World Sight Day: “Eye health is one of our key intervention areas”

Sumrana Yasmin, global technical lead on refractive error at Sightsavers, tells OT  about the charity’s mission to ensure that eye care is included as part of the global COVID-19 recovery

Sightsavers/John Healey

Eye care is one of the most effective ways to bring communities out of poverty, increase life chances and improve productivity – things that are going to be hugely important when the economy globally is recovering from the pandemic. Could you speak a bit about why eye care specifically needs to be invested in at this time, and in the months (and potentially years) ahead?

One of the biggest impacts that COVID-19 has had across the globe is around the economy. We know that since March, many countries have had to close down most of their businesses, most of their industry, to make sure people's lives are saved and that they have necessary infrastructure and services in place to deal with the situation.

We all know how closely linked good eye health and good vision are when it comes to either learning, working in the office environment, or doing any other economy-related work that can increase productivity and bring in resources for communities to live their life in the way they are supposed to. Making sure the right eye health services are in place, and that people who need them are able to access them, will automatically lead towards building back better.

Andrew Esiebo/panos pictures/Sightsavers
6-year-old cataract patient Khadijah’s eye is examined after her eye surgery in Sokoto, Nigeria

We also know that, in the past six months or so, in many countries, eye health services have been suspended on the premise that they are not essential services. That resulted in a backlog. We know that there are many people in the countries where we work who are not accessing those services, at this stage. Making sure they are part of bringing these services back in a safe and effective manner is really important for all governments and other stakeholders working in this space.

Does Sightsavers have a plan to advocate for investment in eye care as part of the recovery plan?

Sightsavers works closely with governments: with the institutes of health, ministers of education, and other relevant ministers. Building their capacity in their respective area is our main approach. Advocacy is a major part of that. We support governments, and we try to create approaches that can demonstrate a positive impact when it comes to either eye health, education or social inclusion-related programmes.

Eye health is one of our key intervention areas. Things have slowed down in 2020. This was the year where the eye care sector was supposed to take a note of what happened in the last 10 years, and how things are right now. We were in the process of developing the roadmap for the next 10 years or so, as a sector. COVID-19 changed everything. It is high time now for the sector, and for us as an organisation, to see that our advocacy-related messages and input can support governments to make sure that eye health-related plans, policies and resources are available to provide the right services to people in need, in the right way. Aggregating key messages, supporting all the stakeholders in a unified voice, is important for us.

Do you worry that those with disabilities and/or sight loss will be left behind by governments in the recovery planning?

It was a major concern for all of us, when COVID-19 happened. Making sure people with disabilities are at the table where any decision making is happening is really important. Making sure they are part of the conversations on COVID-19 has been essential.

As an organisation, we, in partnership with local organisations, are making sure that this happens - we are facilitating the process. We are identifying the right stakeholders in the countries and making sure that they are part of the discussion; that they are sitting at the table and sharing their concerns. Otherwise, the right interventions won't be delivered.

Making sure the right eye health services are in place, and that people who need them are able to access them, will automatically lead towards building back better


That is one of the things that has been slow, but not completely neglected. We need to make sure that, as a sector, we convince all stakeholders that they need to take their opinions, their voices, on board. COVID-19 not only impacted access to services, but it also impacted how people will be able to communicate their messages. Technology has been really effective, but in many countries where we work, access to internet, access to these virtual meetings for people with disabilities, has been a challenge. These are things that we try to ensure we facilitate, but there is still a long way to go.

I'd also like to flag that since COVID-19 was such an unexpected pandemic, nobody was aware of how it was going to evolve; what impact it was going to have. Many governments had no idea how to deal with the situation. They were observing and then developing a phased approach to make sure everybody was part of the process. In some places it was efficient, systematic, but there were some cases where we needed to put in more focus and needed to make sure people with disabilities, and their concerns and recommendations on how to deal with situations, were on board.

Claudia Janke/Sightsavers 2018; Copyright Sightsavers 2018
Truckers receive free eye services at an Eye Camp at Tantipara Balistand, Kolkata, India

As an organisation we also facilitated a process where we developed guidelines and key messages, and tried to influence our local partners to take those guides on board and embed them into their programme implementation strategies. So, making sure international guidance around COVID-19, whether it comes to school health integrated programming or hospital-based cataract surgical programmes or refractive correction programmes, are communicated to our local partners and local governments.

The loss to the global economy from uncorrected myopia is estimated to be $244 USD, whilst the cost of effectively treating 1 billion people is estimated to be between $7 billion and $14 billion. Often governments need to see the economic impact in order to really make them pay attention. How can those in the optical community get the financial importance of sight care across?

The key message from the World Health Organization's World Report on Vision was very encouraging. With refractive correction, in most countries services are provided within the private sector. Take the example of Pakistan: 70% of refractive services are provided in the private sector. Making sure they are part of eye health and development and implementation is equally important.

At Sightsavers right now we are going through our strategy refresh process, and within that eye health and refractive error strategy, ensuring improved access to high quality eye health and refractive services. We make sure we engage with all stakeholders, including industry partners and private sector eye health practitioners, to make sure that, in order to achieve universal health coverage targets by 2030, the people who are providing these services are part of this journey. Otherwise, we won't be able to achieve the targets that we are aiming for. In the spirit of universal health coverage, we are making sure that everybody who is providing health services is included.

If there are gaps in training, we as an organisation make sure we bring it to a level where they can provide high quality services to people in need. We also know that there is this gap in the distribution of the eye health workforce. Many ophthalmologists, optometrists and others are based in urban or semi-urban communities, and there is a massive gap when it comes to provision of care for people in poorer communities. Making sure distribution is at a level where people who need these services have access to them is important if we want to achieve our mission and vision.

How are travel restrictions affecting those in remote areas accessing/not accessing sight saving care currently?

One of the biggest challenges has been travel restrictions. It also highlighted the need to make sure that the services are accessible and closer to the communities. I look at this challenge as an opportunity to advocate to the government to build eye health services or primary eye health care closer to the community, so people do not have to travel five or six hours in a day to reach tertiary level or secondary level care.

In many urban settings, when COVID-19 happened many professionals went back to their hometowns and haven't come back yet. Even if the eye departments are open in the hospitals, you'll notice that there are very few people back to work


There is also associated cost. Pre-COVID-19 there was an issue where long distances were a challenge, but having resources to cover the cost to reach a facility was something we were looking into. We welcome those challenges to our programmes or interventions. But now, no access to dedicated or targeted transportation to reach to these services is added on to an already existing challenge.

Considering the high risk of infection at this stage, there are many people who need eye care services. Surgical services have noticed that patients are not willing to take that chance to use public transport to get to a hospital. That is something that will have long-term impact: they're not accessing services, and that is leading to the backlog of care.

It's not only that patients cannot come to the hospital. It's also that eye care providers cannot either. In many urban settings, when COVID-19 happened many professionals went back to their hometowns and haven't come back yet. Even if the eye departments are open in the hospitals, you'll notice that there are very few people back to work.

Reza Shahriar Rahman / Sightsavers
Eye Hospital staff performing a vision test at a free eye camp in Kurigram, Bangladesh

All of these are compounding challenges, and they have long-term impact on the eye health sector. Ministries of health need to have a very concrete, long-term plan, and address all of these challenges, if they want to make sure that eye health access increases and that people who need it can get it.

How do you think that those providing essential sight saving care globally will be able to go about dealing with the backlog of treatment that’s needed?

2020 was the year when, in many countries, the next five to 10 years of eye health planning was in process. So, having a very targeted approach is going to help governments to deal with this situation.

In Pakistan, we are going through our national eye care plan for 2020 to 2025. As part of that plan, there are some learnings coming out of the COVID-19 situation. Some very focused, dedicated strategies have been embedded to overcome those challenges. One of the things that has been very effective, that I think many countries will take note of, is more focus on timely eye care. So, health promotion: eye health promotion related intervention and preventive interventions. We know that within the eye care sector, a significant number of people who need these services can actually be dealt with at that level.

Unless we have resources in place to address the need, we won't be able to bring people with vision impairment back to work, back to education, and they won't be able to contribute towards the economy of their respective community and country


I think that will help us to make sure that the backlog has been dealt with over a period of time. We know as part of our school health integrated programmes how much happened in 2020. Within education, we also understand that in many instances, the chances are really high that many kids won't be coming back to school. When it comes to girls, we know that in South Asia, and in lots of African countries, they won't be coming back at the same rate as pre-COVID. We also need to address these challenges and find a way to make sure that, when they are part of an education system, they are getting the right eye health services to make sure that they benefit from learning and improving their academic performance.

There are challenges that come from one thing to another. We need to be positive; we need to be creative. We also need to be cautious, so we do not risk opening our communities to any infection or any virus-related complications. Having that positive mindset - if we work together, if we plan our approaches more systematically, if those approaches are based on evidence - I think we will be able to address the needs of eye care across the globe in a very effective manner. I'm keeping my fingers crossed for that.

Do you see the global economic consequences of COVID-19 negatively effecting eye health, either in the short or longer term?

The short-term, it might have - not across the board, but in some instances - negative consequences. Governments are declaring many non sight-threatening conditions as a non-essential services and diverting their resources to more pressing needs, which we understand.

But at the same time, good eye health can significantly improve the economy of any country. We have evidence around it. There are many studies that we as an organisation and other stakeholders within this space use for evidence, to communicate this message to the right people and advocate for the right investment.

If we leave out women and girls and don't deal with their disability or vision impairment, they won't be able to contribute towards the economy of any society


Unless we have resources in place to address the need, we won't be able to bring people with vision impairment back to work, back to education, and they won't be able to contribute towards the economy of their respective community and country. Making a good investment case based on the evidence we have is the need. Many of us are doing that already, but we will probably need to put in more effort in this space moving forward.

At the same time, when we talk about short-term consequences, we also noticed many instances where non eye health-related stakeholders came forward and supported the work. That gave us an opportunity to look outside the 'eye box' to see where we can collaborate with non-traditional partners to bring more resources towards eye care - linking up work, and combining programmes to complement each other. For example, as part of any ageing programme where screenings are happening in communities, we should make sure that vision screening is part of it. Utilising resources more effectively, and reaching more people who are in need, can be a good pitch for other health-related, education-related, and economy-related intervention.

Is there anything else that you would want to add on this issue?

I would like to add one issue, and that is around gender equity in eye care. We know that COVID-19 has impacted everyone, but when it comes to women and girls, especially women and girls with disabilities, they are part of the most vulnerable group. My message is that whoever is working in eye health needs to make sure, when we are designing our programmes, that effective interventions are considered, designed and implemented, focusing on women and girls and making sure that they have access to the services.

If we leave out women and girls and don't deal with their disability or vision impairment, they won't be able to contribute towards the economy of any society. A dedicated focus on women and young girls is equally important.