis of the healthcare workforce shortage in these countries,” she said.

“Building and strengthening the eye care services in these developing countries will only be achieved through training, education and capacity building to ensure that there is a strong base from which they can grow,” she emphasised.

This approach sees VAO support the training of eye care professionals such as optical technicians, ophthalmic nurses and optometrists in the countries they operate in. This training can be observed through everything supporting optometry graduates with practical hands-on training, running six-week refraction training courses for ophthalmic nurses, or running low vision workshops. They also sponsor students from Sierra Leone to train as optometry technicians in the Gambia, as there are no in-country training institutions offering this course.

Intertwined with this work, Ms Buglass explained that the development of an infrastructure is also important. “While we could fly in, test people’s sight and fly out again, it is very important for us to work with governments to create a national health care system that includes eye care,” she said.

As a result, VAO has been supporting the establishment of vision centres – eye care centres within healthcare units and hospitals where anyone can walk in and have an eye test, and walk off with a pair of spectacles made and fitted to their prescription the same day for a nominal fee.

“The key purpose of these centres is that they offer a low cost service – we want to keep prices as low as possible so it’s accessible to as many people as possible,” Ms Buglass explained.

The final cog in VAO’s work is advocacy, Ms Buglass explained.

“Including eye care in national healthcare programmes may seem like a logical requirement – if people can’t see because they don’t have access to eye care, they can miss out on education and they can’t work – but in countries where you are competing for government funds with organisations that focus on malaria, HIV and child’s health, it can be hard to get yourself heard,” Ms Buglass told OT.

Therefore, VAO is building data and creating evidence-base cases from its training programmes and vision centres and using this to illustrate to governments the economic and social benefits that access to eye care can bring. For example, the post project survey from a recently concluded VAO DFID and Essilor UK Ltd funded programme in Ethiopia, which reached over 184,000 people across five districts in southern Ethiopia, reported that, after receiving treatment in the form of minor surgery or the provision of glasses, 78% of patients reported an improvement in their quality of life and an increase in household income. Of the children treated under the project, 73% showed improvements in their school performance.

"Every time I visit Ethiopia its eye care system gets better and better and it is down to the work of VAO"

Bringing change

While the eye care needs of people in developing countries are still vast, Ms Buglass confirmed, the work of VAO as a development charity has seen much success.

“There are examples of success in every country that we work in,” she said, highlighting the charity’s recent recognition in Zambia’s new national eye health strategy and helping to develop the curriculum for the country’s first optometry course.

Ms Buglass labels Zambia as a country that VAO has made “great strides in,” adding that in five to 10 years time, the eye health systems could be well established enough to support themselves. However, the global issue is a large one and one that’s not going away quickly,” she stressed.

Volunteers, like the 100-plus UK practitioners who travel on VAO assignments annually, are key to successfully bringing change.

“They could be training our undergraduate optometrists in clinical theory and providing them with the only practical testing experience they receive pre-qualification during outreach camps, or supporting newly-established vision centres – their value is hard to quantify, but they bring a huge amount of expertise to the programme,” Ms Buglass said honestly.

VAO volunteers training optometrists

On the front line

Optometrist Nina Carlisle has been a VAO volunteer for the last 18 years. Having travelled to India, Ethiopia, Zambia, Burkina Faso and Uganda on two-week projects, she became a volunteer after hearing the experiences of a fellow optometrist who had previously completed a VAO assignment.

Speaking about her first trip, Ms Carlisle said: “It was a bit of a culture shock, but overall the experience was very rewarding.”

Having completed a VAO assignment more-or-less every year since 1999, Ms Carlisle has observed the charity’s evolution from aid to development first-hand and can vouch for the enormous difference that it is making in some countries.

“I visited Ethiopia for the first time in 2002 – it was a country of around 60 million people and there were no optometrists, which was shocking,” Ms Carlisle shared. “However, when I last visited in November 2015, it had changed dramatically – there are two universities offering optometry qualifications and five vision centres operating.”

“Every time I visit Ethiopia its eye care system gets better and better and it is down to the work of VAO,” she added.

Encouraging other practitioners to consider volunteering, Ms Carlisle said: “The need is enormous and we can make a significant difference by supporting the training of optometrists, optometric technicians and refractionists through VAO volunteer projects. We must remember that, in the UK, we are very lucky to have access to education and healthcare, with a choice of thousands of opticians on the High Street.”

Reflecting on her nearly two decades as a VAO volunteer, Ms Carlisle concluded: “It gets under your skin – I find it incredibly rewarding and it teaches me a lot,” she said: “It has helped me be a better practitioner.”

You can find out more about the work of VAO, including the charities urgent appeal to support the training of eye care workers in Ethiopia, on its website.